A challenging modified measles outbreak in vaccinated healthcare providers.
ED, Emergency Department
EMR, Eastern Mediterranean Region
HCP, Healthcare Providers
Infection control
MOPH, Lebanese Ministry of Public Health
Measles
Measles immunity
Measles outbreak
Modified measles
NSVI, Non-specific Signs of Viral Illness
PPE, Personal Protective Equipment
SGHUMC, Saint George Hospital University Medical Center
Vaccination
Journal
Infection prevention in practice
ISSN: 2590-0889
Titre abrégé: Infect Prev Pract
Pays: England
ID NLM: 101777928
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
23
07
2020
accepted:
10
12
2020
entrez:
9
8
2021
pubmed:
10
8
2021
medline:
10
8
2021
Statut:
epublish
Résumé
Modified measles is rarely reported and thought to be an attenuated, less transmissible form of measles. The occupational safety and management of previously immunized healthcare providers (HCP) facing the global reemergence of measles is controversial and unclear.Aim: We report a measles outbreak with an unusual presentation among our vaccinated HCP at Saint George Hospital University Medical Center (SGHUMC) in Lebanon that occurred during a nationwide measles epidemic. We recorded cases at SGHUMC, a 333-bed tertiary-care center, from April 2018 to June 2018. We established a measles clinic for investigating all febrile patients. HCP exposure was linked to influx of index cases through our Emergency Department. Modified measles was defined as any variation in the classic presentation with a pinpoint/vesicular rash, documented exposure and evidence of prior immunity. We performed serology testing to diagnose and/or document immunity and implemented outbreak controls measures including PPE, airborne isolation, and mass notification. We diagnosed 8 inpatients with classic measles, and 9 affected HCP. We diagnosed 8 HCP with modified measles. One previously immunized HCP developed classic measles despite being immunized and having a positive IgG titer. Our contact tracing revealed a total of 96 exposed HCP with 27 HCP showing non-specific signs of viral illness. We required all the 9 affected HCP to undergo home isolation. We believe it is a top priority to achieve adequate measles immunity, especially among HCP that are at the frontline of healthcare systems. This necessitates revisiting vaccination schedules and achieving seroprotective titers to reclaim proper herd immunity.
Sections du résumé
BACKGROUND
BACKGROUND
Modified measles is rarely reported and thought to be an attenuated, less transmissible form of measles. The occupational safety and management of previously immunized healthcare providers (HCP) facing the global reemergence of measles is controversial and unclear.Aim: We report a measles outbreak with an unusual presentation among our vaccinated HCP at Saint George Hospital University Medical Center (SGHUMC) in Lebanon that occurred during a nationwide measles epidemic.
METHODS
METHODS
We recorded cases at SGHUMC, a 333-bed tertiary-care center, from April 2018 to June 2018. We established a measles clinic for investigating all febrile patients. HCP exposure was linked to influx of index cases through our Emergency Department. Modified measles was defined as any variation in the classic presentation with a pinpoint/vesicular rash, documented exposure and evidence of prior immunity. We performed serology testing to diagnose and/or document immunity and implemented outbreak controls measures including PPE, airborne isolation, and mass notification.
FINDINGS
RESULTS
We diagnosed 8 inpatients with classic measles, and 9 affected HCP. We diagnosed 8 HCP with modified measles. One previously immunized HCP developed classic measles despite being immunized and having a positive IgG titer. Our contact tracing revealed a total of 96 exposed HCP with 27 HCP showing non-specific signs of viral illness. We required all the 9 affected HCP to undergo home isolation.
CONCLUSION
CONCLUSIONS
We believe it is a top priority to achieve adequate measles immunity, especially among HCP that are at the frontline of healthcare systems. This necessitates revisiting vaccination schedules and achieving seroprotective titers to reclaim proper herd immunity.
Identifiants
pubmed: 34368732
doi: 10.1016/j.infpip.2020.100105
pii: S2590-0889(20)30069-X
pmc: PMC8336165
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100105Informations de copyright
© 2020 The Authors.
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