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Measles: lessons from an outbreak
I Gurevich1, R A Barzarga, B A Cunha
1Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501.
Background:
Measles outbreaks continue to be a problem for infection control in hospitals--patients, personnel, and employee health service. Guidelines for measles outbreaks are not clear for medical personnel in the hospital.
Methods:
Outbreak investigation in a university-affiliated teaching hospital.
Results:
Four primary cases resulted in 607 staff exposures and two secondary cases. Forty-seven medical personnel were furloughed and 88 were vaccinated for measles. Minimal serologic criteria for immunity were found to be inadequate in the outbreak setting.
Conclusions:
We found that serologic guidelines for assessing immunity to measles are inadequate. During the outbreak, we arbitrarily doubled the acceptable enzyme-linked immunosorbent assay titers that we would consider protective, > or = 2, to decrease the possibility of further secondary cases. Employees with enzyme-linked immunosorbent assay measles titers less than 2 and without a definite history of natural measles were revaccinated with a measles vaccine. This strategy takes advantage of the anamnestic response that revaccination would confer in persons with low antibody titer.
Insights
Hospital measles outbreaks reveal inadequate immunity guidelines. Doubling enzyme-linked immunosorbent assay (ELISA) titers and revaccinating staff improved protection against measles transmission.
Area of Science:
- Infectious Disease Epidemiology
- Hospital Infection Control
- Vaccinology
Background:
- Measles outbreaks pose significant challenges for hospital infection control, affecting patients and healthcare personnel.
- Existing guidelines for managing measles outbreaks among hospital staff are unclear and insufficient.
Observation:
- An investigation of a measles outbreak in a university-affiliated teaching hospital revealed substantial staff exposure.
- Four initial cases led to 607 staff exposures and two secondary infections, necessitating furloughs and vaccinations for 47 and 88 personnel, respectively.
Findings:
- Established serologic criteria for measles immunity proved inadequate during the outbreak.
- Minimal enzyme-linked immunosorbent assay (ELISA) antibody titers were insufficient to prevent secondary transmission.
Implications:
- Adjusting serologic immunity thresholds, such as doubling ELISA titers, may be necessary during hospital measles outbreaks.
- Revaccination strategies leveraging the anamnestic response can enhance protection in healthcare workers with low measles antibody titers.
- Revised guidelines are needed to effectively manage measles immunity and prevent outbreaks in healthcare settings.