Man with Measles Lands at Airport - What Do You Do? Commissioner Barry Explains Boston's Approaches to Infectious Disease Control, May 11, 2007, Harvard Public Health NOW

Anita Barry

In May 2006, a young man from India touched down at Logan Airport in Boston and was immediately whisked away to a local hospital for what was later diagnosed as measles. In the next few weeks, more cases were reported - this time in a handful of employees who worked in downtown Boston. The city's Public Health Commission sprang into action, spreading the word of the outbreak to health care workers and to the public.

"It was telephone call hell," recalled Anita Barry, who is director of Communicable Disease Control for the Boston Public Health Commission, at a talk at HSPH in April.

Officials needed to identify anyone possibly infected with measles within 72 hours of their exposure. That was the narrow timeframe in which a vaccine would still be effective in preventing the development of the disease. More than 4,000 people were vaccinated in the course of the outbreak, and more than 10,000 vaccines were distributed.

"People born in the late 1950s and [through the early] 1960s may be susceptible despite having good health care," Barry explained. "The measles vaccines given at that time weren't effective."

Barry spoke at an event co-sponsored by HSPH's Division of Public Health Practice and Center for Public Health Preparedness. At the talk, she shared stories of health threats in Boston over the past five years and explained how the city surveys potential disease outbreaks and curtails such threats to its 600,000 inhabitants.

She shared a second example of such work. From June 2004 to June 2005, a health care worker rotated through four Boston area hospitals, while experiencing symptoms of tuberculosis. After the illness was confirmed, the Boston Public Health Commission identified nearly 3,000 patients and 4,000 staff members who may have been exposed through contact with the worker. Of those tested, none were found to have tuberculosis.

Both of these examples demonstrated Barry's main point, which is that communication is the key to controlling communicable diseases. In the example of the measles scare, the commission used daily press briefings and podcasting to issue alerts to the city about the threat.

Barry also explained how the commission tracks diseases in order to curb possible epidemics or bioterrorism threats. Every day of every week, epidemiologists and nurses look through health complaints from many sources, including data from every emergency department in Boston, reported communicable diseases, restaurant inspections, environmental tests, and death certificates.

"We're looking for aberrant patterns," Barry said. In particular, death certificates for young healthy individuals who die from non-traumatic reasons without co-morbidities could signify a concern for public health. "These are young healthy people who are dying, and we want to know why," she said.

—MM