Transmission of measles among healthcare Workers in Hospital W, Xinjiang Autonomous Region, China, 2016

Abstract

BackgroundAs China approaches the elimination of measles, outbreaks of measles continue to occur. Healthcare workers (HCWs) are known to be at high risk of infection and transmission of measles virus. A measles outbreak occurred in a hospital in Xinjiang Uighur Autonomous Region of the People’s Republic of China. We report an investigation of this outbreak and its implications for measles elimination and outbreak preparedness.MethodsWe conducted a retrospective search for measles cases using hospital records. Information on cases was collected by interview, and was used to determine epidemiological linkages. We surveyed HCWs to determine their demographic characteristics, disease history and vaccination status, and knowledge about measles.ResultsWe identified 19 cases, ages 18 to 45 years, in Hospital W between December 2015 and January 2016; 14 were laboratory-confirmed, and 5 were epidemiologically linked. The primary case was a 25-year-old neurology department nurse who developed a rash on 22 December 2015 that was reported on 11 January 2016. She continued working and living with her workmates in a dormitory during her measles transmission period. Among the 19 infected HCWs, 2 had received a dose of measles-containing vaccine (MCV) before the outbreak, and 16 had unknown vaccination status. Outbreak response immunization activities were started on 8 January in a non-selective manner by offering vaccine regardless of vaccination history; 605(68%) of 890 HCWs were vaccinated. The HCW survey had a 73% response rate (646/890); 41% of HCWs reported that they had received MCV before outbreak, and 56% exhibited good knowledge of measles symptoms, transmission, complications, and vaccination.ConclusionsLow MCV coverage, low measles knowledge among HCWs, delayed reporting of measles cases, and absence of proper case management were associated with this outbreak. Training and vaccinating HCWs against measles are essential activities to prevent measles virus transmission among HCWs.

Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era

“…This feature has also been documented in other outbreaks [9,15]. The high frequency of cases among vaccinated people, likely due to waning vaccine-derived immunity [15] in a situation where natural boosting is taking place to a very limited extent, points towards the need to further investigate this issue to recommend new approaches.…”

“…Several efforts have been made globally to eliminate measles [6][7][8], a highly contagious viral communicable disease that has the potential to infect 75-90% susceptible contacts [9] and is spread by airborne transmission [10].…”

“…Vaccination or acquired immunity after illness are considered reliable protections against the disease [9]. Portugal is a country with a high level of reported vaccination coverage for MMR vaccine [12] and in 2017, MMR vaccine coverage at the age of 5 years was 96% [13].…”

“…According to the National Plan for Measles Elimination [14], HCW are highly recommended to receive two doses of MMR vaccine or documented evidence of measles infection, considering they are at a higher risk of exposure to the virus. Nevertheless, we are seeing outbreaks occurring that encompass healthcare settings [9,15]. The frequency of cases among HCW directs attention to the need of considering interventions to ensure this group is well protected, including vaccination and infection control and prevention measures.…”

<p>Healthcare Workers’ Preparedness: An Exploratory Study for Measles Control in a Middle-Income Country</p>

“…3 Recently, outbreak events were reported, in Egypt and worldwide, characterized by the nosocomial transmission of measles with subsequent infection of HCWs. 4,5 World Health Organization (WHO) defined measles elimination as the absence of endemic measles transmission in a defined geographical area for at least 12 months. Meanwhile, eradication is defined as the worldwide interruption of measles virus transmission in the presence of a surveillance system that has been verified to be performing well.…”