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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

If Measles Finds Unvaccinated Populations it will Infect Them. Trust Me.

April 2nd, 2015

As infected measles cases continue to find susceptible -- often unvaccinated populations -- employee health professionals and infection preventionists must ensure that staff are immunized to avoid the chaos that can ensue when a single undiagnosed case enters a hospital.

“It has become clear that we are in the midst of a larger, very disturbing trend,” the Pediatric Infectious Diseases Society said in a recent statement on the situation. “Despite the fact that measles was eradicated from the United States 15 years ago, this country had 644 measles cases in 2014, more than in any year since 1994. 2015 is now on pace to well exceed that number.”

There is little doubt that some of the infections and outbreaks can be traced to the influence of a high profile anti-vaccine movement that cites discredited research in falsely linking the MMR (measles-mumps-rubella) vaccine to autism.

“It is a tragedy that some parents, often because of misinformation they may have received from friends, colleagues, or the Internet, are putting their children and others in harm’s way by refusing to vaccinate,” the Pediatric ID group said.

From January 1 to March 20, 2015, 178 people from 17 states and the District of Columbia were reported to have measles, the Centers for Disease Control and Prevention reports. Most of these cases -- 131 (74%) -- are part of a large, ongoing multi-state outbreak linked to Disney Land in Anaheim, CA. The current situation is characterized by the volatile combination of pockets of non-immunized populations and travelers coming into the country from areas where measles is much more common. Given measles legendary transmission ability, a measles case reaching these non-vaccinated groups is like throwing a lit match on gasoline. As a result health care facilities must be vigilant for measles introductions, with employee health ensuring that all workers have presumptive evidence of immunity, the CDC recommends.1 This information should be documented and readily available at the facility. Recently vaccinated health care workers do not require any restriction in their work activities.

According to the CDC, presumptive evidence of immunity to measles for persons who work in health-care facilities includes any of the following

: • written documentation of vaccination with 2 doses of live measles or MMR vaccine administered at least 28 days apart

• laboratory evidence of immunity

• laboratory confirmation of disease

• birth before 1957.

If this information is not readily available, a measles case can set off a laborious and expensive follow-up of exposed patients and health care workers. For example, a single imported case of measles once cost two Arizona hospitals some $800,000, with much of the expense related to ensuring the immunity of employees and furloughing workers.2 Because of the greater opportunity for exposure, health care workers are at much higher risk than the general population for becoming infected with measles. During 2001–2008, in the 23 health-care settings in which measles transmission was reported, eight cases occurred among health care workers, six of whom were unvaccinated or had unknown vaccination status, the CDC reports. One health-care provider was hospitalized in an intensive care unit for 6 days from severe measles complications, the CDC reports.

For more on this story see the May 2015 issue of Hospital Employee Health.

REFERENCES
1. CDC. Measles: http://1.usa.gov/1CfIIhG
2. Chen SY, et al. Health care-associated measles outbreak in the United States
after an importation: challenges and economic impact. J Infect Dis 2011;203:1517–25.