Measles outbreak related to healthcare transmission

Torner, Núria; Ferràs, Joaquim; Curtò, Lorenzo; Rebull, J.; Sol, Joaquím; Costa, Josep; Mosquera, María Mar; Izquierdo, Conchita; Martı́nez, Ana; Jané, Mireia

doi:10.1016/j.vacune.2021.01.003

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…HCS-WP has proven to be an effective environment for spreading airborne infectious diseases. For some highly controlled infectious diseases, such as measles in post-elimination settings, the healthcare environment might act as a reservoir of infectious agents while agent circulation is extremely low in the general population [ 6 , 15 , 16 ]. A prolonged high-intensity exposure to an acute case in a medical setting is thought to play an important role in the occurrence of measles in vaccinated individuals [ 8 , 12 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

López-Perea

Fernández-García

Echevarrı́a

et al. 2021

Viruses

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The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.

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Section: Discussionmentioning

confidence: 99%

“…A high intensity of exposure is known to play a role in the occurrence of measles breakthrough cases, mainly in previously vaccinated individuals [ 12 , 13 ]. Measles among vaccinated healthcare workers has been central in many outbreaks declared in healthcare settings in the post elimination era [ 6 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

López-Perea

Fernández-García

Echevarrı́a

et al. 2021

Viruses

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Guarding the gatekeepers: a comprehensive approach to control nosocomial measles

Limavady,

Tu,

Bedford

2024

Infection

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Purpose Despite substantial vaccination progress, persistent measles outbreaks challenge global elimination efforts, particularly within healthcare settings. In this paper, we critically review the factors contributing to measles outbreak and effective control measures for nosocomial transmission of measles. Methods We systematically searched electronic databases for articles up to 17th May, 2023. This was performed by two independent reviewers, with any disagreements resolved by a third reviewer. We also searched governmental and international health agencies for relevant studies. Results Forty relevant articles were systematically reviewed, revealing key factors fuelling measles outbreak in healthcare settings, including high transmissibility capability; high intensity exposure; delayed care; failure to use protective equipment and implement control measures; vaccine failure; unclear immunisation history and lack of registries; and lacking recommendation on healthcare workers’ (HCWs) measles vaccination. To combat these challenges, successful control strategies were identified which include early notification of outbreak and contact tracing; triaging all cases and setting up dedicated isolation unit; strengthening protective equipment use and physical measures; improving case detection; determining immunity status of HCWs; establishing policy for measles vaccination for HCWs; management of exposed personnel; and developing a pre-incident response plan. Conclusion A coordinated and comprehensive approach is essential to promptly identify and manage measles cases within healthcare settings, necessitating multifactorial strategies tailored to individual settings. These findings provide a valuable foundation for refining strategies to achieve and maintain measles elimination status in healthcare environments.

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Measles outbreak related to healthcare transmission

Cited by 2 publications

References 22 publications

Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

Guarding the gatekeepers: a comprehensive approach to control nosocomial measles

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