Health Care-Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact

Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia.
The Journal of Infectious Diseases (Impact Factor: 6). 06/2011; 203(11):1517-25. DOI: 10.1093/infdis/jir115
Source: PubMed


On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care-associated transmission and assessed outbreak-associated hospital costs.
Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non-measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals.
Of 14 patients with confirmed cases, 7 (50%) were aged ≥ 18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities.
Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs.

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    • "Most HCW are immune to measles, but many cannot provide sufficient accessible evidence of documented immunity. If outbreaks occur, these HCW should be temporarily taken off health care work, which may cause severe logistic and financial problems [24,26]. In circumstances in which HCW state they know their history [30,31], undocumented information is clearly not sufficient to justify overriding these problems. "
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    • "This is an important issue since health care associated spread is not uncommon. Different outbreak reports have already described how measles spreads in consultation rooms and emergency departments [21-24]. "
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    Full-text · Article · Jul 2013 · Archives of Public Health
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    • "Nosocomial outbreaks are costly and highly disruptive [8] [9] [20], and are associated with increased HCP absenteeism and medical leave, and more importantly with transmission to highly vulnerable patients. We believe that it is imperative that all HCP have documented and easily retrievable evidence of measles immunity to ensure case management and rapid outbreak response [6] [9]. To protect the public and the patients we serve, receipt of appropriate measles immunization(s) should be mandatory, absent a valid medical contraindication, for all HCP. "

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