The instructions and the reading is attached below. Please follow all the instructions carefully. The role that I selected is Patient Experience Management, and the title is Patient advocate.
Morbidity and Mortality Weekly Report
Weekly / Vol. 66 / No. 27 July 14, 2017
718 Mortality from Amyotrophic Lateral Sclerosis and
Parkinson’s Disease Among Different Occupation
Groups — United States, 1985–201
723 Racial and Geographic Differences in Breastfeeding —
United States, 2011–201
728 Pneumococcal Vaccination Among Medicare
Beneficiaries Occurring After the Advisory
Committee on Immunization Practices
Recommendation for Routine Use Of 13-Valent
Pneumococcal Conjugate Vaccine and 23-Valent
Pneumococcal Polysaccharide Vaccine for Adults
Aged ≥65 Year
734 High Risk for Invasive Meningococcal Disease
Among Patients Receiving Eculizumab (Soliris)
Despite Receipt of Meningococcal Vaccine
Continuing Education examination available at
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Victoria Hall, DVM1,2; Emily Banerjee, MPH2; Cynthia Kenyon, MPH2; Anna Strain, PhD2; Jayne Griffith, MPH2; Kathryn Como-Sabetti, MPH2;
Jennifer Heath, DNP2; Lynn Bahta2; Karen Martin, MPH2; Melissa McMahon, MPH2; Dave Johnson, MPH3; Margaret Roddy, MPH2;
Denise Dunn, MPH2; Kristen Ehresmann, MPH
On April 10, 2017, the Minnesota Department of Health
(MDH) was notified about a suspected measles case. The patient
was a hospitalized child aged 25 months who was evaluated for fever
and rash, with onset on April 8. The child had no history of receipt
of measles-mumps-rubella (MMR) vaccine and no travel history or
known exposure to measles. On April 11, MDH received a report
of a second hospitalized, unvaccinated child, aged 34 months, with
an acute febrile rash illness with onset on April 10. The second
patient’s sibling, aged 19 months, who had also not received MMR
vaccine, had similar symptoms, with rash onset on March 30. Real-
time reverse transcription–polymerase chain reaction (rRT-PCR)
testing of nasopharyngeal swab or throat specimens performed at
MDH confirmed measles in the first two patients on April 11, and
in the third patient on April 13; subsequent genotyping identified
genotype B3 virus in all three patients, who attended the same child
care center. MDH instituted outbreak investigation and response
activities in collaboration with local health departments, health
care facilities, child care facilities, and schools in affected settings.
Because the outbreak occurred in a community with low MMR
vaccination coverage, measles spread rapidly, resulting in thousands
of exposures in child care centers, schools, and health care facilities.
By May 31, 2017, a total of 65 confirmed measles cases had been
reported to MDH (Figure 1); transmission is ongoing.
Investigation and Results
After receiving notification of the first case on April 10, MDH
and the Hennepin County Human Services and Public Health
Department began an investigation. The Council of State and
Territorial Epidemiologists and CDC case definition* was used
* An acute illness in a Minnesota resident during January 1, 2017–May 12, 2017,
characterized by generalized, maculopapular rash lasting ≥3 days with a temperature
≥101°F (≥38.3°C) and cough, coryza, or conjunctivitis. A confirmed case is an acute
febrile rash illness with isolation of measles virus from a clinical specimen; or
detection of measles-virus specific nucleic acid from a clinical specimen using
polymerase chain reaction; or immunoglobulin G seroconversion or a significant
rise in measles immunoglobulin G antibody using an evaluated and validated
method; or a positive serologic test for measles immunoglobulin M antibody; or
direct epidemiologic linkage to a case confirmed by one of these methods.
to identify confirmed cases of measles in Minnesota (1). A health
alert was issued April 12, which notified health care providers
of the two measles cases in Hennepin County and provided
recommendations concerning laboratory testing for measles
and strategies to minimize transmission in health care settings.
Emphasis was placed on recommendations for all children
aged ≥12 months to receive a first dose of MMR. Providers
identified patients with suspected measles based on clinical
findings and reported suspected cases to MDH. Testing with
rRT-PCR was performed at MDH on nasopharyngeal or throat
swabs and urine specimens. Among persons testing positive by
rRT-PCR who had received vaccine ≤21 days before the test,
genotyping was performed to distinguish wild-type measles virus
Morbidity and Mortality Weekly Report
714 MMWR / July 14, 2017 / Vol. 66 / No. 27 US Department of Health and Human Services/Centers for Disease Control and Prevention
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30329-4027.
Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2017;66:[inclusive page numbers].
Centers for Disease Control and Prevention
Brenda Fitzgerald, MD, Director
William R. Mac Kenzie, MD, Acting Associate Director for Science
Joanne Cono, MD, ScM, Director, Office of Science Quality
Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services
Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services
MMWR Editorial and Production Staff (Weekly)
Sonja A. Rasmussen, MD, MS, Editor-in-Chief
Charlotte K. Kent, PhD, MPH, Executive Editor
Jacqueline Gindler, MD, Editor
Teresa F. Rutledge, Managing Editor
Douglas W. Weatherwax, Lead Technical Writer-Editor
Soumya Dunworth, PhD, Kristy Gerdes, MPH, Teresa M. Hood, MS,
Martha F. Boyd, Lead Visual Information Specialist
Maureen A. Leahy, Julia C. Martinroe,
Stephen R. Spriggs, Tong Yang,
Visual Information Specialists
Quang M. Doan, MBA, Phyllis H. King,
Paul D. Maitland, Terraye M. Starr, Moua Yang,
Information Technology Specialists
MMWR Editorial Boar
Timothy F. Jones, MD, Chairman
Matthew L. Boulton, MD, MPH
Virginia A. Caine, MD
Katherine Lyon Daniel, PhD
Jonathan E. Fielding, MD, MPH, MBA
David W. Fleming, MD
William E. Halperin, MD, DrPH, MPH
King K. Holmes, MD, PhD
Robin Ikeda, MD, MPH
Rima F. Khabbaz, MD
Phyllis Meadows, PhD, MSN, RN
Jewel Mullen, MD, MPH, MPA
Jeff Niederdeppe, PhD
Patricia Quinlisk, MD, MPH
Patrick L. Remington, MD, MPH
Carlos Roig, MS, MA
William L. Roper, MD, MPH
William Schaffner, MD
FIGURE 1. Number of measles cases (N = 65) by date of rash onset — Minnesota, March 30–May 27, 2017
Date of rash onset
30 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 1 3 5 7 9 11 13 15 17 19 21 23 25 26
Mar Apr May
(genotype B3 virus) from the vaccine virus (genotype A virus).
Patients (or their parents or guardians) with confirmed measles
were interviewed by local public health officials to confirm symp-
toms, onset date, and exposure history for the 21 days before
rash onset and identify contacts during their infectious period
(4 days before through 4 days after rash onset). Contacts were
defined as persons who had any contact with patients during
their infectious period.
Among the 65 confirmed cases, the median patient age was
21 months (range = 3 months–49 years). Patients were residents
of Hennepin, Ramsey, LeSueur, and Crow Wing counties.
During April 10–May 31, confirmed measles patients were iden-
tified in five schools, 12 child care centers, three health care facili-
ties, and numerous households; an estimated 8,250 persons were
potentially exposed to measles in these settings. Rash onset dates
ranged from March 30–May 27, 2017. Sixty-two (95%) cases
were identified in unvaccinated persons, including 50 (77%) in
children aged ≥12 months (i.e., age-eligible for MMR vaccina-
tion). U.S.-born children of Somali descent (Somali children)
accounted for 55 (85%) of the cases. Among the three patients
Morbidity and Mortality Weekly Report
MMWR / July 14, 2017 / Vol. 66 / No. 27 715US Department of Health and Human Services/Centers for Disease Control and Prevention
with a history of measles vaccination, all had received 2 MMR
doses before illness onset. As of May 31, 20 (31%) patients had
been hospitalized, primarily for treatment of dehydration or
pneumonia; no deaths had been reported.
Public Health Response
Rosters and attendance records were obtained from child
care centers and schools where persons might have been
exposed to measles, and the vaccination status of each
attendee was verified through the Minnesota Immunization
Information Connection, a system that stores electronic
immunization records (http://www.health.state.mn.us/
miic). Health care facilities similarly identified contacts
who were exposed to measles patients and followed up with
susceptible (i.e., unvaccinated, pregnant, or immunocom-
promised) exposed persons. In accordance with the Advisory
Committee on Immunization Practices 2013 guidelines (2),
postexposure prophylaxis (PEP) with MMR or immune
globulin was recommended for susceptible, exposed persons.
Persons who received PEP with MMR within 72 hours of
exposure or with immune globulin within 6 days of exposure
were placed on a 21-day self-monitoring symptom watch for
development of fever or rash, but could continue attending
child care and school. Susceptible exposed persons who
did not receive PEP according to recommendations were
excluded from child care centers or school, and MDH rec-
ommended that they avoid public gatherings for 21 days,
including having visitors who were susceptible to measles
virus. By May 31, at least 154 persons had received PEP
(26 MMR doses and 128 courses of immune globulin),
and 586 susceptible exposed persons who did not receive
recommended PEP were excluded from child care centers or
school and advised to receive MMR vaccination to protect
against future measles illness.
On April 18, as the outbreak continued, MDH recom-
mended an accelerated MMR schedule; to provide additional
protection, a second dose of MMR vaccine was recommended
for children who had received a first dose >28 days previ-
ously.† These recommendations were initially for all children
living in Hennepin County and for all Minnesota Somali
children regardless of county of residence, because MMR
coverage rates among Somali children in Hennepin County
have declined since 2007. In 2014, coverage with the first
dose of MMR among Somali children in Hennepin County
was 35.6% (Figure 2). In response to the rapid increase in the
† The Advisory Committee on Immunization Practices (ACIP) recommends
MMR vaccine for prevention of measles, mumps, and rubella for persons aged
≥12 months. ACIP recommends 2 doses of MMR vaccine routinely for children,
with the first dose administered at age 12 through 15 months and the second
dose administered at age 4 through 6 years before school entry. https://www.
number of reported cases, on May 4, 2017, MDH recom-
mended an accelerated vaccination schedule for all children
aged ≥12 months residing in all counties where a measles case
had been reported during the previous 42 days; MDH further
recommended that health care providers throughout the state
consider using an accelerated schedule.
Previously established culturally appropriate community out-
reach approaches (e.g., working with community and spiritual
leaders, interpreters, health care providers, and community
members) (3) were intensified during the outbreak. Using exist-
ing partnerships, state and local public health officials worked
with MDH Somali public health advisors, Somali medical pro-
fessionals, faith leaders, elected officials, and other community
leaders to disseminate educational materials, attend community
events, and create opportunities for open dialogue and educa-
tion about measles and concerns about MMR vaccine. Child
care centers and schools were provided talking points and
informational sheets on measles and MMR vaccine, and posters
with key messages were distributed in mosques and shopping
malls popular with the Somali community. Community out-
reach focused on oral communication, which is preferred by
this community, including radio and television messaging and
telephone call-in lines that permit approximately 500 persons
at a time to listen to a health professional.
Outreach to encourage vaccination was increased during the out-
break. By the second week of May, the average number of MMR
vaccine doses administered per week in Minnesota had increased
from 2,700 doses before the outbreak to 9,964, as reported by the
Minnesota Immunization Information Connection.
Minnesota law requires that children aged ≥2 months be
vaccinated against certain diseases or file a medical or consci-
entious exemption to enroll in school, child care, or school-
based early childhood programs. Before 2008, first-dose MMR
vaccination coverage among Minnesota-born Somali children
aged 2 years in Hennepin County exceeded 90%. However,
MMR vaccination coverage rates declined among Minnesota’s
Somali-American community members starting with the 2008
birth-year cohort. The decline in vaccination coverage was in
response to concerns about autism, the perceived increased
rates of autism in the Somali-American community, and the
misunderstanding that autism was related to MMR vaccine
(3,4). Studies have consistently documented that there is not
a relationship between vaccines and autism (5,6). The low
vaccination rate resulted in a community highly susceptible to
measles. Parental concerns were addressed by building trust with
the community and identifying effective, culturally appropriate
ways to address questions, concerns, and misinformation about
MMR vaccine. In 2011, a smaller measles outbreak began in
Morbidity and Mortality Weekly Report
716 MMWR / July 14, 2017 / Vol. 66 / No. 27 US Department of Health and Human Services/Centers for Disease Control and Prevention
FIGURE 2. Percentage of children receiving measles-mumps-rubella vaccine at age 24 months among children of Somali and non-Somali
descent, by birth year — Hennepin County, Minnesota, 2004–2014
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Source: Minnesota Immunization Information Connection, Minnesota Department of Health.
What is already known about this topic?
Measles was declared eliminated from the United States in 2000
but continues to circulate in many regions of the world and can
be imported into the United States by travelers. Measles vaccine
is highly effective, with 1 dose being 93% effective and 2 doses
being 97% effective at preventing measles.
What is added by this report?
In a community with previously high vaccination coverage,
concerns about autism, the perceived increased rates of autism
in the Somali-American community, and the misunderstanding
that autism was related to the measles-mumps-rubella (MMR)
vaccine resulted in a decline in MMR vaccination coverage to a
level low enough to sustain widespread measles transmission in
the Somali-American community following introduction of the
virus. Studies have consistently documented that there is not a
relationship between vaccines and autism.
What are the implications for public health practice?
This outbreak demonstrates the challenge of combating
misinformation about MMR vaccine and the importance of
creating long-term, trusted relationships with communities to
disseminate scientific information in a culturally appropriate
and effective manner.
the Somali community in Hennepin County and resulted in 21
cases, including eight cases in persons of Somali descent (4,7).
At that time, the 1-dose MMR vaccination coverage rate among
Somali children aged 2 years in Hennepin County was 54%. The
source of the 2011 outbreak was a Somali child aged 30 months
who acquired measles while visiting Kenya (7). However, the
source of the current outbreak is unknown, which suggests that
additional cases have likely occurred that did not come to the
attention of health care providers or public health departments.
Although indigenous measles transmission has been elimi-
nated in the United States, the virus continues to circulate
widely in many regions of the world, including Africa,
Europe, and parts of Asia, and is often introduced into the
United States by international travelers (8). High measles
vaccination coverage rates across subpopulations within com-
munities are necessary to prevent the spread of measles. The
current Minnesota measles outbreak, with 31% (20 of 65) of
cases requiring hospitalization, demonstrates the importance
of addressing low vaccination coverage rates to ensure that
children are adequately protected from a potentially serious
vaccine-preventable disease (3).
Andrew Murray, Carol Hooker, Erica Bagstad, Hennepin County
Human Services and Public Health Department; Ruth Lynfield,
Malini DeSilva, Richard Danila, Danushka Wanduragala, Kirk
Smith, Ben Christianson, Ellen Laine, Hannah Friedlander, Sean
Buuck, Austin Bell, Carmen Bernu, Erica Bye, Corinne Holtzman,
Katherine Schleiss, Victor Cruz, Megan Sukalski, Dave Boxrud,
Brian Nefzger, Victoria Lappi, Katie Harry, Net Bekele, Jacob Garfin,
Gongping Liu, Ruth Rutledge, Lisa Levoir, Barbara Miller, Fatuma
Sharif-Mohamed, Asli Ashkir, Hinda Omar, Minnesota Department
of Health; Kris Bisgard, Stacy Holzbauer, Raj Mody, Paul Gastañaduy,
Paul Rota, Rebecca McNall, Adam Wharton, CDC.
Morbidity and Mortality Weekly Report
MMWR / July 14, 2017 / Vol. 66 / No. 27 717US Department of Health and Human Services/Centers for Disease Control and Prevention
Conflict of Interest
No conflicts of interest were reported.
1Epidemic Intelligence Service, CDC; 2Minnesota Department of Health;
3Hennepin County Human Services and Public Health Department,
Corresponding author: Victoria Hall, email@example.com, 651-201-5193.
1. Council of State and Territorial Epidemiologists. Public health reporting
and national notification for measles. Atlanta, GA: Council of State and
Territorial Epidemiologists; 2012. http://c.ymcdn.com/sites/www.cste.
2. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles,
rubella, congenital rubella syndrome, and mumps, 2013: summary
recommendations of the Advisory Committee on Immunization Practices
(ACIP). MMWR Recomm Rep 2013;62(No. RR-4).
3. Bahta L, Ashkir A. Addressing MMR vaccine resistance in Minnesota’s
Somali community. Minn Med 2015;98:33–6.
4. Gahr P, DeVries AS, Wallace G, et al. An outbreak of measles in an
undervaccinated community. Pediatrics 2014;134:e220–8. https://doi.
5. Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, Newschaffer CJ.
Autism occurrence by MMR vaccine status among US children with older
siblings with and without autism. JAMA 2015;313:1534–40. https://doi.
6. Madsen KM, Hviid A, Vestergaard M, et al. A population-based study
of measles, mumps, and rubella vaccination and autism. N Engl J Med
7. CDC. Notes from the field: measles outbreak—Hennepin County,
Minnesota, February–March 2011. MMWR Morb Mortal Wkly Rep
8. Orenstein WA, Papania MJ, Wharton ME. Measles elimination in
the United States. J Infect Dis 2004;189(Suppl 1):S1–3. https://doi.
- Measles Outbreak — Minnesota April–May 2017
Week 1 Assignment: Role Application to Selected Case Study
Instructions – Provide a 2 to 3 research page (
How to write a research paper)
paper that includes the following items:
1. A description of the role/position as you understand it, specifically
– The level of the management the position is on (please remember- none of the positions is about Chief Executive, Chief Financial or Chief Operations officers at hospitals or other HC organizations. Your roles are not performing at the senior executive level);
-Immediate supervisory and subordinate chains;
– The main skills that are necessary to be effective and efficient in this position.
2. An explanation as to how the role you have selected is vital to this particular case:
-Discuss two job-specific managerial points affecting your organizational performance from the position of the provider
Case: increased Tuberculosis incidence among the homeless population of Nsk.
Job: a financial/business officer.
Managerial issue: an inability to send payments to the vendors for the supplies due to the lack of funds.
Reason: a high number of rejected health care insurance claims or not insured population served; high supply utilization due to the contagious nature of the issue and requirements to its clinical management.
Organizational outcome: clinical services are lacking appropriate medicine and supplies>low patient satisfaction>people refuse to come to the clinic or follow the treaments> low service utilization>reduced clinic income.
Solution: The business officer seeks additional funding sources from government organizations and grant providers. The insurance claim process is reassessed and the insurance claim cycle optimization process is established.
***This example cannot be used in the students’ submissions.
3. A description of how your role will interact with the other roles. What will the reporting structure look like? Who will you be working with and in what capacity?
The paper (no more than 3 pages) should be formatted according to APA style requirements and include a minimum of two credible resources from the course readings, UMGC library or other credible sources. An abstract is not required.
1. To write a winning submission you need to learn how to write a research paper.
2. Makes sure to apply APA, develop citations correlating to your references.
3. The paper has two main portions: research about the job itself and what job-specific managerial issues are relevant to the specific case (personal conclusions + supportive evidence). Please note, the same managerial issue may be perceived differently from the position of a provider, payer or patient.
For example, Administrative Officer job>Measles in WA state case
Managerial issue: identify unvaccinated children in the assigned area.
-provider: run Electronic Health Record reports and cross-check them with the local public health department (potential data on unvaccinated children between 1 and 5 y.o.) and administration (demographic data in the area). Plan for educational and vaccination fair efforts to offset the vaccinated population numbers.
-payer: examine member subscriptions (through the claim reimbursement) and identify insured children between 1 and 5 that were not vaccinated. Project financial losses relevant to the spike of vaccination or health care related issues relevant to Measles in case of epidemics.
-patient: having vaccinated child>not worrying about Measles. In the case of falling sick, seeking immediate medical attention. Plan for the out of pocket expense in an emergency fund. Having unvaccinated child>seeking educational information on the case, making decision to vaccinate or not, to be ready for significant caregiving and medical out of pocket expenses in case the child is falling sick.