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Transmission of measles in medical settings--United States, 1985-1989
W L Atkinson1, L E Markowitz, N C Adams
1Division of Immunization, Centers for Disease Control, Atlanta, Georgia 30333.
Abstract:
Measles cases reported to the Centers for Disease Control from 1985 to 1989 were analyzed to determine the characteristics of measles cases transmitted in medical settings. A total of 1,209 medial setting cases were identified, which represented 3.5% of all reported cases. Of medical setting cases, 66% (795) were in known or presumed patients and 28% (341) were in health care workers. The largest groups of health care workers with measles were nurses (101, 29.6%) and physicians (65, 19.1%). Health care workers acquired measles from patients (90.6%) and other health care workers (9.4%), and transmitted measles to patients, other health care workers, and family members. Of 333 (97.7%) health care workers with known measles vaccination status, 232 (68.0%) were eligible for vaccine; only 46 (19.8%) had received a documented dose. Twenty-nine percent of health care workers with measles were born before 1957, older than the age for routine measles vaccination. The relative risk of measles for physicians and nurses was 8.4 (95% confidence interval [CI], 6.6, 10.8) and 2.1 (95% CI, 1.8, 2.7) respectively, compared with nonhealth care workers of the same ages. In 1989 the Immunization Practices Advisory Committee (ACIP) recommended that health care workers be required to document two doses of measles vaccine or other evidence of measles immunity at the time of employment. Implementation of ACIP recommendations for health care workers and appropriate isolation precautions for known and suspected patients with measles could reduce the transmission of measles in medical settings.
Insights
Measles transmission in healthcare settings is a significant concern, with many cases occurring among patients and healthcare workers. Inadequate vaccination among healthcare workers contributed to outbreaks, highlighting the need for updated immunization policies.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Measles transmission within medical facilities poses a risk to vulnerable patients and healthcare personnel.
- Analysis of measles cases from 1985-1989 reveals patterns of spread in healthcare settings.
Purpose of the Study:
- To characterize measles cases transmitted in medical settings.
- To identify risk factors and transmission dynamics among healthcare workers and patients.
Main Methods:
- Retrospective analysis of measles cases reported to the Centers for Disease Control (CDC) between 1985 and 1989.
- Identification and categorization of cases occurring in medical settings, including patients and healthcare workers.
Main Results:
- 1,209 medical setting measles cases represented 3.5% of all reported cases.
- Healthcare workers, particularly nurses and physicians, accounted for 28% of medical setting cases.
- A significant proportion of healthcare workers with measles lacked documented vaccination, and many were born before routine vaccination age.
Conclusions:
- Healthcare workers are at increased risk of measles infection compared to the general population.
- Inadequate measles vaccination among healthcare workers facilitates transmission within medical settings.
- Implementing stringent vaccination policies and isolation precautions is crucial to prevent measles spread in healthcare environments.