Journal of Hospital Infection 86 (2014) 144e146 Available online at www.sciencedirect.com
Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin
Short report
Consequences of incomplete measles vaccine uptake in healthcare workers during an outbreak in North East England P. Bogowicz a, b, J. Waller a, D. Wilson a, K. Foster a, * a b
North East Health Protection Team, Public Health England Centre North East, Newcastle upon Tyne, UK Newcastle University, Newcastle upon Tyne, UK
A R T I C L E
I N F O
Article history: Received 1 August 2013 Accepted 4 December 2013 Available online 20 December 2013 Keywords: Healthcare workers Immunization Measles
S U M M A R Y
Two cases of measles-infected healthcare workers are described, plus the case of a third who was excluded from work for an extended period of time due to non-immunity, during an outbreak in North East England. There is clearly a need for further effort to ensure that healthcare workers are protected against measles. Vaccine uptake may be increased by establishing a one-off measles immunization programme in conjunction with systematic pre-employment screening. Such programmes could be strengthened through incentivized or mandatory vaccination. Staff and policymakers at all levels should work together to prevent hospital-acquired measles infection. Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved.
Introduction Measles is one of the most infectious communicable diseases known.1 Between September 2012 and July 2013, an outbreak of measles occurred in North East England, with a total of 416 laboratory-confirmed cases. Smaller outbreaks occurred in this region in 2006 and 2009. The total number of confirmed measles cases in the North East has always been relatively low, compared with other areas in England (Figure 1). There has been poor recognition of measles in a variety of healthcare settings during the current outbreak, which is understandable given the historical paucity of cases. In addition, a concurrent rise in the number of scarlet fever notifications has complicated the diagnostic process. It is recognized that healthcare settings play an important role in the spread of measles.2 One study found that 3.3% of healthcare workers at a hospital in England were not immune * Corresponding author. Address: North East Health Protection Team, Public Health England Centre North East, Floor 2, Citygate, Gallowgate, Newcastle upon Tyne NE1 4WH, UK. Tel.: þ44 844 225 3550. E-mail address: [email protected] (K. Foster).
to measles.3 A survey of healthcare providers in South East England found that two organizations of 11 considered did not have pre-employment screening for measles immunity.4 Healthcare organizations in England and Wales are advised to provide occupational health services, protecting healthcare workers from vaccine-preventable diseases.5 Guidance was issued from the Director of Immunisation at the Department of Health in 2008 advising healthcare workers to be specifically immunized against measles if not immune. Similar guidance was issued by the health protection team to all hospitals in the North East in 2006, 2008, and 2012, in light of regional outbreaks. Hospitals have a duty to respond to such advice. This article describes three cases involving measles nonimmune healthcare workers and highlights key lessons from their management.
Case details Case 1 A 33-year-old general practitioner (GP), unaware of his own measles immune status, developed a fever about 9 days after
0195-6701/$ e see front matter Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved. http://dx.doi.org/10.1016/j.jhin.2013.12.002
P. Bogowicz et al. / Journal of Hospital Infection 86 (2014) 144e146
145
2500
Number of cases
2000
1500
1000
500
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year North East
North West
Yorkshire & Humberside
East Midlands
West Midlands
East of England
London
South East
South West
Figure 1. Laboratory-confirmed measles cases in England, by region, 2000e2012.
visiting a patient at home. The patient, an unimmunized 14-year-old, had had prodromal symptoms for 3e4 days and a maculopapular rash for 1e2 days prior to the home visit. The GP diagnosed scarlet fever and prescribed antibiotics. The case was reported to the health protection unit 2 days later by an emergency department physician and was later confirmed as measles infection by oral fluid testing. While infectious, the GP had worked three shifts at his regular practice and two shifts at two acute care clinics over 5 days. Contacts at the GP’s regular practice were managed in line with national public health guidance. Nineteen patients who had been seen by the GP were identified as being either susceptible (healthy with no prior history of measles infection or vaccination) or vulnerable (immunocompromised, susceptible and pregnant, or aged
Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin
Short report
Consequences of incomplete measles vaccine uptake in healthcare workers during an outbreak in North East England P. Bogowicz a, b, J. Waller a, D. Wilson a, K. Foster a, * a b
North East Health Protection Team, Public Health England Centre North East, Newcastle upon Tyne, UK Newcastle University, Newcastle upon Tyne, UK
A R T I C L E
I N F O
Article history: Received 1 August 2013 Accepted 4 December 2013 Available online 20 December 2013 Keywords: Healthcare workers Immunization Measles
S U M M A R Y
Two cases of measles-infected healthcare workers are described, plus the case of a third who was excluded from work for an extended period of time due to non-immunity, during an outbreak in North East England. There is clearly a need for further effort to ensure that healthcare workers are protected against measles. Vaccine uptake may be increased by establishing a one-off measles immunization programme in conjunction with systematic pre-employment screening. Such programmes could be strengthened through incentivized or mandatory vaccination. Staff and policymakers at all levels should work together to prevent hospital-acquired measles infection. Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved.
Introduction Measles is one of the most infectious communicable diseases known.1 Between September 2012 and July 2013, an outbreak of measles occurred in North East England, with a total of 416 laboratory-confirmed cases. Smaller outbreaks occurred in this region in 2006 and 2009. The total number of confirmed measles cases in the North East has always been relatively low, compared with other areas in England (Figure 1). There has been poor recognition of measles in a variety of healthcare settings during the current outbreak, which is understandable given the historical paucity of cases. In addition, a concurrent rise in the number of scarlet fever notifications has complicated the diagnostic process. It is recognized that healthcare settings play an important role in the spread of measles.2 One study found that 3.3% of healthcare workers at a hospital in England were not immune * Corresponding author. Address: North East Health Protection Team, Public Health England Centre North East, Floor 2, Citygate, Gallowgate, Newcastle upon Tyne NE1 4WH, UK. Tel.: þ44 844 225 3550. E-mail address: [email protected] (K. Foster).
to measles.3 A survey of healthcare providers in South East England found that two organizations of 11 considered did not have pre-employment screening for measles immunity.4 Healthcare organizations in England and Wales are advised to provide occupational health services, protecting healthcare workers from vaccine-preventable diseases.5 Guidance was issued from the Director of Immunisation at the Department of Health in 2008 advising healthcare workers to be specifically immunized against measles if not immune. Similar guidance was issued by the health protection team to all hospitals in the North East in 2006, 2008, and 2012, in light of regional outbreaks. Hospitals have a duty to respond to such advice. This article describes three cases involving measles nonimmune healthcare workers and highlights key lessons from their management.
Case details Case 1 A 33-year-old general practitioner (GP), unaware of his own measles immune status, developed a fever about 9 days after
0195-6701/$ e see front matter Crown Copyright ª 2014 Published by Elsevier Ltd on behalf of the Healthcare Infection Society. All rights reserved. http://dx.doi.org/10.1016/j.jhin.2013.12.002
P. Bogowicz et al. / Journal of Hospital Infection 86 (2014) 144e146
145
2500
Number of cases
2000
1500
1000
500
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year North East
North West
Yorkshire & Humberside
East Midlands
West Midlands
East of England
London
South East
South West
Figure 1. Laboratory-confirmed measles cases in England, by region, 2000e2012.
visiting a patient at home. The patient, an unimmunized 14-year-old, had had prodromal symptoms for 3e4 days and a maculopapular rash for 1e2 days prior to the home visit. The GP diagnosed scarlet fever and prescribed antibiotics. The case was reported to the health protection unit 2 days later by an emergency department physician and was later confirmed as measles infection by oral fluid testing. While infectious, the GP had worked three shifts at his regular practice and two shifts at two acute care clinics over 5 days. Contacts at the GP’s regular practice were managed in line with national public health guidance. Nineteen patients who had been seen by the GP were identified as being either susceptible (healthy with no prior history of measles infection or vaccination) or vulnerable (immunocompromised, susceptible and pregnant, or aged
