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Rubella outbreak among hospital employees
Abstract:
A rubella outbreak among medical staff on the obstetric service of a large Los Angeles hospital was studied. Fifteen cases of suspected rubella were reported among hospital personnel during a 2-month period in 1978. Of these, 4 were confirmed, 2 by viral isolation and serology and 2 by serologic study alone. A fifth case, the index, had a convalescent-phase serum with an elevated rubella hemagglutination inhibition (HAI) antibody titer. A list of 231 pregnant women who may have been exposed to any of the 15 suspect cases was assembled. The authors succeeded in contacting and obtaining postexposure sera for only 140 (61%) of the exposed women. Thirty-five (25%) of these women were without detectable rubella HAI antibody. A second serum sample was obtained from 93 women 2 to 3 weeks after the first, and no fourfold rises in titer were observed. To evaluate those with suspicious high stationary titers, 60 specimens were selected for immunoglobulin M (IgM) testing. Only 1 was positive for IgM antibody. A postexposure illness survey revealed that 20 (15%) of 130 women reported various rash-like illnesses after their visit to the hospital. There were no reports of affected offspring in any of the exposed women. Four hundred ten staff members submitted sera for antibody testing; 76 (19.2%) were without detectable rubella HAI antibody. This outbreak is discussed in light of recent changes in rubella epidemiology, and several recommendations for hospital policy are proposed.
Insights
A 1978 rubella outbreak in a Los Angeles hospital revealed low staff immunity and exposed pregnant patients. No evidence of fetal rubella infection was found, but hospital policies needed updates.
Area of Science:
- Infectious Disease Epidemiology
- Public Health Surveillance
- Hospital Outbreak Investigation
Background:
- Rubella outbreaks pose risks to healthcare settings, particularly for pregnant individuals.
- Assessing population immunity and transmission dynamics is crucial for outbreak control.
Purpose of the Study:
- To investigate a rubella outbreak among medical staff in a Los Angeles hospital.
- To assess the risk of rubella transmission to pregnant patients and evaluate immunity levels.
Main Methods:
- Retrospective analysis of suspected rubella cases among hospital staff.
- Serological testing (hemagglutination inhibition and IgM) of exposed pregnant women and staff.
- Postexposure illness and offspring outcome surveys.
Main Results:
- Four confirmed rubella cases among 15 suspected staff cases; 19.2% of staff lacked protective antibodies.
- 25% of 140 exposed pregnant women lacked detectable rubella antibodies; no significant seroconversion observed.
- 15% of exposed women reported rash-like illness; no congenital rubella syndrome cases reported.
Conclusions:
- The outbreak highlighted potential vulnerabilities in healthcare worker immunity and patient exposure risks.
- Recommendations for enhanced hospital policies regarding rubella vaccination and outbreak management were proposed.