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Outbreak stopped

Facing a potential measles epidemic, health workers employed high-tech alerts, old-fashioned quarantines

Boston hadn't seen anything like it for 17 years.

Measles, one of the most infectious diseases on earth, had landed in the city's signature skyscraper, the John Hancock Tower. But it didn't stay there.

Within weeks this spring, one infected person sought treatment at a crowded East Boston clinic, another shopped at a grocery store in Provincetown, and a third worked shifts at two popular Boston restaurants.

What once seemed theoretical -- a disease epidemic capable of felling thousands -- no longer appeared so remote. Time was passing, the virus was spreading, the roster of potential cases was growing.

How could it be stopped?

Disease sleuths relied on priests in sacred vestments, podcasts that beamed warnings, vaccinations administered by the thousands, and quarantines that sequestered as many as 1,200 exposed workers.

Now, it's been 47 days since the last Boston resident came down with a confirmed case of measles -- almost long enough to declare the outbreak over.

Already, health officials and businesses are learning from the experience, acknowledging they need to know more about the vaccination status of workers. The measles outbreak, which resulted in no deaths or permanent complications among its 15 victims, was a dress rehearsal for something far worse.

``This was to us a microcosm of what could happen if we had an awful outbreak of something" such as a global flu epidemic, said Jack Craddock, chief executive officer of the East Boston Neighborhood Health Center, where one infected person sought treatment. ``It's a frightening prospect."

Within hours of receiving word from the state on May 8 that a suspected case of measles had been identified, Boston health workers began assembling a profile of the first patient, a man who had just arrived from India and who worked as a computer programmer somewhere in Boston.

``I remember hoping it was a small, two-person operation somewhere that he worked," said Dr. Anita Barry , Boston's director of communicable disease control. ``Sometimes, though, you can't always get what you wish."

He was, they discovered, working for Investors Bank & Trust , a financial services firm with 1,500 workers scattered on several floors of the Hancock Tower. Neither he nor any of the other measles patients have been identified by authorities because of patient privacy laws.

The Boston specialists knew they were racing both time and a virus so infectious that it lingers in the air two hours after a contagious patient has left, still capable of spreading illness.

``You can very quickly lose your grasp on your ability to control the spread," said Justin Pendarvis, an epidemiologist at the Boston Public Health Commission. ``Very early on, we realized that we had to act pretty quickly. With measles, no one today in our society is used to getting it."

Vaccinations were offered at Investors Bank, in hopes of containing the disease there. But by mid-May, reports of possible cases had begun to accelerate. When Barry arrived at work one morning, she recalled, five new suspected cases sat on her desk. By that afternoon, the number had grown to nine.

It was no longer enough to confine control efforts to the 18th floor of the Hancock, where the computer programmer worked. . Barry recorded a podcast for all Hancock Tower employees, discussing the basics of measles -- believed to be the first time that high-tech strategy had been used as a public health measure.

At the same time, health authorities asked Hancock employers to collect information about whether workers had been vaccinated against measles or if they had natural immunity to the disease because they had been exposed earlier in life.

That's not as simple as it might seem.

While measles shots today provide a thick shield of protection, that wasn't always the case. An early-generation vaccine given in the 1960s turned out to be not especially effective, meaning that people in their 30s and 40s who were inoculated might still be vulnerable to infection.

Then there was the matter of sheer volume: Over a period of just a few weeks, the Boston Public Health Commission had to review the medical records of 3,586 people.

``The fax machine was steaming over here," Barry said.

Still there were hundreds of workers who could produce no evidence of vaccination or immunity. So health authorities increasingly resorted to an old standby of disease control, the quarantine. It's something that evokes images of a different era: sepia-hued films of heaving tuberculosis patients consigned to the sanitarium.

But it was resurrected three years ago to much acclaim. When SARS -- severe acute respiratory syndrome -- arrived in Toronto, there was no drug to treat it, no complete understanding of how dangerous the germ was. In a matter of weeks after quarantining began, the virus had burned itself out and the danger was gone.

But how do you persuade someone to stay at home when he's feeling fine -- and has tickets to the Red Sox? That was Pat Tormey's task one Friday afternoon.

The phone rang in her office at the Boston Public Health Commission. It was a woman whose husband had been asked not to leave his house because he might have been exposed to measles. But the family was keen to head to Fenway Park.

At first, recalled Tormey, a communicable disease official, the woman ``was not very happy."

But then, Tormey explained what might happen if he came into contact with someone who wasn't immune ``and what if he gave that person measles and what if that person developed a very serious case?"

The woman eventually agreed everyone in her family should stay home, as part of the voluntary quarantine, which could last longer than two weeks.

At one point, as many as 1,209 people were quarantined -- and that exacted a toll on employers big and small. At Investors Bank, hundreds were told to stay at home, although many could work via computer.

That wasn't an option at Skipjack's, one of the two restaurants where an infected worker cleared tables. Out of a staff of 85, six had no proof of vaccination. They had to stay home, so owner Jeff Senior moved workers from his other restaurants to the Copley location, which sits in the shadow of the Hancock Tower. The workers who were furloughed, Senior said, received partial pay.

Senior now requires his workers -- both those already on staff and more recent hires -- to prove they're immunized against measles and other preventable diseases, such as mumps and rubella.

``I realize you can't live in a bubble, that there are other potential hazards out there," Senior said. ``It's about protecting not only my employees but our guests, so they know they're going to a safe dining establishment."

John Auerbach , executive director of the Boston Public Health Commission , is now encouraging all Boston employers to follow the path charted by Skipjack's -- including his own agency. In the midst of the outbreak, Auerbach recognized that the commission didn't have immunization documents for some employees needed to assist with vaccination campaigns.

Barry, acknowledging that she gets ``nervous about employers having too much employee medical information," suggested that worker privacy concerns could be addressed by having outside data firms maintain custody of immunization records.

Even big hospitals sometimes lack immunization records. Boston Medical Center, for example, is now screening all veteran staff members to ensure they are fully protected against all illnesses that can be prevented by vaccinations -- or, if they object to being vaccinated, at least the hospital has that information on file, said Patricia Webb, the hospital's vice president for human resources.

At the East Boston Neighborhood Health Center, anyone on the staff of 500 who wasn't protected was vaccinated -- including Craddock, the CEO. To ensure the safety of patients who might have been exposed by the infected woman who came to the clinic, health workers embarked on a hunt for those who visited at the same time as the infected woman. They called and mailed, and when that didn't work, they knocked. In one case, they traveled to Salem to track down a patient.

Clinic workers also offered vaccinations at eight sidewalk tables in front of the Most Holy Redeemer Roman Catholic Church across the street, Craddock said.

``The two priests who said the noontime Mass both came out in their robes and had their immunizations right out on the sidewalk," Craddock said. By the time Sunday services were finished, 865 shots had been administered.

And the virus was gone from the streets of East Boston.

Stephen Smith can be reached at stsmith@globe.com.

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