Measles among healthcare workers: a potential for nosocomial outbreaks (original) (raw)
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Background Nosocomial transmission of measles is a near avoidable event with the potential for serious sequelae. Those who acquire infection in hospitals may be particularly susceptible to serious disease. UK guidance recommends measles, mumps, rubella vaccine (MMR) vaccination for healthcare workers (HCWs) as a key preventative measure against nosocomial transmission. We report an incident of transmission of measles from a patient to an unvaccinated HCW, with subsequent onward transmission to a patient in a paediatric unit. Methods Response to the incident was undertaken in accordance with guidance from the Health Protection Agency (now Public Health England) and UK Department of Health. Results The index case had travelled to France, where there was an ongoing outbreak. There were 110 contacts identified for this HCW, of whom 61 were advised to have MMR and 5 were given immunoglobulin. All three cases were found to have the same D4 genotype. Conclusions The report highlights the large number of potential contacts in a hospital setting and the time and resource implications involved to prevent further cases. It also highlights the importance of timely identification of measles, early public health notification and complete contact tracing. Such incidents are nearly avoidable given the availability of an efficacious vaccine.
Measles immunity in an Italian teaching hospital
Occupational Medicine
Background Healthcare workers (HCWs) have an increased exposure risk to measles, which can put them, their patients and their relatives at risk of infection. In Italy, 4617 cases of measles were reported in 2017; 302 involving HCWs. According to the Italian National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles. Aims To evaluate measles immunization status in HCWs at a large Italian teaching hospital. Methods We analysed clinical records and measles-specific IgG antibody titres of HCWs undergoing occupational health surveillance between 1 January and 31 August 2017. Results Among the 1532 HCWs (mean age 32.7 ± 10.4 years) included in the study, 87% (1328) had protective antibody titres. The proportion of protective titres was highest in those born before 1982. No significant gender differences in mean measles-specific IgG antibody titres were detected. Conclusions Our study shows non-protective measles IgG antibody titres in a substantial percentage of HCWs, especially those born in the 1980s and 1990s. Due to the increased risk of measles transmission in the hospital environment, increased prevention strategies are required, including rigorous screening and prompt vaccination of non-immune workers.
Vaccines
Measles is a highly contagious vaccine-preventable disease (VPD) that also commonly affects health-care workers (HCWs). Measles immunization of HCWs was strongly recommended by international health authorities, in order to limit the spreading of the illness to susceptible patients and colleagues. An observational study, evaluating the immunization and vaccination status against measles of HCWs working at three Sicilian university hospitals, was conducted. All subjects not completely immune (vaccinated with only one dose in their lifetime), not immune (not vaccinated or not naturally immunized), and with an unknown immunization status were considered not immunized. Among HCWs operating in the three Sicilian university hospitals, 54.6% were not immune against measles. The average age of not immune HCWs was 51.3 (SD ± 9.8), ranging between 25 and 71 years old. In particular, 46.9% of HCWs not immunized worked in “at-risk” hospital units, based on medical conditions of patients which in...
International Journal of Environmental Research and Public Health, 2020
The aim of this serological survey was to assess the persistence of measles antibodies among health care workers (HCWs) at risk of incidental measles. A prospective study of measles-specific antibodies in serum samples obtained from a total of 2782 participants aged 19–89 years was conducted between May 2018 and December 2019. The seropositivity rate of 93.7% (95% CI: 92.4–94.9%) in fully vaccinated participants aged 19–48 years was significantly lower than that of 98.0% (95% CI: 96.5–99.0%) in participants naturally immunised before 54 years. A cohort of those born in 1971–1975, vaccinated predominantly with one dose, showed lower seropositivity persistence (86.6%) than those fully vaccinated with two doses or naturally immunised. Otherwise, seropositivity was not markedly influenced by sex, age, smoking status, overweight, obesity or concomitant disease. The presence of sufficient antibody levels in a high proportion of HCWs irrespective of the way they acquired immunity is a favo...
Measles in health-care settings
American Journal of Infection Control, 2013
Outbreak Nosocomial Hospital Transmission Health-care workers Vaccine-preventable disease Despite the availability of an effective and safe vaccine for almost half a century, measles is re-emerging in several developed countries because of the insufficient vaccination coverage among specific subpopulations, the emerging anti-vaccination movement, and the increasing movement of humans across borders. In this context, health-care settings play a critical role in the transmission of infection and generation of numerous cases. Health-care-associated outbreaks may be associated with severe morbidity and mortality among specific groups of patients, disruption of health-care services, and considerable costs. Misdiagnosis or delayed diagnosis of a measles case and inadequate implementation of infection control measures are common in almost all events of nosocomial spread. Measles vaccination of health-care workers is an effective means of prevention of nosocomial measles outbreaks. Eliminating measles by 2010 has not been accomplished. Stronger recommendations and higher vaccination coverage against measles in health-care workers could contribute to eliminate measles in the general population.
A Potential Outbreak of Measles and Chickenpox Among Healthcare Workers in a University Hospital
Euromediterranean Biomedical Journal, 2019
In Italy there is currently a measles outbreak among the general population related to insufficient vaccine coverage. Despite the highest infectivity of some diseases, the guidelines released in the National Vaccination Plan recommend basic vaccination among HCWs. In March 2018, one case of measles and one of chickenpox occurred among two young medical doctors who had come into contact with 153 people. We investigated, within 24 hours, the immunization status of close contacts, providing vaccinations for those not immune and isolation for people with premature signs/symptoms of infection. All patients analyzed (n=13) were immune. Among HCWs (n=140), 16 weren't immune for chickenpox and 7 for measles. All contacts that were not immunized were vaccinated within 72 hours, however, despite this, in one case we found antibody values that indicated a recent infection. The high contagiousness of measles led to a further case of illness among close contacts of the first young HCW infect...
Vaccination and Immunity toward Measles: A Serosurvey in Future Healthcare Workers
Vaccines
Measles is a very contagious infectious disease, and vaccination is the only medical aid to counter the spread of the infection. The aim of this study was to evaluate the influence of vaccination schedule and type of vaccine, number of doses, and sex on the immune response. In a population of Italian medical students (8497 individuals born after 1980 with certificate of vaccination and quantitative measurement of antibodies against measles), the prevalence of positive antibodies to measles and antibody titer was measured. Vaccination schedule such as number of doses and vaccine type (measles alone or combined as measles, mumps and rubella (MMR)) and sex were the variables considered to influence the immune response. The vaccination schedule depends on the year of birth: students born before 1990 were prevalently vaccinated once and with measles vaccine alone (not as MMR). One dose of vaccine induces a significantly (p < 0.0001) higher positive response and antibody titer than two...
BMC Infectious Diseases, 2013
Background: Interruption of measles transmission was achieved in Catalonia (Spain) in 2000. Six years later, a measles outbreak occurred between August 2006 and June 2007 with 381 cases, 11 of whom were health care workers (HCW). The objective was to estimate susceptibility to measles in HCW and related demographic and occupational characteristics. Methods: A measles seroprevalence study was carried out in 639 HCW from six public tertiary hospitals and five primary healthcare areas. Antibodies were tested using the Vircell Measles ELISA IgG Kit. Data were analyzed according to age, sex, type of HCW, type of centre and vaccination history. The odds ratios (OR) and their 95% CI were calculated to determine the variables associated with antibody prevalence. OR were adjusted using logistic regression. Positive predictive values (PPV) and the 95% confidence intervals (CI) of having two documented doses of a measles containing vaccine (MCV) for the presence of measles antibodies and of reporting a history of measles infection were calculated. Results: The prevalence of measles antibodies in HCW was 98% (95% CI 96.6-98.9), and was lower in HCW born in 1981 or later, after the introduction of systematic paediatric vaccination (94.4%; 95% CI 86.4-98.5) and higher in HCW born between 1965 and 1980 (99.0%; 95% CI 97.0-99.8). Significant differences were found for HCW born in 1965-1980 with respect to those born in 1981 and after (adjusted OR of 5.67; 95% CI: 1.24-25.91). A total of 187 HCW reported being vaccinated: the proportion of vaccinated HCW decreased with age. Of HCW who reported being vaccinated, vaccination was confirmed by the vaccination card in 49%. Vaccination with 2 doses was documented in only 50 HCW, of whom 48 had measles antibodies. 311 HCW reported a history of measles. The PPV of having received two documented doses of MCV was 96% (95% CI 86.3-99.5) and the PPV of reporting a history of measles was 98.7% (95% CI 96.7-99.6). Conclusions: Screening to detect HCW who lack presumptive evidence of immunity and vaccination with two doses of vaccine should be reinforced, especially in young workers, to minimize the risk of contracting measles and infecting the susceptible patients they care for.
European journal of public health, 2015
During 2008-12, France and Europe experienced large measles outbreaks, involving also healthcare workers (HCW). We aimed to estimate the vaccination coverage (VC) of measles among medical residents of the University of Aix/Marseille, in South-Eastern France. In March 2013, we conducted a cross-sectional study among all medical residents of the Medical Faculty of Aix/Marseille. We used a self-administered questionnaire to collect information on self-reported VC and reasons for vaccination and non-vaccination. We compared proportions, using the chi-squared test and prevalence ratios (PRs) with 95% confidence intervals (95% CIs). Of 1152 eligible residents, 703 (61%) participated in the study and 95 (14%; 95% CI: 12-17%) reported having had measles in the past. Of all participants, 613 (93%; 95% CI: 91-95%) reported having been vaccinated against measles and 389 (76%; 95% CI: 73-80%) received two doses. Only 268 (38%) reported having visited an occupational health physician. Vaccinated...
Nosocomial transmission of measles among healthcare workers, Bulgaria, 2010
Eurosurveillance, 2011
This report describes 326 cases of nosocomial transmission of measles with 286 cases among non-healthcare workers who acquired the disease in a hospital setting. Between October 2009 and April 2010, 40 healthcare workers from seven different regions in Bulgaria have contracted the disease.