Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-06-04T23:55:38.025Z Has data issue: false hasContentIssue false
  • English
  • Français

Transmission of Measles Virus in Healthcare Settings During a Communitywide Outbreak

Published online by Cambridge University Press:  02 January 2015

Karen R. Steingart ,
Ann R. Thomas ,
Clare A. Dykewicz  and
Stephen C. Redd
Karen R. Steingart*
Affiliation:
Southwest Washington Health District, Vancouver, Washington
Ann R. Thomas
Affiliation:
Division of Applied Public Health, Epidemiology Program Office
Clare A. Dykewicz
Affiliation:
Division of AIDS, STD, and TB Laboratory Research, Office of the Director, National Center for Infectious Diseases
Stephen C. Redd
Affiliation:
Environmental Hazards and Health Effects Division, Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Southwest Washington Health District, 2000 Fort Vancouver Way, Vancouver, WA 98663
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the epidemiology of measles in medical settings and to evaluate the implementation and effectiveness of the 1989 Advisory Committee on Immunization Practices (ACIP) guidelines for measles immunization in healthcare workers (HCWs).

Design:

Confirmed cases of measles reported in Clark County, Washington, from March 14 to June 2,1996, were analyzed for characteristics of cases occurring in medical settings. A questionnaire was used to assess employee immunization (95% response rate).

Setting and Participants:

Reported measles cases and HCWs at community hospitals, primary-care medical facilities, a health-maintenance organization, and a multispecialty group practice.

Results:

Of 31 cases of measles, 8 (26%) occurred in HCWs, and 5 (16%) occurred in patients or visitors to medical facilities. Cases of measles occurred in HCWs who were not required to have proof of measles immunity as defined by the 1989 ACIP guidelines. The relative risk of measles in HCWs compared to Clark County adults was 18.6 (95% confidence interval, 7.4-45.8; P<.001).

A survey of medical facilities revealed that 47% had an employee measles immunization policy; only 21% met ACIP recommendations and enforced their policies.

Conclusions:

HCWs were at higher risk of measles than the adult population. Transmission of measles in medical settings was related to both deficiencies in, and lack of implementation of, the ACIP guidelines.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 2 , February 1999 , pp. 115 - 119
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 1997. MMWR 1998;46(54):1–88.Google Scholar
2.Atkinson, WL, Markowitz, LE, Adams, NC, Seastrom, GR. Transmission of measles in medical settings—United States, 1985-1989. Am J Med 1991(suppl 3B);91:320S–324S.CrossRefGoogle ScholarPubMed
3.Atkinson, WL, Markowitz, LE. Measles and measles vaccine. Seminars in Pediatric Infectious Diseases 1991;2:100–107.Google Scholar
4.Gindler, JS, Atkinson, WL, Markowitz, LE, Hutchins, SS. Epidemiology of measles in the United States in 1989 and 1990. Pediatr Infect Dis J 1992;11:841–846.Google Scholar
5.Foulon, G, Cottin, JF, Matheron, S, Perronne, C, Bouvet, E. Transmission and severity of measles acquired in medical settings. JAMA 1986;256:1135–1136.Google Scholar
6.Rivera, ME, Mason, WH, Ross, IA, Wright, HT Jr. Nosocomial measles infection in a pediatric hospital during a community-wide epidemic. The Journal of Pediatrics 1991;119:183–186.CrossRefGoogle Scholar
7.Raad, II, Sherertz, RJ, Rains, CS, Cusick, JL, Fauerbach, LL, Reuman, PD, et al. The importance of nosocomial transmission of measles in the propagation of a community outbreak. Infect Control Hosp Epidemiol 1989;10:161–166.Google Scholar
8.Kaplan, LJ, Daum, RS, Smaron, M, McCarthy, CA. Severe measles in immunocompromised patients. JAMA 1992;267:1237–1241.Google Scholar
9.Centers for Disease Control. Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1989;38(S-9):1–13.Google Scholar
10.Centers for Disease Control. Case definitions for public health surveillance. MMWR 1990;39(RR-13):23.Google Scholar
11.Erdman, DD, Anderson, LJ, Adams, DR, Stewart, JA, Markowitz, LE, Bellini, WJ, et al. Evaluation of monoclonal antibody-based capture enzyme immunoassays for detection of specific antibodies to measles virus. J Clin Microbiol 1991;29:1466–1471.Google Scholar
12.Centers for Disease Control and Prevention. Summary of Notifiable Diseases, United States, 1995, 1996;44(53):1–87.Google Scholar
13.Centers for Disease Control and Prevention. Measles—United States, 1996, and the interruption of indigenous transmission. MMWR 1997;46(11):242–246.Google Scholar
14.Dejong, JG, Winkler, KC. Virology: survival of measles virus in air. Nature 1964; Y201:1054–1055.CrossRefGoogle Scholar
15.Atkinson, WL. Measles and healthcare workers. Infect Control Hosp Epidemiol 1994;15:5–7.Google Scholar
16.Kim, M, LaPointe, J, Liu, FJG. Epidemiology of measles immunity in a population of healthcare workers. Infect Control Hosp Epidemiol 1992;13:399–402.Google Scholar
17.Subbarao, EK, Amin, S, Kumar, ML. Prevaccinalion serologic screening for measles in healthcare workers. J Infect Dis 1991;163:876–878.Google Scholar
18.Wright, LJ, Carlquist, JF. Measles immunity in employees of a multihospital healthcare provider. Infect Control Hosp Epidemiol 1994;15:8–11.Google Scholar
19.Houck, P, Scott-Johnson, G, Krebs, L. Measles immunity among community hospital employees. Infect Control Hosp Epidemiol 1991:12: 663–668.Google Scholar
20.Schwarcz, S, McCaw, B, Fukushima, P. Prevalence of measles susceptibility in hospital staff. Evidence to support expanding the recommendations of the Immunization Practices Advisory Committee. Arch Intern Med 1992;152:1481–1483.Google Scholar
21.Braunstein, H, Thomas, S, Ito, R. Immunity to measles in a large population of varying age. American Journal of Diseases in Children 1990;144:296–298.Google Scholar
22.Willy, ME, Koziol, DE, Fleisher, T, Koo, S, McFarland, H, Schmitt, J, et al. Measles immunity in a population of healthcare workers. Infect Control Hosp Epidemiol 1994;15:12–17.Google Scholar
23.Centers for Disease Control and Prevention. Immunization of healthcare workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997;46(RR-18): 1–42.Google Scholar
24.Agerton, TB, Mahoney, FJ, Polish, LB, Shapiro, CN. Impact of the bloodborne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infect Control Hosp Epidemiol 1995;16:287–291.Google Scholar
25.Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Dept of Health and Human Services publication (PHS) 91-50212; 1991:513.Google Scholar