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BACKGROUND: In January 2014, the Massachusetts Department of Public Health (MDPH) received confirmation of a resident with measles. Given that measles is highly transmissible, contacts of cases must be quickly identified and assessed for susceptibility to infection. Multiple exposure sites were involved, including three rides in taxis and two in car service vehicles during the infectious period. Because measles virus can remain suspended in an enclosed area for up to two hours, MDPH needed to assess the immune status of the five drivers and subsequent passengers occupying those vehicles. Notably, the car service involved makes use of a smartphone application for a registered user to request transportation.
METHODS: Upon interview, the case provided MDPH with electronic receipts from the car service rides, and a voucher number for one of the taxis used. MDPH contacted the car service provider, whose only direct means of communication was via e-mail. Within hours, MDPH was able to identify a point of contact at the service. Upon the service’s request, MDPH provided a detailed letter explaining follow-up and requesting specific information required for the investigation.
RESULTS: The car service queried their records of registered clients and provided MDPH with detailed contact information for the two drivers and eleven passengers identified as having occupied those two specific vehicles. MDPH epidemiologists assessed risk to those exposed and reviewed with them necessary control measures. Verification of immune status for all eleven passengers was obtained within five days of the case’s confirmation. Generally, passengers were able to obtain immunization records from recently attended universities. One driver had records of a positive titer, and the other received prophylactic MMR vaccine. In contrast, despite the voucher identifying the vehicle and ultimately the driver, the traditional taxi company was not able to provide any such records of passengers, though the driver was identified and found to be immune. The two remaining taxis were paid for in cash, and MDPH was unable to determine details regarding individuals exposed in those two vehicles.
CONCLUSIONS: The car service’s automated and application-mediated system allowed for prompt identification of persons exposed to the case, contrasting with limited capacity for follow-up involving traditional taxis. This system proved highly valuable during investigation, as contacts must be quickly and accurately assessed for risk of developing illness. Public health institutions must be prepared to adapt to, and incorporate, developing technologies in unconventional ways in order to best meet the needs of the populations they serve.