HEALTH CARE–ASSOCIATED MEASLES OUTBREAK IN THE UNITED STATES AFTER AN IMPORTATION: CHALLENGES AND ECONOMIC IMPACT.

Tuesday, 8th of October 2013

[source]Journal of Infectious Diseases[|source]

In this report, Chen and colleagues report on measles outbreak in Arizona, with 14 confirmed cases, including 7 health care–associated infections, is the largest reported health care–associated measles outbreak in the United States since 1989. During this outbreak, 2 hospitals spent almost US$800,000 responding to 7 patients with measles. In the post-elimination settings, physicians being less familiar with diagnosing measles is one of the greatest challenges. The authors conclude by recommending a high index of suspicion, especially in persons with history of travel overseas or contact with someone with measles.  More details are available at http://jid.oxfordjournals.org/content/203/11/1517.full

Abstract

Background:  On 12 February 2008, an infected Swiss traveller visited hospital A in Tucson, Arizona, and initiated a predominantly health care–associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care–associated transmission and assessed outbreak-associated hospital costs.

Methods:  Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non–measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals.

Results:  Of 14 patients with confirmed cases, 7 (50%) were aged ≥18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities.

Conclusions:  Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care–associated spread and in minimizing hospital outbreak–response costs.