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CDC: measles outbreak is a wake-up call for clinicians.


A 2009 measles outbreak linked to an unvaccinated child who was treated in the emergency department of a hospital in southwestern Pennsylvania highlights both the potential for measles transmission in healthcare settings and the need for clinicians to include the disease in differential diagnoses of patients with fever and rash.

Hospitals should document employees' immunity and be otherwise prepared to limit outbreaks, according to a report released last month by the Centers for Disease Control and Prevention in Morbidity and Mortality Weekly Report.

In March of 2009, a physician report to the Pennsylvania Department of Health of a measles case involving an unvaccinated child--followed within 5 days by reports of four additional reported cases, including three unvaccinated children and one physician, who had been in the same community hospital ED on the same day earlier in the month--led to an electronic medical record review to identify the source patient.

The source was also a child (the brother of the initially diagnosed patient) who had recently arrived in the United States with his family from India, and who had been treated previously in the ED for a rash diagnosed as viral exanthema and released, the CDC reported (MMWR 2012;61:30-2).

The discovery led to an extensive and expensive regional search and investigation of the approximately 4,000 individuals who had been in contact with all six of the patients during the incubation period. A review of employee health records to identify exposed personnel without serologic evidence of measles immunity was also conducted.

The investigation did not identify any additional measles cases, but did identify 72 of 168 potentially exposed employees with no documented measles immunity who were then required to undergo serologic testing and, if necessary, vaccination, according to the report. Testing found that eight did not have measles IgG antibodies, and of those, five were furloughed for 18 days after exposure.

Of note, the authors wrote in an editorial note, "of the six cases, only the index patient initially was suspected of having measles; therefore, he was the only patient for whom isolation precautions were taken," despite 2007 guidelines issued by the Hospital Infection Control Practices Advisory Committee (HICPAC) recommending precautions against airborne transmission for any patient who has a maculopapular rash accompanied by cough, coryza, and fever. The failure to readily identify potential measles cases may be attributable to U.S. clinicians' limited experience with the contagious disease--itself an unintended consequence of the high U.S. vaccination coverage levels and the efficacy of the measles-mumps-rubella vaccine, they wrote.

In addition to the public health implications, health care-associated measles outbreaks pose a substantial burden on public health resources and healthcare facilities, in terms of the time and cost of extensive record reviews, contact tracing, and requisite communications, the authors wrote.

Healthcare facilities also "should ensure that their employees are fully vaccinated from measles or have laboratory evidence of immunity," the authors stressed.

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Author:Mahoney, Diana
Publication:Family Practice News
Date:Feb 1, 2012
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