It takes a team to combat communicable diseases

On May 24, 2025, Provincetown health officials announced that they were working closely with the Massachusetts Department of Public Health and the Barnstable County Department of Health and Environment to respond to a case of hepatitis A that was contracted by a food service worker at a local restaurant.

Over the winter, 26 cases of another highly contagious disease, pertussis, were reported in children in Barnstable County. Previous communicable diseases in our area have included varicella (chicken pox) and Mpox. Other communicable diseases on the rise include the tick-borne diseases babesiosis, anaplasmosis and alpha gal.

When these communicable diseases appear, a team of healthcare workers, and county and state health officials spring into action in a coordinated effort to keep the public safe.

“We’re very lucky here,” said Meg Payne, director of Public Health, Provider Relations & Telehealth at the Visiting Nurse Association of Cape Cod. “We’re on calls with the state. We’re on calls with other regions in Massachusetts. We have a really great working relationship and partnership with various entities in the community and we all come together. It’s a really strong public health response.”

Molly Ives, communicable disease investigator and health educator at the VNA, agrees.

“There’s a pretty great group of investigators on the Cape,” she said. “We meet monthly or twice a month to discuss what is going on and answer any questions. Lately, we’ve been talking about measles. We’ve been chatting with the infection preventionists at the hospital and meeting with them to talk about what would happen and how we could coordinate a measles outbreak.”

Currently all communicable diseases except enteric diseases (anything you can get from contaminated food or water) are investigated by Ives. Enteric diseases are handled by Lea Hamner, contract epidemiologist for Barnstable County Department of Health and Environment. Hamner and her team are a valuable resource for the VNA, and she helps them navigate between the state and local boards of health when an infectious disease occurs.

Calling the Exposed

Most people don’t know that if they contract a communicable disease, they will be contacted by either Ives or Barnstable County to follow up and ask questions. The questions are all designed to identify who else might have been infected and to protect others.

“We have a whole script of questions we need to ask depending on the disease,” Payne said. “Essentially our role is to gather that information, and document it in MAVEN (Massachusetts Virtual Epidemiological Network) so that the state has record of it.”

Making the calls can be difficult, according to both Payne and Ives. Depending on the disease, Ives has to ask sensitive questions that are sometimes met with resistance. Sometimes people don’t respond at all. The best scenario is when a person is an open book because that helps her gather accurate information that keeps others safe by preventing the spread of disease.

Some of the general questions Ives might ask include:

• Did you have symptoms?
• When did they start/end?
• Were you hospitalized?
• Did you travel? If so, when and where?
• Have you ever received a blood transfusion or organ transplant?
• Have you donated blood?
• Who have you been in contact with recently?
• What is your vaccine status (depending on the disease)?

For certain diseases like hepatitis A, more sensitive questions about drug use and sexual partners will be asked. For children, a parent will be asked the questions and the school nurse will be contacted so Ives can find out who sat next to the child in the classrooms, the cafeteria, classrooms, after school activities and on the bus.

For a typical case, somebody who has symptoms of a disease goes to the doctor or a lab to get tests done. The doctor and lab then report the case to MAVEN. MAVEN then sends the case to either the VNA or Barnstable County, depending on the disease and jurisdiction. There are 90 reportable cases from the state, Ives said.

Once she gets a case, she follows up with a phone call to the patient and sometimes with the patient’s doctor to collect medical records. She then reports the information back to MAVEN so the state can have accurate epidemiological records of all communicable diseases.

The VNA disease investigators also work closely with Valerie Al-Hachem, director and grants administrator at Infectious Disease Clinical Services (IDCS) at CCHC. IDCS can help connect people with appointments and help overcome any barriers, like transportation or language, that make it hard to get to their appointments.

Mary Slater and Amy Laptew at the CCHC Hospital Infection Prevention department are also part of the team that helps keep diseases from spreading. Their focus is geared toward the hospitals and other Cape Cod Healthcare settings.

“We’re all on the same page, and we all have the same message,” Payne said. “It makes me really proud to think about how we work collaboratively and all of the different pieces that have come together to help mitigate the spread of disease and keep our community healthy.