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Vaccine-Associated Measles in an Immunocompromised Host: Hospital Infection Prevention and Control and Public Health
Dara Petel1, Nabilah Juma2, Cara-Lee Coghill3
1Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Introduction:
Vaccine-associated measles is generally not considered to be transmissible, as opposed to wild-type measles, which is one of the most highly contagious diseases. Data on contact and exposure management of vaccine-associated measles is limited, with varied approaches to such cases described in the literature.
Methods:
We report the case of a 2-year-old immunosuppressed child who developed a febrile exanthem with mild conjunctivitis 18 days after receiving the measles-mumps-rubella-varicella vaccine.
Results:
Given the patient's recent measles-containing vaccination while on immunosuppressive medications, consistent clinical findings, and the lack of epidemiological risk factors for wild-type infection the decision was made to treat this as a presumptive case of vaccine-associated measles virus prior to return of confirmatory genotyping results. After consultation with public health experts, contact tracing was not considered necessary. No secondary measles cases were identified, despite a large exposure potential due to lack of consistent airborne precautions during hospital admission.
Discussion:
This case highlights the lack of transmissibility of vaccine-associated measles in immunocompromised hosts, adding to the scant body of literature on this topic, with the potential to inform hospital infection prevention and control as well as public health management in similar situations.
Insights
Vaccine-associated measles is not transmissible, even in immunocompromised children. This case study supports limited public health interventions for vaccine-associated measles, even with potential exposure.
Area of Science:
- Immunology
- Virology
- Public Health
Background:
- Wild-type measles is highly contagious, necessitating strict isolation and contact tracing.
- Vaccine-associated measles is generally considered non-transmissible, but data on management is limited.
Observation:
- A 2-year-old immunosuppressed child developed a rash and conjunctivitis 18 days post-measles-mumps-rubella-varicella vaccination.
- The child was treated presumptively for vaccine-associated measles.
Findings:
- Contact tracing was deemed unnecessary by public health experts.
- No secondary measles cases were identified despite potential exposure and lack of consistent airborne precautions.
Implications:
- This case suggests vaccine-associated measles has limited transmissibility, even in immunocompromised individuals.
- Findings can inform infection control and public health strategies for managing vaccine-associated measles.
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