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Limavady A, Tu IT, Bedford H. Guarding the gatekeepers: a comprehensive approach to control nosocomial measles. Infection 2024; 52:1195-1206. [PMID: 38353874 PMCID: PMC11289298 DOI: 10.1007/s15010-024-02186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/12/2024] [Indexed: 08/02/2024]
Abstract
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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Affiliation(s)
- Andrew Limavady
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - I-Ting Tu
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Helen Bedford
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK.
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2
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Gaviola GC, Desai S. Immunization requirements in medical school accreditation standards. Vaccine 2024; 42:753-756. [PMID: 37127525 DOI: 10.1016/j.vaccine.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
Healthcare workers (HCW) are at risk of contracting vaccine-preventable diseases and spreading these infections to their patients. Vaccination against preventable diseases prior to clinical training can mitigate this risk. Accreditation guidance can be used as an opportunity to enforce desirable norms and standards. Standards from 144 national accreditation organizations spanning 123 member states listed in the Directory of Organizations that Recognize/Accredit Medical Schools by the Foundation for Advancement of International Medical Education and Research were reviewed and summarized. Findings were further stratified by World Bank income group and WHO region. While higher-income countries were more likely to have accreditation guidelines available than lower- or middle-income countries, few national medical school accreditation bodies specifically request immunization status of trainees as a standard. Further, almost none mention specific antigens for which immunity should be assessed. These findings should be used by medical school and other health professional training accreditation bodies to inform future policy direction to protect trainees as future HCW.
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Affiliation(s)
- G C Gaviola
- Division of Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, United States
| | - S Desai
- Immunization, Vaccines and Biologicals, World Health Organization, Switzerland.
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3
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Santoro PE, Paladini A, Borrelli I, Amantea C, Rossi MF, Fortunato C, Gualano MR, Marchetti A, Cadeddu C, Moscato U. Vaccine-preventable diseases: Immune response in a large population of healthcare students. Vaccine 2024; 42:930-936. [PMID: 38246845 DOI: 10.1016/j.vaccine.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Students in medicine and other health professions are exposed to numerous occupational hazards, primarily biological hazards, during their academic careers at university. The aim of the present study was to investigate the seroprevalence characteristics of anti-HBsAg, anti-Measles, anti-Mumps, anti-Rubella and anti-Varicella IgG antibodies in healthcare students of a large teaching hospital in Rome. METHODS To accomplish the study's aims, antibody serology data were gathered from students of Medicine and Surgery, Dentistry, and Health Professions at the Catholic University of the Sacred Heart (Rome Campus) during their first Health Surveillance visit, that took place from 2013 to 2023. RESULTS Our study sample included 2523 students, 44.4 % were protected against Hepatitis B, 87.3 % against measles, 85.5 % against mumps, 94.6 % rubella and 95.2 % against varicella. Differences in antibody coverage between age groups were statistically significant (p < 0.001), except for mumps. It found a lower probability of having seronegative anti-HBVs with an older date since the presumed primary vaccination. CONCLUSION In our sample, seropositivity rate against vaccine-preventable diseases, especially for Hepatitis B, was often inadequate to prevent possible biological risks connected with the activities carried out on the ward.
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Affiliation(s)
- Paolo Emilio Santoro
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Paladini
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Ivan Borrelli
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Carlotta Amantea
- Section of Occupational Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
| | - Maria Francesca Rossi
- Section of Occupational Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Corinna Fortunato
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Rosaria Gualano
- Saint Camillus International University of Health Sciences, UniCamillus, Rome, Italy
| | - Antonio Marchetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Chiara Cadeddu
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Umberto Moscato
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy; Section of Occupational Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
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Castiñeiras ACP, Sales AC, Picone CDM, Diogo CL, Rossi ÁD, Galliez RM, Ferreira ODC, Castiñeiras TMPP, Lopes MH, Sartori AMC. The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis. Rev Inst Med Trop Sao Paulo 2024; 66:e4. [PMID: 38198377 PMCID: PMC10768653 DOI: 10.1590/s1678-9946202466004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 01/12/2024] Open
Abstract
The global reemergence of measles in 2018-2019 reinforces the relevance of high-coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun®) and chemiluminescence (LIASON®). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.
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Affiliation(s)
- Anna Carla Pinto Castiñeiras
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amanda Caroline Sales
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Camila de Melo Picone
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
| | - Constância Lima Diogo
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Átila Duque Rossi
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Mello Galliez
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Orlando da Costa Ferreira
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Terezinha Marta Pereira Pinto Castiñeiras
- Universidade Federal do Rio de Janeiro, Núcleo de Enfrentamento e Estudos de Doenças Infecciosas e Emergentes e Reemergentes, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marta Heloísa Lopes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Centro de Referência para Imunobiológicos Especiais, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
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Chen J, Zhang W, Wang Y, Yang W. Determinants of measles persistence in Beijing, China: A modelling study. Epidemiol Infect 2023; 151:e144. [PMID: 37605994 PMCID: PMC10540187 DOI: 10.1017/s0950268823001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/10/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
In Beijing, the capital of China, routine measles mass vaccination has been in place for decades with high coverage; and since the 2000s, catch-up vaccination programmes have been implemented for migrant workers coming to the city. However, measles epidemics in Beijing persisted. Here, we explored the contributing factors of persistent measles transmission in Beijing using an epidemic model in conjunction with a particle filter. Model inputs included data on birth, death, migration, and vaccination. We formulated a series of hypotheses covering the impact of migrant influx, early waning of maternal immunity, and increased mixing among infants; we compared the plausibility of the hypotheses based on model fit to age-grouped, weekly measles incidence data from January 2005 to December 2014, and out-of-fit prediction during 2015-2019. Our best models showed close agreement with the data, and the out-of-fit prediction generally captured the trend of measles incidence from 2015 to 2019. We found that large influx of migrants with considerably higher susceptibility likely contributed to the persistent measles transmission in Beijing. Our findings suggest that stronger catch-up vaccination programmes for migrants may help eliminate measles transmission in Beijing.
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Affiliation(s)
- Jianjiu Chen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Yong Wang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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6
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Wang XY, Zhang XJ, Xia X, Chang SZ, Wu AZ. Epidemiological and Clinical Characteristics of Measles in Jinan, Shandong Province, China, from 1991 to 2022. Int J Gen Med 2023; 16:2305-2312. [PMID: 37304905 PMCID: PMC10257416 DOI: 10.2147/ijgm.s407121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study aimed to analyze the epidemiological and clinical characteristics of measles in Jinan, Shandong, China, over a 32-year stage to facilitate measles prevention in the future. Methods Data on measles cases from 1991 to 2022 were obtained from the public health department and medical records of patients at Shandong Public Health Clinical Center. Retrospective analysis was conducted on the distribution of measles cases in different years, months, and age groups, and observation of the differences in clinical manifestations and complications among different age groups. Results From January 1991 to December 2022, 7531 measles cases were recorded at Shandong Public Health Clinical Center. During the 32-year period, there were two outbreaks of measles in 2008 and 2016, respectively. During the COVID-19 pandemic period from 2020 to 2022, the number of cases reached the lowest point in the past 30 years. The number and percentage of cases in the 0-1y groups was significantly higher than in other age groups, and 97.75% patients in this group did not receive measles vaccine. Complications such as pneumonia and myocarditis appeared more frequent in patients under 12 years of age, but liver function damage is more common in adult patients. Conclusion Although the measles epidemic has been greatly controlled since the use of measles vaccine, intermittent outbreaks still exist, so there is still a long way to go to eliminate measles. The proportion of infants under the age of 1 without measles vaccine and adults over 24 years old accounts for nearly 80% of the total. This group of people should be of concern, and feasible measures should be designated to protect these susceptible populations.
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Affiliation(s)
- Xiao-Yan Wang
- Infectious Diseases Department II, Shandong Public Health Clinical Center, Jinan, 250000, People’s Republic of China
| | - Xiao-Jing Zhang
- Public Health Department, Shandong Public Health Clinical Center, Jinan, 250000, People’s Republic of China
| | - Xiao Xia
- Medical Insurance Office, Shandong Public Health Clinical Center, Jinan, 250000, People’s Republic of China
| | - Shu-Zhen Chang
- TCM & Western Medicine Department, Shandong Public Health Clinical Center, Jinan, 250000, People’s Republic of China
| | - An-Zhao Wu
- TCM & Western Medicine Department, Shandong Public Health Clinical Center, Jinan, 250000, People’s Republic of China
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7
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Seroprevalence of Varicella-Zoster Virus and Measles among Healthcare Workers in a Tertiary Medical Center in Korea. Vaccines (Basel) 2022; 10:vaccines10111956. [PMID: 36423051 PMCID: PMC9697537 DOI: 10.3390/vaccines10111956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Measles and varicella still occur in the general population despite the widespread vaccination against them, and healthcare workers (HCWs) are still at risk of exposure to these diseases. Here, we evaluated the seroprevalence of measles and varicella-zoster virus (VZV) in HCWs and the trend of seroprevalence according to age, birth year, and occupational group. The serostatuses of measles and VZV of HCWs during new employee medical examinations between October 2015 and October 2021 were included. Thereafter, the trends of seroprevalence according to age, birth year, and occupational groups were evaluated. Overall, 2070 and 1827 HCWs were evaluated for VZV and measles serostatus, respectively. The seroprevalences of VZV and measles were 91% (1884/2070) and 70% (1284/1827), respectively. Younger HCWs had a significantly lower seroprevalence of measles (p = 0.02, age) and VZV (p = 0.003, birth year and p < 0.001, age). The seroprevalence of measles and VZV was significantly higher among doctors and nursing assistants than among nurses and other HCWs (p < 0.001 in both). In conclusion, the seroprevalence of measles and VZV significantly decreased in younger HCWs. Additionally, monitoring the serostatus of measles and VZV and the immunization of susceptible HCWs are required to prepare and control infectious diseases in healthcare facilities.
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8
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Jang B, Kim HW, Kim HS, Park JY, Seo H, Kim YK. Measles Virus Neutralizing Antibody Response and Durability Two Years after One or Two Doses of Measles-Mumps-Rubella Vaccine among Young Seronegative Healthcare Workers. Vaccines (Basel) 2022; 10:vaccines10111812. [PMID: 36366321 PMCID: PMC9698570 DOI: 10.3390/vaccines10111812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022] Open
Abstract
Although there have been several studies regarding the immunogenicity of one or two booster doses of the measles−mumps−rubella (MMR) vaccine in measles-seronegative young adults, limited data are available about how long the immune response is sustained compared with natural infection. This study included seronegative healthcare workers (HCWs) (aged 21−38 years) who received one or two doses of the measles−mumps−rubella (MMR) vaccine and HCWs with laboratory-confirmed measles infection during an outbreak in 2019. We compared neutralizing antibody titers measured using the plaque reduction neutralization (PRN) test and measles-specific immunoglobulin G (IgG) using chemiluminescent immunoassays 2 years after vaccination or infection. Among 107 HCWs with seronegative measles IgGs, the overall seroconversion rate of measles IgGs remained 82.2% (88/107), and 45.8% (49/107) of the participants had a medium (121−900) or high (>900) PRN titer after 2 years from one or two booster doses. The measles-neutralizing antibody titers of both PRN titer (ND50) and geometric mean concentration 2 years after natural infection were significantly higher than those of one or two booster doses of the MMR vaccine (p < 0.001 and p < 0.001, respectively). Our results suggest that serologic screening followed by appropriate postexposure prophylaxis can be beneficial for young HCWs without a history of natural infection especially in a measles outbreak setting, because of possible susceptibility to measles despite booster MMR vaccination 2 years ago. Long-term data about sustainable humoral immunity after one or two booster vaccination are needed based on the exact vaccination history.
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Affiliation(s)
- Byungki Jang
- Ilsong Institute of Life Science, Hallym University, Seoul 01000, Korea
| | - Han Wool Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Ji Young Park
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Hyeonji Seo
- Department of Internal Medicine, Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14100, Korea
- Correspondence: ; Tel.: +82-31-380-3724
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Liu Y, Xu B, Wang Q, Xu J, Zhang Y. A study on relationship between the incidence of measles and nosocomial exposure at measles epidemic season in Chongqing. Medicine (Baltimore) 2022; 101:e31109. [PMID: 36281197 PMCID: PMC9592507 DOI: 10.1097/md.0000000000031109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
After measles vaccine supplementary immunization, the epidemiological characteristics of measles have changed in Chongqing, China. In addition, according to data from the National Measles Surveillance Information System, the proportion of measles cases with a history of hospital visit 7 to 21 days prior to onset of measles increased year by year to 32.1% in 2016. Further studies are necessary to eliminate the influence of nosocomial exposure on measles. We performed a case-control study in seven districts of Chongqing from June to August 2016 to identify risk factors for measles virus infection and susceptibility. Laboratory-confirmed measles who younger than 5 years old were matched with one control by age and residence. We interviewed case patients and controls regarding potential risk factors for measles virus infection and susceptibility. Unadjusted and adjusted matched odds ratios and 95% confidence intervals (CIs) were calculated using non-conditional logistic regression. After a cross-sectional analysis of the behavioral characteristics of visiting hospitals in the case and control groups, it was found that there was a difference between the two groups in the choice of hospitals visited for the first time (χ2 = 35.500, P = .000), and that nosocomial transmission risk tended to develop in outpatient services of respiratory medicine. After analysis using one-way ANOVA, the relationship between hospital visits prior to onset and the incidence risk of measles was that visiting hospitals five times within 1 to 3 weeks prior to onset affected the incidence (OR = 44.866, 95%CI = 5.938-338.981). The relationship between the number of types of hospitals visited prior to onset and the risk of nosocomial exposure to measles showed that visiting any community hospital, children's hospital, or general hospital had no risk, but visiting two or more of these hospitals affected the incidence (OR = 6.928, 95%CI = 3.849-13.754). Based on further analysis, the relationship between the number of hospital visits after onset and the risk of nosocomial exposure to measles was that the chances of visiting hospitals increased after onset. Risks of nosocomial exposure to measles and infections are high in pediatric hospitals. Nosocomial exposure risk factors should be considered when controlling measles.
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Affiliation(s)
- Yang Liu
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Binyue Xu
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Qing Wang
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Jiawei Xu
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Yuanyuan Zhang
- Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing, China
- *Correspondence: Yuanyuan Zhang, Expanded Program on Immunization, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China (e-mail: )
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10
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Bianchi FP, Stefanizzi P, De Maria L, Martinelli A, Diella G, Larocca AMV, Vimercati L, Tafuri S. Vaccination Offer during the Occupational Health Surveillance Program for Healthcare Workers and Suitability to Work: An Italian Retrospective Cohort Study. Vaccines (Basel) 2022; 10:vaccines10101633. [PMID: 36298499 PMCID: PMC9610769 DOI: 10.3390/vaccines10101633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
The active immunization of health care workers (HCWs) is a crucial measure to avoid nosocomial infection; nevertheless, vaccine coverage (VC) among health personnel in Italy is unsatisfactory. To improve VC in the healthcare set, the Hygiene and Occupational Medicine departments of Bari Policlinico General University Hospital applied a specific program. The operative procedure demands that in the context of the occupational medical examination, all workers are evaluated for susceptibility to vaccine-preventable diseases (VDPs), with immunization prophylaxis offered to those determined to be susceptible. This study analyzed data from workers who attended the biological risk assessment protocol from December 2017 to October 2021 (n = 1477), who were evaluated for the immune status for measles, mumps, rubella, and varicella. Among the enrolled subjects, non-protective antibody titers were higher for measles and mumps (13%), followed by rubella (11%) and varicella (8%). Appropriate vaccinations were offered to all susceptible HCWs, and HCWs were re-tested one month after immunization. The seroconversion rate after the administration of one or more booster dose(s) was over 80%. Overall, 2.5% of the subjects refused the offered vaccine(s); the main determinant of immunization compliance was younger age (aOR = 0.86; 95%CI = 0.80–0.92). Especially during the COVID-19 pandemic, VPDs may still present a hazard in nosocomial environment. Our experience suggests that, despite hospital procedures and dedicated human assets, satisfactory VC cannot be reached without the provision of federal regulations. Nevertheless, public health policymakers have to improve the promotion of vaccine prophylaxis and education to reach higher VC.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | - Andrea Martinelli
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | - Giusy Diella
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | | | - Luigi Vimercati
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-80-5478473; Fax: +39-80-5478472
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La Torre G, Marte M, Imeshtari V, Colaprico C, Ricci E, Shaholli D, Barletta VI, Serruto P, Gaeta A, Antonelli G. Susceptibility towards Chickenpox, Measles and Rubella among Healthcare Workers at a Teaching Hospital in Rome. Vaccines (Basel) 2022; 10:vaccines10101573. [PMID: 36298438 PMCID: PMC9612096 DOI: 10.3390/vaccines10101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022] Open
Abstract
Immunization is the best protection against chickenpox, measles and rubella. It is important to identify and immunize susceptible healthcare workers to prevent and control hospital infections. Our aim was to estimate the susceptibility level of healthcare workers at a Teaching Hospital in Rome concerning these diseases and the factors associated to the susceptibility. Methods: a cross sectional study was carried out at the Department of Occupational Medicine of the Umberto I General Hospital of Rome. Participants were recruited during routine occupational health surveillance. As far as inclusion criteria, the following professionals were considered: doctors, nurses, laboratory technicians and other health professionals. Concerning the exclusion criteria, patients with HIV, cancer and diseases of the immune system, and acute illness or fever more than 38.5 °C, were not included in the study. A blood sample was tested for the presence of antibodies against measles, rubella and chicken pox. Results: 1106 healthcare professionals were involved in the study (41.8% nurses, 30.4% doctors, 12.3% laboratory technicians, 15.1% other health professionals): 25 (2.3%), 73 (6.6%) and 35 (3.2%) of these were susceptible to measles, rubella and chicken pox, respectively. The only variable associated with susceptibility of measles was age (p < 0.001). Furthermore, there was evidence of an association between various susceptibilities, particularly between measles and chickenpox (OR: 4.38). Conclusion: this study showed that even if the majority of our healthcare professionals are immunized for MRV, it is necessary not to underestimate the seronegativity of non-immune ones. All health professionals should be vaccinated to ensure safety for patients, especially the weakest.
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Affiliation(s)
- Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Mattia Marte
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Valentin Imeshtari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Corrado Colaprico
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Eleonora Ricci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - David Shaholli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Vanessa India Barletta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Pasquale Serruto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Laboratory of Virology, Sapienza University of Rome, 00185 Rome, Italy
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12
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Song K, Lee JM, Lee EJ, Lee BR, Choi JY, Yun J, Lee SN, Jang MY, Kim HW, Kim HS, Moon SM, Kim YK. Control of a nosocomial measles outbreak among previously vaccinated adults in a population with high vaccine coverage: Korea, 2019. Eur J Clin Microbiol Infect Dis 2022; 41:455-466. [PMID: 34999974 DOI: 10.1007/s10096-021-04390-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
We describe a measles outbreak among previously vaccinated healthcare workers (HCWs) and inpatients and the control measures implemented at a tertiary care hospital in 2019. Case-patients were laboratory-confirmed measles with throat swabs tested by quantitative polymerase chain reactions (PCR), during April-May 2019. Medical histories and documented immunization records were obtained. We compared attack rates (ARs) among HCWs by occupational subgroup and age and examined the outbreak-associated costs. The index case was not ascertained. Among 26 measles case-patients (22 HCWs, four inpatients) aged 18-28 years, 25 had previously received measles-mumps-rubella (MMR) vaccine (12/26, 46% (two doses); 13/26, 50% (one dose)), and 16 (62%) had positive results of measles IgG prior to measles diagnosis. ARs were higher among HCWs aged < 30 years (1.88%), especially in the subgroup under 25 years of age (2.22%). Control measures included work restrictions for seronegative HCWs (218/2320, 9.4%) in immunity verification, administration of the MMR vaccine (207 HCWs) or intravenous immunoglobulin (2 HCWs and 11 inpatients), enhanced health surveillance of HCWs, and mandatory assessment of patients with measles-like symptoms at the infectious diseases screening units. The hospital spent 90,417,132 Korean won (US $79,733) in response to the outbreak. Measles outbreaks can occur in healthcare settings despite high population immunity, highlighting the importance of stronger vaccination policies, particularly among young HCWs. Moreover, an effective outbreak response comprising immunization activities and enhanced surveillance of HCWs and patients to rapidly detect measles-like symptoms at a prodromal phase is essential to control nosocomial measles outbreaks.
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Affiliation(s)
- Kyunghyun Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ju Mi Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Ju Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bo Ram Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Young Choi
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jihee Yun
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Se Na Lee
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Young Jang
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Han Wool Kim
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Han-Sung Kim
- Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.,Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea. .,Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, Korea. .,Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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13
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Klompas M, Milton DK, Rhee C, Baker MA, Leekha S. Current Insights Into Respiratory Virus Transmission and Potential Implications for Infection Control Programs : A Narrative Review. Ann Intern Med 2021; 174:1710-1718. [PMID: 34748374 DOI: 10.7326/m21-2780] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Policies to prevent respiratory virus transmission in health care settings have traditionally divided organisms into Droplet versus Airborne categories. Droplet organisms (for example, influenza) are said to be transmitted via large respiratory secretions that rapidly fall to the ground within 1 to 2 meters and are adequately blocked by surgical masks. Airborne pathogens (for example, measles), by contrast, are transmitted by aerosols that are small enough and light enough to carry beyond 2 meters and to penetrate the gaps between masks and faces; health care workers are advised to wear N95 respirators and to place these patients in negative-pressure rooms. Respirators and negative-pressure rooms are also recommended when caring for patients with influenza or SARS-CoV-2 who are undergoing "aerosol-generating procedures," such as intubation. An increasing body of evidence, however, questions this framework. People routinely emit respiratory particles in a range of sizes, but most are aerosols, and most procedures do not generate meaningfully more aerosols than ordinary breathing, and far fewer than coughing, exercise, or labored breathing. Most transmission nonetheless occurs at close range because virus-laden aerosols are most concentrated at the source; they then diffuse and dilute with distance, making long-distance transmission rare in well-ventilated spaces. The primary risk factors for nosocomial transmission are community incidence rates, viral load, symptoms, proximity, duration of exposure, and poor ventilation. Failure to appreciate these factors may lead to underappreciation of some risks (for example, overestimation of the protection provided by medical masks, insufficient attention to ventilation) or misallocation of limited resources (for example, reserving N95 respirators and negative-pressure rooms only for aerosol-generating procedures or requiring negative-pressure rooms for all patients with SARS-CoV-2 infection regardless of stage of illness). Enhanced understanding of the factors governing respiratory pathogen transmission may inform the development of more effective policies to prevent nosocomial transmission of respiratory pathogens.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland (D.K.M.)
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (S.L.)
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14
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Occupational Health Update: Evaluation and Management of Exposures and Postexposure Prophylaxis. Infect Dis Clin North Am 2021; 35:735-754. [PMID: 34362541 DOI: 10.1016/j.idc.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health care personnel (HCP) are at risk of exposure to infectious agents depending on their job duties and other factors. Risks include percutaneous exposure to blood-borne pathogens via sharp injuries (eg, human immunodeficiency virus, hepatitis B virus, hepatitis C virus); exposure by direct contact, droplet, or airborne transmission of pathogens through direct patient care (eg, pertussis, invasive meningococcus infections, tuberculosis); and through indirect contact transmission related to the contaminated health care environment (eg, Clostridioides difficile). Occupational health programs must effectively identify and respond to potential exposures and provide guidance to HCP on postexposure prophylaxis.
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15
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Lee JS, Jeong O, Yang H. Screening and Vaccination Against Measles and Varicella Among Health Care Workers: A Cost-effectiveness Analysis. Asia Pac J Public Health 2021; 33:508-515. [PMID: 34165349 DOI: 10.1177/10105395211026468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to examine the most cost-effective strategy of screening and vaccinating measles- and varicella-susceptible health care workers (HCWs). A retrospective cost-effectiveness analysis was conducted at a tertiary hospital in Korea with 300 HCWs who were at high risk of infection. Self-reported histories of vaccinations, infectious diseases, and contact with such cases were collected. Serological tests for immunoglobulin G titers of measles and varicella were performed. Data were analyzed using analysis of variance, Kruskal-Wallis test, χ2 test, and Fisher exact test. Seropositivity rates were 96.3% for measles and 95.7% for varicella. Four different strategies (cases) for vaccination were investigated. Considering the progressive decline in antibody concentrations and the false-positive responses in self-reported histories, case 3, which involved administering 2-dose vaccinations to susceptible HCWs demonstrated by antibody screening tests for both measles and varicella, was the most cost-effective strategy. Health care facilities should establish mandatory immunization policies that reduce the risk of transmission of vaccine-preventable diseases.
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Affiliation(s)
- Ji-Suk Lee
- Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyunju Yang
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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16
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Impfungen von Personal in medizinischen Einrichtungen in Deutschland: Empfehlung zur Umsetzung der gesetzlichen Regelung in § 23a Infektionsschutzgesetz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:636-642. [PMID: 33929567 PMCID: PMC8086965 DOI: 10.1007/s00103-021-03313-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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17
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Risk factors for measles deaths among children during a Nationwide measles outbreak - Romania, 2016-2018. BMC Infect Dis 2021; 21:279. [PMID: 33740895 PMCID: PMC7976682 DOI: 10.1186/s12879-021-05966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background Case fatality ratio (CFR) among all age groups during the 2016–2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles. Methods National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged < 59 months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases (“cases”) and 250 non-fatal cases (“controls”) matched by age, sex, district of residence, and urban/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors. Results Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21 day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0–24.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4–35.3]). Conclusions Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05966-3.
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18
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Stein-Zamir C, Abramson N, Sonnenfeld-Alroey H, Charnes J, Eckstein D, Dienstag A, Wolf D, Moses AE, Weiss YG. Utilization of the Public Health Ordinance to prevent nosocomial spread in a case of acute measles-associated psychosis. Isr J Health Policy Res 2021; 10:2. [PMID: 33451324 PMCID: PMC7809232 DOI: 10.1186/s13584-020-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
Measles is a highly contagious disease. A 24 years old patient, recently exposed to measles (unvaccinated), presented in the emergency department with severe agitation, compatible with an acute psychotic episode, during the measles epidemic which spread in Israel in 2018-2019. Upon hospital admission, strict isolation was instructed, yet, without compliance, probably due to the patient's status. Measles diagnosis was promptly confirmed. As measles transmission was eminent, public health measures were employed through immediate implementation of the section 15 of the Public Health Ordinance, allowing for compulsory short-term isolation. The patient's condition improved within a few days and the measures were no longer necessary. This measles case occurred in the pre-Coronavirus disease 2019 (COVID-19) epidemic when use of a Public Health Ordinance was considered an extreme measure. This is in contrast to the current global use of Public Health laws to enforce strict quarantine and isolation on persons infected or potentially exposed to COVID-19. Nevertheless, minimizing infectious diseases transmission is a core function of public health law. Utilizing legal enforcement in circumstances of immediate public health hazard, such as nosocomial measles transmission, necessitates careful consideration. The integrative clinical and public health approach and prompt measures employed in this exceptional case, led to prevention of further infection spread.
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Affiliation(s)
- Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel. .,The Hebrew University of Jerusalem, Faculty of Medicine, Braun School of Public and Community Medicine, Jerusalem, Israel.
| | - Nitza Abramson
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | | | - Jacob Charnes
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Dana Eckstein
- Department of Neurology, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Aryeh Dienstag
- Department of Psychiatry, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Dana Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Allon E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
| | - Yoram G Weiss
- Central Administration, Hadassah Hebrew University School of Medicine, Jerusalem, Israel
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19
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Coppeta L, D'Alessandro I, Pietroiusti A, Somma G, Balbi O, Iannuzzi I, Magrini A. Seroprevalence for vaccine-preventable diseases among Italian healthcare workers. Hum Vaccin Immunother 2020; 17:1342-1346. [PMID: 33017204 DOI: 10.1080/21645515.2020.1818523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Healthcare workers (HCWs) have an increased risk to be exposed to infectious diseases compared to the general population. For this reason, according to the National Immunization and Prevention Plan, all HCWs should have demonstrable evidence of immunity to measles, mumps, rubella, varicella and Hepatitis B. Earlier studies have already shown that a large percentage of Italian operators lacked immune protection for one or more of those pathogens.The aim of this study was to evaluate the immunization status for vaccine-preventable diseases of HCWs in a large Italian teaching hospital. We retrospectively evaluated clinical records and serological data of HCWs who followed the occupational health surveillance program between January 1 and December 31 2019. We reviewed the clinical records of 1,017 HCWs: 393 males and 624 females with a median age of 35.69 y (range: 19-67). Protective IgG antibody values were documented in the 88.0%, 75.7%, 90.3%, 87.4% and 85.7% of the HCWs screened, respectively, against measles, mumps, rubella, varicella and Hepatitis B. Age was significantly related to serological protection against measles, mumps and varicella but was not significantly related to protective IgG levels for rubella and HBV.Female gender was significantly related to a higher protection rate against Hepatitis B (87.8 vs 82.4%; p < .01) whereas males were significantly more protected against varicella (92-4 vs 84.1%; p < .01).Our study shows suboptimal levels of protection among Italian HCWs and a consequent increased risk of infection for them and their patients. Public health policies should be focused on improving preventive strategies, including serological screening and workplace vaccination of nonimmune individuals.
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Affiliation(s)
- Luca Coppeta
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | - Iacopo D'Alessandro
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | | | - Giuseppina Somma
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | - Ottavia Balbi
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | - Ilaria Iannuzzi
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy
| | - Andrea Magrini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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20
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Impfschutz für medizinisches Personal*. INFO HÄMATOLOGIE + ONKOLOGIE 2020. [PMCID: PMC7474325 DOI: 10.1007/s15004-020-8218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Westgeest A, de Mooij D, Eger C, Delfos N, van der Feltz M, Visser L, Groeneveld G. Measles outbreaks - potential threat for health care professionals. Infect Prev Pract 2020; 2:100074. [PMID: 34368715 PMCID: PMC8336041 DOI: 10.1016/j.infpip.2020.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/02/2020] [Indexed: 12/02/2022] Open
Abstract
The ongoing spread of measles is a major concern for public health. Optimal vaccination coverage amongst health care professionals (HCP) is essential for individual protection. This is illustrated by our two cases of measles infection in HCP during the 2018 outbreak in Europe. We developed a questionnaire to assess protection against measles amongst HCP working in acute care of a tertiary hospital in The Netherlands. In total, 29% of these professionals were not protected against measles. During current worldwide measles outbreaks, it is paramount for employee health protection, patient protection and disease control to register and optimize employees' immunity.
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Affiliation(s)
- A.C. Westgeest
- Leiden University Medical Centre, Department of Infectious Diseases, C5-P, P.O. box 9600, 2300 RC Leiden, The Netherlands
- Corresponding author. Address: Leiden University Medical Centre, Department of Infectious Diseases, C5-P, P.O. box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31715262613.
| | - D. de Mooij
- Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
| | - C.Y. Eger
- Leiden University Medical Centre, Department of Infectious Diseases, C5-P, P.O. box 9600, 2300 RC Leiden, The Netherlands
| | - N.M. Delfos
- Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
| | - M. van der Feltz
- Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
| | - L.G. Visser
- Leiden University Medical Centre, Department of Infectious Diseases, C5-P, P.O. box 9600, 2300 RC Leiden, The Netherlands
| | - G.H. Groeneveld
- Leiden University Medical Centre, Department of Infectious Diseases, C5-P, P.O. box 9600, 2300 RC Leiden, The Netherlands
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22
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Vink JP, Snell LB, Bernard K, Mitchell H, Heathcock RT, Cordery R, Newsholme W. Mapping a nosocomial outbreak of measles, coinciding with a period of sustained transmission in South London in 2018. J Hosp Infect 2020; 105:747-751. [PMID: 32544506 DOI: 10.1016/j.jhin.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
A measles outbreak in London is described, involving 34 cases across two hospitals and a local community across two countries. After a single introduction to hospital, spread propagated via unvaccinated retail shop workers to healthcare staff, highlighting the importance of expanding occupational health policies to non-clinical hospital staff. Further spread into an under-vaccinated Traveller community is a reminder that measles can spread in the absence of herd immunity. Subsequently endemic measles transmission has been re-established in the UK.
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Affiliation(s)
- J P Vink
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK.
| | - L B Snell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK
| | - K Bernard
- South London Health Protection Team, Public Health England, London, UK
| | - H Mitchell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R T Heathcock
- South London Health Protection Team, Public Health England, London, UK
| | - R Cordery
- South London Health Protection Team, Public Health England, London, UK
| | - W Newsholme
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
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23
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Biribawa C, Atuhairwe JA, Bulage L, Okethwangu DO, Kwesiga B, Ario AR, Zhu BP. Measles outbreak amplified in a pediatric ward: Lyantonde District, Uganda, August 2017. BMC Infect Dis 2020; 20:398. [PMID: 32503450 PMCID: PMC7274507 DOI: 10.1186/s12879-020-05120-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. Methods We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. Results We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7–21 days before case-patient’s onset (ORadj = 34, 95%CI: 5.1–225). Estimated vaccine effectiveness was 95% (95%CI: 75–99%) and vaccination coverage was 76% (95%CI: 68–82%). During the outbreak, an “isolation” ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. Conclusions This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.
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Affiliation(s)
| | | | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda.,Ministry of Health, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda.,Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
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Ma C, Hao L, Rodewald L, An Q, Wannemuehler KA, Su Q, An Z, Quick L, Liu Y, Yan R, Liu X, Zhang Y, Yu W, Zhang X, Wang H, Cairns L, Luo H, Gregory CJ. Risk factors for measles virus infection and susceptibility in persons aged 15 years and older in China: A multi-site case-control study, 2012–2013. Vaccine 2020; 38:3210-3217. [PMID: 32173094 PMCID: PMC10375840 DOI: 10.1016/j.vaccine.2020.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated >100 million children in 2010. An increasing proportion of infections now occur among adults and there is concern that persistent susceptibility in adults is an obstacle to measles elimination in China. We performed a case-control study in six Chinese provinces between January 2012 to June 2013 to identify risk factors for measles virus infection and susceptibility among adults. METHODS Persons ≥15 years old with laboratory-confirmed measles were age and neighborhood matched with three controls. Controls had blood specimens collected to determine their measles IgG serostatus. We interviewed case-patients and controls about potential risk factors for measles virus infection and susceptibility. Unadjusted and adjusted matched odds ratios and 95% confidence intervals (CIs) were calculated via conditional logistic regression. We calculated attributable fractions for infection for risk factors that could be interpreted as causal. RESULTS 899 cases and 2498 controls were enrolled. Among controls, 165 (6.6%) were seronegative for measles IgG indicating persistent susceptibility to infection. In multivariable analysis, hospital visit and travel outside the prefecture in the prior 1-3 weeks were significant risk factors for measles virus infection. Occupation and reluctance to accept measles vaccination were significant risk factors for measles susceptibility. The calculated attributable fraction of measles cases from hospital visitation was 28.6% (95% CI: 20.6-38.8%). CONCLUSIONS Exposure to a healthcare facility was the largest risk factor for measles virus infection in adults in China. Improved adherence to hospital infection control practices could reduce risk of ongoing measles virus transmission and increase the likelihood of achieving and sustaining measles elimination in China. The use of control groups stratified by serological status identified distinct risk factors for measles virus infection and susceptibility among adults.
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Bianchi FP, Vimercati L, Mansi F, De Nitto S, Stefanizzi P, Rizzo LA, Fragnelli GR, Cannone ESS, De Maria L, Larocca AMV, Tafuri S. Compliance with immunization and a biological risk assessment of health care workers as part of an occupational health surveillance program: The experience of a university hospital in southern Italy. Am J Infect Control 2020; 48:368-374. [PMID: 31753548 DOI: 10.1016/j.ajic.2019.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The active immunization of health care workers (HCWs) is a primary measure to prevent nosocomial infection; despite this, vaccine coverage among HCWs in most countries is low. To increase vaccine coverage in the health care setting, the hygiene and occupational medicine departments of Bari Policlinico General University-Hospital implemented a vaccination procedure. This operative procedure requires that during the occupational medical examination, all employees are evaluated for immunity/susceptibility to vaccine-preventable diseases, with vaccination offered to those determined to be susceptible. METHODS The study sample comprised HCWs who attended the biological risk assessment program from December 2017 to January 2019 (n = 449). RESULTS Susceptibility was higher for hepatitis B virus (23%), followed by rubella (11%), varicella (9%), mumps (8%), and measles (7%). The seroconversion rate after the administration of booster dose(s) was >80% for all vaccines. Overall, 15% of the HCWs refused the offered vaccine(s), and the main determinants of vaccination compliance were younger age (P < .0001) and being a physician (P < .05). DISCUSSION Despite the several recommendations and campaigns to promote vaccinations, achieving high immunization rates among HCWs is still a challenge. CONCLUSIONS In this scenario, public health institutions have to choose between the enforcement of the promotion or the adoption of a mandatory policy.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy.
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Francesca Mansi
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Sara De Nitto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Letizia Alessia Rizzo
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Grazia Rita Fragnelli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Enza Sabrina Silvana Cannone
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, Section of Occupational Medicine, Aldo Moro University of Bari, Bari, Italy
| | | | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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Park SH, Lee MS, Kim SR, Kwak YG. A Nationwide Survey on the Hospital Vaccination Policies in Korea. J Korean Med Sci 2020; 35:e76. [PMID: 32233157 PMCID: PMC7105507 DOI: 10.3346/jkms.2020.35.e76] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Healthcare personnel (HCP) are at risk of being exposed to or transmitting infections in hospitals, and vaccination against vaccine-preventable diseases (VPDs) is a well-known preventive strategy. Vaccination against influenza, hepatitis B virus, measles-mumps-rubella, varicella, and pertussis is recommended for HCP. However, there is no information on the current status of hospitals' vaccination policies for HCP in Korea. METHODS We conducted a nationwide survey on hospital vaccination policies and barriers to implementing recommended vaccination programs in 2018. The online survey questionnaire was distributed to 652 hospitals, and 200 of them responded. RESULTS Of the 200 surveyed hospitals, 151 (75.5%) conducted a pre-employment screening program for at least one VPD, and 196 (98%) had vaccination programs that included at least one vaccine. Influenza vaccine was most commonly included in their programs (97.5%, n = 195), followed by hepatitis B vaccines (69%, n = 138). However, < 25% of the hospitals included other vaccines in their policies (measles-mumps-rubella, 24.5%; varicella, 18.5%; pertussis, 11%). Only 13 hospitals (6.5%) included the five recommended vaccines for HCP in their policies. Influenza vaccination coverage had a mean of 89.9% and was significantly higher in hospitals fully funding the vaccination cost (91.8% vs. 80.4%, P < 0.001). Among hospitals funding influenza vaccines, the coverage was lower in hospitals with ≥ 700 beds (-6.5%, P = 0.003). Hospitals' financial burden was the most important barrier to implementing vaccination polices as recommended (78.6%, 121/154), followed by lack of awareness (21%) or campaign (21%) and lack of leadership (17%). CONCLUSION Despite the recommendations on vaccination for HCP, the vaccination policies for HCP differ in hospitals and appear to be insufficient to protect HCP and prevent nosocomial transmission. Strong leadership of each hospital to protect HCP and financial support from the government are required to implement appropriate vaccination policies in hospitals.
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Affiliation(s)
- Sun Hee Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Sung Ran Kim
- Infection Control Office, Korea University Guro Hospital, Seoul, Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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High number of hospitalisations and non-classical presentations: lessons learned from a measles outbreak in 2017, Belgium. Epidemiol Infect 2020; 148:e35. [PMID: 32089145 PMCID: PMC7058656 DOI: 10.1017/s0950268820000278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe and analyse an outbreak of measles that affected Belgium early 2017. In total, 289 cases were reported, mostly (53%) in people 15 years or older. For 133 (46%) vaccination status was unknown and a further 117 (41%) were not vaccinated. According to national guidelines, 83 of the unvaccinated cases (29% of total cases) should have received minimum one dose of vaccine, but did not. One in five cases (21%) did not present with the classical triad of fever, rash and any of coryza, conjunctivitis or cough. Rash was the most sensitive symptom, being absent in only six cases. A large proportion of cases (125/289, 43%) required hospitalisation. In hospitalised patients, the most commonly observed complications were hepatic disorders (present in 58/125 hospitalised patients, 46%). Thirty-six of the cases (12%) were in healthcare workers and nosocomial spread contributed importantly to the outbreak. Older age at presentation, altered clinical presentations and presence of complications like hepatitis can delay the correct diagnosis of measles. Clinicians should maintain a high index of suspicion in any individual presenting with rash. If the elimination target is to be reached, catch-up vaccination campaigns should be intensified and target young adults and health care workers.
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Kalemaki D, Karakonstantis S, Galanakis E, Lionis C. Vaccination coverage of general practitioners: a cross-sectional study from Greece. Public Health 2020; 181:110-113. [PMID: 32000009 DOI: 10.1016/j.puhe.2019.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/06/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Vaccination coverage of general practitioners (GPs) is important for their own and for their colleagues' and patients' protection and has been associated with the coverage of the general population. Our study aims to evaluate the vaccination practices of GPs in Crete, Greece. STUDY DESIGN Cross-sectional, questionnaire-based survey. METHODS All practicing GPs in Crete (n = 294) were surveyed either by questionnaires or by phone call. We assessed the vaccination coverage and practices for influenza, measles, hepatitis B, and pertussis (booster Tdap dose) and the reasons for nonvaccination for influenza. RESULTS A total of 260 (88% response rate) GPs participated. Vaccination rates were 56% for influenza (current season), 26% for measles (two doses), 68% for hepatitis B (three doses), and 18% for the booster dose with Tdap. Negligence (47%) and perceived low risk (29.6%) were the most common reasons for nonvaccination for influenza. History of natural measles infection was reported by 169 (65%) GPs, but none of the interviewed 31 provided laboratory confirmation. GPs with self-reported natural measles infection were less vaccinated than their peers (10% vs 55%, P < 0.001). Finally, 23 of 130 (18%) GPs contacted by phone falsely reported vaccination with Tdap in their childhood, when Tdap was not yet available. CONCLUSION This study revealed insufficient vaccination rates and misconceptions among GPs that should be the focus of future evidence-based interventions with potential to significantly improve vaccination coverage of GPs and indirectly of their patients.
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Affiliation(s)
- D Kalemaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - S Karakonstantis
- Infectious Diseases Unit, School of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - E Galanakis
- Department of Paediatrics, School of Medicine, University of Crete, Heraklion, 71003, Greece.
| | - C Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, 71003, Greece.
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A call for improved occupational surveillance for measles in the United States. Am J Infect Control 2019; 47:1519-1520. [PMID: 31345613 DOI: 10.1016/j.ajic.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022]
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Seroprevalence of measles, mumps, and rubella and genetic characterization of mumps virus in Khartoum, Sudan. Int J Infect Dis 2019; 91:87-93. [PMID: 31759167 DOI: 10.1016/j.ijid.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Sudan, neither mumps nor rubella vaccines are currently used and comprehensive data on the seroepidemiology of measles, mumps, and rubella (M.M.R), as well as information about circulating mumps virus genotypes, are lacking. METHODS In 2015/2016, dried blood spot samples were collected from 294 children, 153 adults from the general population, and 241 healthcare workers (HCWs) from Khartoum. The samples were investigated for M.M.R IgG antibodies using ELISA. Oral fluid samples from 16 clinical mumps cases collected in 2017 were characterized by RT-PCR and sequencing. RESULTS The seroprevalence of M.M.R antibodies among children was 93.5%, 63.6%, and 55.8%, while it was 93.5%, 90.8%, and 94.1% among adult volunteers and 99.2%, 97.1%, and 97.9% among HCWs. A high measles seroprevalence was observed among all children age groups, suggesting an effective control programme, while the mumps and rubella seroprevalence increased significantly with age (p<0.001), documenting active wild-type circulation. Our results demonstrated higher M.M.R seropositivity rates and IgG titres in HCWs compared to adult volunteers. Phylogenetic analysis showed the presence of genotype C mumps virus for the first time in Sudan. CONCLUSIONS The study findings provided new information on M.M.R epidemiology in Sudan, which may guide future control programmes in the country.
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Lake JG, Luvsansharav UO, Hagan JE, Goodson JL, Jigjidsuren N, Gombojamts N, Park BJ, Smith R. Healthcare-Associated Measles After a Nationwide Outbreak in Mongolia. Clin Infect Dis 2019; 67:288-290. [PMID: 29394341 DOI: 10.1093/cid/ciy067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
Measles virus is highly infectious and can spread rapidly where vaccine coverage is low and isolation precautions suboptimal. We describe healthcare-associated measles transmission during the 2015-2016 measles outbreak in Mongolia, describe infection prevention gaps, and outline preventive strategies.
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Affiliation(s)
- Jason G Lake
- Division of Healthcare Quality Promotion, Atlanta, Georgia
| | | | - José E Hagan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nyamsuren Jigjidsuren
- National Center for Communicable Diseases, Mongolia Ministry of Health and Sports, Ulaanbaatar
| | - Narantuya Gombojamts
- National Center for Communicable Diseases, Mongolia Ministry of Health and Sports, Ulaanbaatar
| | | | - Rachel Smith
- Division of Healthcare Quality Promotion, Atlanta, Georgia
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Lee CT, Hagan JE, Jantsansengee B, Tumurbaatar OE, Altanchimeg S, Yadamsuren B, Demberelsuren S, Tserendorj C, Munkhtogoo O, Badarch D, Gunregjav N, Baatarkhuu B, Ochir C, Berman L, Anderson R, Patel MK, Gregory CJ, Goodson JL. Increase in Infant Measles Deaths During a Nationwide Measles Outbreak-Mongolia, 2015-2016. J Infect Dis 2019; 220:1771-1779. [PMID: 30923799 PMCID: PMC7034305 DOI: 10.1093/infdis/jiz140] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/23/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Surveillance data from a large measles outbreak in Mongolia suggested increased case fatality ratio (CFR) in the second of 2 waves. To confirm the increase in CFR and identify risk factors for measles death, we enhanced mortality ascertainment and conducted a case-control study among infants hospitalized for measles. METHODS We linked national vital records with surveillance data of clinically or laboratory-confirmed infant (aged <12 months) measles cases with rash onset during March-September 2015 (wave 1) and October 2015-June 2016 (wave 2). We abstracted medical charts of 95 fatal cases and 273 nonfatal cases hospitalized for measles, matched by age and sex. We calculated adjusted matched odds ratios (amORs) and 95% confidence intervals (CIs) for risk factors. RESULTS Infant measles deaths increased from 3 among 2224 cases (CFR: 0.13%) in wave 1 to 113 among 4884 cases (CFR: 2.31%) in wave 2 (P < .001). Inpatient admission, 7-21 days before measles rash onset, for pneumonia or influenza (amOR: 4.5; CI, 2.6-8.0), but not other diagnoses, was significantly associated with death. DISCUSSION Measles infection among children hospitalized with respiratory infections likely increased deaths due to measles during wave 2. Preventing measles virus nosocomial transmission likely decreases measles mortality.
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Affiliation(s)
- Christopher T Lee
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jose E Hagan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Samdan Altanchimeg
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | | | | | | | | | - Darmaa Badarch
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | - Nyamaa Gunregjav
- Mongolia National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | | | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - LaShondra Berman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Raydel Anderson
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Minal K Patel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christopher J Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA
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Javelle E, Colson P, Parola P, Raoult D. Measles, the need for a paradigm shift. Eur J Epidemiol 2019; 34:897-915. [DOI: 10.1007/s10654-019-00569-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/03/2019] [Indexed: 01/24/2023]
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Measles outbreak from Hong Kong International Airport to the hospital due to secondary vaccine failure in healthcare workers. Infect Control Hosp Epidemiol 2019; 40:1407-1415. [PMID: 31587686 DOI: 10.1017/ice.2019.278] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report an outbreak of measles with epidemiological link between Hong Kong International Airport (HKIA) and a hospital. METHODS Epidemiological investigations, patients' measles serology, and phylogenetic analysis of the hemagglutinin (H) and nucleoprotein (N) genes of measles virus isolates were conducted. RESULTS In total, 29 HKIA staff of diverse ranks and working locations were infected with measles within 1 month. Significantly fewer affected staff had history of travel than non-HKIA-related measles patients [10 of 29 (34.5%) vs 28 of 35 (80%); P < .01]. Of 9 airport staff who could recall detailed exposure history, 6 (66.7%) had visited self-service food premises at HKIA during the incubation period, where food trays, as observed during the epidemiological field investigation, were not washed after use. Furthermore, 1 airport baggage handler who was admitted to hospital A before rash onset infected 2 healthcare workers (HCWs) known to have 2 doses of MMR vaccination with positive measles IgG and lower viral loads in respiratory specimens. Infections in these 2 HCWs warranted contact tracing of another 168 persons (97 patients and 71 HCWs). Phylogenetic comparison of H and N gene sequences confirmed the clonality of outbreak strains. CONCLUSION Despite good herd immunity with overall seroprevalence of >95% against measles, major outbreaks of measles occurred among HKIA staff having daily contact with many international pssengers. Lessons from severe acute respiratory syndrome (SARS) and measles outbreaks suggested that an airport can be a strategic epidemic center. Pre-exanthem transmission of measles from airport staff to HCWs with secondary vaccine failure poses a grave challenge to hospital infection control.
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Orsi A, Butera F, Piazza MF, Schenone S, Canepa P, Caligiuri P, Arcuri C, Bruzzone B, Zoli D, Mela M, Sticchi L, Ansaldi F, Icardi G. Analysis of a 3-months measles outbreak in western Liguria, Italy: Are hospital safe and healthcare workers reliable? J Infect Public Health 2019; 13:619-624. [PMID: 31561963 DOI: 10.1016/j.jiph.2019.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/26/2019] [Accepted: 08/25/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND From January 2017 to June 2018 more than 7000 measles cases were reported in Italy, of which more than 400 among unvaccinated healthcare workers. We described a measles outbreak occurred in Western Liguria, Italy, characterized by a high involvement of healthcare workers and hospital visitors. METHODS Suspected measles cases and data regarding vaccination status and clinical management of the patients were collected by reviewing 3 different surveillance systems: the routine mandatory notification system, the National Integrated Surveillance System for Measles and Rubella and the regional reference laboratory for measles diagnosis. RESULTS Thirty-six cases were reported, with a median age of 31 years and >95% in unvaccinated subjects. One death occurred, 15 cases were hospitalized. Hospital transmission was confirmed or suspected in 12 cases; amongst this cases, 5 were healthcare workers (a gynaecologist, an obstetric nurse, a radiologist, a physiotherapist and a nurse working in an infectious disease ward), all certified unvaccinated. Phylogenetic analysis revealed the circulation of a single B3 genotype variant. CONCLUSIONS Our experience highlighted the key role of nosocomial transmission and the need for targeted strategies, in particular (i) to implement a measles catch-up immunization campaign in susceptible groups, especially in healthcare workers, (ii) to intensify the check of immunisation status of healthcare workers and to offer vaccination for those who need it, (iii) to improve timeliness and completeness of surveillance systems. Efforts are needed to guarantee the safety of the hospital and the reliability of the healthcare workers. Only high vaccination coverage among HCWs can prevent the diffusion of measles in the hospital setting.
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Affiliation(s)
- Andrea Orsi
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy; Hygiene Unit, San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, Genoa, 16132, Italy.
| | - Francesca Butera
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy
| | - Maria F Piazza
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy
| | - Sara Schenone
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy
| | - Paola Canepa
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy
| | - Patrizia Caligiuri
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy
| | - Claudia Arcuri
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy
| | - Bianca Bruzzone
- Hygiene Unit, San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, Genoa, 16132, Italy
| | - Daniela Zoli
- Department of Prevention, Public Health Unit, ASL1 Imperiese, Via Aurelia 97, Bussana di Sanremo, Sanremo, 18038, Italy
| | - Marco Mela
- Department of Prevention, Public Health Unit, ASL1 Imperiese, Via Aurelia 97, Bussana di Sanremo, Sanremo, 18038, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy; Hygiene Unit, San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, Genoa, 16132, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy; Azienda Ligure Sanitaria della Regione Liguria "A.Li.Sa.", Piazza della Vittoria 15, Genoa, 16121, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy; Hygiene Unit, San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, Genoa, 16132, Italy
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Tavoschi L, Quattrone F, Agodi A, Lopalco PL. Risk of transmission of vaccine-preventable diseases in healthcare settings. Future Microbiol 2019; 14:9-14. [PMID: 31210537 DOI: 10.2217/fmb-2018-0236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The transmission of infectious agents within healthcare settings is a priority public health problem. Although the main burden of healthcare-associated infections is commonly caused by Gram-negative bacteria and fungi, vaccine-preventable diseases represent an additional infectious risk for patients attending healthcare facilities. Hepatitis B, rotavirus gastroenteritis, influenza, measles, pertussis and pneumococcal and meningococcal invasive bacterial infections still represent a threat, notwithstanding the presence of universal vaccination programs. For this reason, healthcare worker immunization is an important strategy to limit the risk of vaccine-preventable diseases in such a fragile population.
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Affiliation(s)
- Lara Tavoschi
- Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Filippo Quattrone
- Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Antonella Agodi
- Department of Medical & Surgical Sciences & Advanced Technologies 'GF Ingrassia', University of Catania, via S. Sofia, 87, 95123, Catania, Italy
| | - Pier L Lopalco
- Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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37
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Hiller U, Mankertz A, Köneke N, Wicker S. Hospital outbreak of measles - Evaluation and costs of 10 occupational cases among healthcare worker in Germany, February to March 2017. Vaccine 2019; 37:1905-1909. [PMID: 30850241 DOI: 10.1016/j.vaccine.2019.02.068] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
After treatment of an inpatient with measles, an outbreak occurred within the unprotected healthcare workers (HCW) of a regional hospital in Hesse, Germany in February and March 2017. Overall, 10 HCW contracted measles. Remarkably, none of the affected HCW had direct contact to the index patient. One nosocomial transmission to a patient occurred. The economic impact of the outbreak is estimated to approximately 700,000€. Medical institutions play a major role in the management of measles outbreaks, since the risk of exposure as well as nosocomial transmission to vulnerable patients and HCW is very high. To avoid outbreaks it is essential to have an easily accessible documentation of the immune-status of all HCW. The role of occupational medicine in identifying and closing vaccination gaps is of particular importance.
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Affiliation(s)
- Ute Hiller
- Infection Prevention and Control Team, Lahn-Dill-Kliniken GmbH, Forsthausstraße 1-3, D-35578 Wetzlar, Germany.
| | - Annette Mankertz
- National Reference Center Measles, Mumps, Rubella, Robert Koch-Institute, Seestraße 10, 13353 Berlin, Germany
| | - Norbert Köneke
- Lahn-Dill-Kliniken GmbH, Forsthausstr. 1-3, 35578 Wetzlar, Germany
| | - Sabine Wicker
- Occupational Health Service, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
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Watanabe A, Shimada T, Takahashi T, Arima Y, Kinoshita H, Saitoh T, Kanou K, Matsui T, Sunagawa T, Tanaka-Taya K, Oishi K. Correlates of laboratory-confirmed measles in Japan, 2011-2015. Vaccine 2019; 37:1756-1762. [PMID: 30803842 DOI: 10.1016/j.vaccine.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND With the progressive decline in the incidence of measles in Japan, its diagnosis has become challenging, with fewer physicians having experience in examining measles patients. We aimed to determine the correlates of laboratory-confirmed measles to help physicians improve their measles diagnosis. METHODS This study was conducted using the National Epidemiological Surveillance of Infectious Disease (NESID) system data during 2011-2015. Among clinically suspected measles patients reported to NESID, measles virus (MV)-positive patients were compared with MV-negative patients. The odds ratios (OR) and associated 95% confidence intervals (CI) were determined using logistic regression. RESULTS A total of 4168 laboratory-tested patients were notified to NESID. We analysed 618 MV-positive patients (median age, 17 years; interquartile range [IQR], 4-30 years) and 600 MV-negative (median age, 10 years; IQR, 1-29 years) patients after excluding those that met the exclusion criteria or were reported during the rubella epidemic period (the 18th epidemiological week of 2012 to the 46th week of 2013). Having an epidemiological link with a measles patient within 14 days of onset (OR, 14.9; 95% CI, 10.0-23.3), a history of recent international travel (OR, 11.7; 95% CI, 6.9-19.9), and unvaccinated/unknown vaccination status for measles-containing vaccine (MCV; OR, 3.7; 95% CI, 2.3-5.7) were significantly associated with MV-positive status. International travel (adjusted OR, 10.2; 95% CI, 5.9-17.7) and unvaccinated/unknown MCV vaccination status (adjusted OR, 5.8; 95% CI, 3.5-9.8) remained significantly associated with MV-positive status after adjusting for age, sex, and each other. CONCLUSION In low-incidence Japan, having an epidemiological link, international travel, and lack of MCV vaccination were correlates of laboratory-confirmed measles. The findings of this study could potentially improve the clinical diagnosis of measles, which can lead to more efficient testing and earlier laboratory confirmation.
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Affiliation(s)
- Aika Watanabe
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan; Department of Epidemiology for Infectious Diseases, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tomoe Shimada
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
| | - Takuri Takahashi
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Yuzo Arima
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Hitomi Kinoshita
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Takehiko Saitoh
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Kazuhiko Kanou
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Tamano Matsui
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Tomimasa Sunagawa
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Keiko Tanaka-Taya
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Kazunori Oishi
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan
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Gualano MR, Olivero E, Voglino G, Corezzi M, Rossello P, Vicentini C, Bert F, Siliquini R. Knowledge, attitudes and beliefs towards compulsory vaccination: a systematic review. Hum Vaccin Immunother 2019; 15:918-931. [PMID: 30633626 DOI: 10.1080/21645515.2018.1564437] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Currently, many countries are dealing with groups refusing available recommended vaccinations. Despite several studies having demonstrated the efficacy of mandatory vaccinations in ensuring herd immunity, opposition is widespread. The aim of our study was to systematically review published studies evaluating attitudes towards mandatory vaccination programs. PubMed and Scopus scientific databases were searched and 4,198 results were returned, of these 29 met the inclusion criteria. Twenty-two studies assessed attitudes towards mandatory vaccination programs in general, while 9 papers focused specifically on the Human Papilloma Virus (HPV) vaccine. Most of the studies were performed in Europe and North America. According to the assessed studies, the majority of the population seems to be in favour of compulsory vaccinations, although attitudes differed among studies. The results presented in this review could be an important starting point to further understand the issue of vaccine hesitancy and support the implementation of effective vaccination strategies.
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Affiliation(s)
- M R Gualano
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - E Olivero
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - G Voglino
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - M Corezzi
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - P Rossello
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - C Vicentini
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - F Bert
- a Department of Public Health Sciences , University of Turin , Turin , Italy
| | - R Siliquini
- a Department of Public Health Sciences , University of Turin , Turin , Italy
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40
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A hospital-associated measles outbreak in health workers in Beijing: Implications for measles elimination in China, 2018. Int J Infect Dis 2019; 78:85-92. [DOI: 10.1016/j.ijid.2018.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022] Open
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41
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Bianchi S, Frati E, Lai A, Colzani D, Ciceri G, Baggieri M, Lamberti A, Senatore S, Faccini M, Mazzilli F, Gramegna M, Zehender G, Magurano F, Tanzi E, Amendola A. Genetic characterisation of Measles virus variants identified during a large epidemic in Milan, Italy, March-December 2017. Epidemiol Infect 2019; 147:e80. [PMID: 30869017 PMCID: PMC6518568 DOI: 10.1017/s0950268818003606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
In 2017, Italy experienced a large measles epidemic with 5408 cases and four deaths. As Subnational Reference Laboratory of the Measles and Rubella surveillance NETwork (MoRoNET), the EpiSoMI (Epidemiology and Molecular Surveillance of Infections) Laboratory (University of Milan) set up rapid and active surveillance for the complete characterisation of the Measles virus (Mv) responsible for the large measles outbreak in Milan and surrounding areas (Lombardy, Northern Italy). The aims of this study were to describe the genetic profile of circulating viruses and to track the pathway of measles transmission. Molecular analysis was performed by sequencing the highly variable 450 nucleotides region of the N gene (N-450) of Mv genome. Two-hundred and ninety-nine strains of Mv were analysed. The phylogenetic analysis showed five different variants, two not previously described in the studied area, belonging to D8 and B3 genotypes. Three events of continuous transmission of autochthonous variants (D8-Osaka, D8-London and B3-Milan variants) and two events of continuous transmission of imported variants (B3-Dublin and D8-Hulu Langat) tracked five different transmission pathways. These pathways outlined two epidemic peaks: the first in April and the second in July 2017. The correlation between Mv variant and the epidemiological data may enable us to identify the sources of virus importation and recognise long-lasting virus transmission pathways.
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Affiliation(s)
- S. Bianchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - E.R. Frati
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - A. Lai
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, Milan, Italy
| | - D. Colzani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - G. Ciceri
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - M. Baggieri
- National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - A. Lamberti
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - S. Senatore
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
- DG Salute, UO Governo della prevenzione e tutela sanitaria, Lombardy Region, Milan, Italy
| | - M. Faccini
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - F. Mazzilli
- National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - M. Gramegna
- DG Salute, UO Governo della prevenzione e tutela sanitaria, Lombardy Region, Milan, Italy
| | - G. Zehender
- Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, University of Milan, Milan, Italy
- Coordinated Research Center ‘EpiSoMI’, University of Milan, Milan, Italy
| | - F. Magurano
- National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - E. Tanzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Coordinated Research Center ‘EpiSoMI’, University of Milan, Milan, Italy
| | - A. Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Coordinated Research Center ‘EpiSoMI’, University of Milan, Milan, Italy
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42
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Healthcare-Associated Viral Infections: Considerations for Nosocomial Transmission and Infection Control. HEALTHCARE-ASSOCIATED INFECTIONS IN CHILDREN 2018. [PMCID: PMC7121921 DOI: 10.1007/978-3-319-98122-2_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Nosocomial and healthcare-associated viral infections are major contributors to patient morbidity and mortality, prolonged hospitalization, and increased healthcare costs in all pediatric age groups. Healthcare workers are also at risk of acquiring nosocomial viral infections, affecting their own health, as well as facilitating spread of the infection to other patients, their family, and the community. Healthcare-associated viral infections may occur in a variety of healthcare settings, including clinics, emergency centers, urgent care centers, procedure suites, operating rooms, hospital wards, nurseries, and intensive care units. In addition, non-patient care areas, such as the cafeteria, waiting areas, and playrooms may also be a source of viral infections that can spread in the healthcare setting. These infections may be device-related or transmitted via blood products or organ donation and respiratory droplets, through food including human milk, person to person, or via air ducts, fomites, and surfaces. They most commonly involve the respiratory and gastrointestinal tracts; however, all organ systems may potentially be involved. Both DNA and RNA viruses, either common or exotic, may contribute to healthcare-associated viral infections. Advances in molecular viral diagnostics have enabled rapid detection and routine surveillance for viral infections and now allow early identification of viruses. Prompt identification allows timely containment measures to minimize transmission to other patients or healthcare workers and avoids hospital, community, and global outbreaks.
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43
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Hagan JE, Greiner A, Luvsansharav UO, Lake J, Lee C, Pastore R, Takashima Y, Sarankhuu A, Demberelsuren S, Smith R, Park B, Goodson JL. Use of a Diagonal Approach to Health System Strengthening and Measles Elimination after a Large Nationwide Outbreak in Mongolia. Emerg Infect Dis 2018; 23. [PMID: 29155667 PMCID: PMC5711310 DOI: 10.3201/eid2313.170594] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Measles is a highly transmissible infectious disease that causes serious illness and death worldwide. Efforts to eliminate measles through achieving high immunization coverage, well-performing surveillance systems, and rapid and effective outbreak response mechanisms while strategically engaging and strengthening health systems have been termed a diagonal approach. In March 2015, a large nationwide measles epidemic occurred in Mongolia, 1 year after verification of measles elimination in this country. A multidisciplinary team conducted an outbreak investigation that included a broad health system assessment, organized around the Global Health Security Agenda framework of Prevent-Detect-Respond, to provide recommendations for evidence-based interventions to interrupt the epidemic and strengthen the overall health system to prevent future outbreaks of measles and other epidemic-prone infectious threats. This investigation demonstrated the value of evaluating elements of the broader health system in investigating measles outbreaks and the need for using a diagonal approach to achieving sustainable measles elimination.
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Gagneux-Brunon A, Lucht F, Launay O, Berthelot P, Botelho-Nevers E. Vaccines for healthcare-associated infections: present, future, and expectations. Expert Rev Vaccines 2018; 17:421-433. [DOI: 10.1080/14760584.2018.1470507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Amandine Gagneux-Brunon
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Frédéric Lucht
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
| | - Odile Launay
- Inserm CIC 1417, I-REIVAC, University of Paris-Descartes, University Hospital of Cochin-Broca-Hôtel-Dieu, Paris, France
| | - Philippe Berthelot
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
- Infection control unit, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Inserm, CIC 1408, I-REIVAC, University Hospital of Saint-Etienne, Saint-Etienne, France
- GIMAP EA 3064, University of Lyon, Saint-Etienne, France
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45
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Amendola A, Bianchi S, Frati ER, Ciceri G, Faccini M, Senatore S, Colzani D, Lamberti A, Baggieri M, Cereda D, Gramegna M, Nicoletti L, Magurano F, Tanzi E. Ongoing large measles outbreak with nosocomial transmission in Milan, northern Italy, March-August 2017. ACTA ACUST UNITED AC 2018; 22:30596. [PMID: 28840825 PMCID: PMC5572939 DOI: 10.2807/1560-7917.es.2017.22.33.30596] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2001] [Accepted: 08/10/2017] [Indexed: 11/20/2022]
Abstract
A large measles outbreak has been ongoing in Milan and surrounding areas. From 1 March to 30 June 2017, 203 measles cases were laboratory-confirmed (108 sporadic cases and 95 related to 47 clusters). Phylogenetic analysis revealed the co-circulation of two different genotypes, D8 and B3. Both genotypes caused nosocomial clusters in two hospitals. The rapid analysis of epidemiological and phylogenetic data allowed effective surveillance and tracking of transmission pathways.
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Affiliation(s)
- Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Coordinated Research Center 'EpiSoMI', University of Milan, Milan, Italy
| | - Silvia Bianchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Elena R Frati
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giulia Ciceri
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Marino Faccini
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - Sabrina Senatore
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - Daniela Colzani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anna Lamberti
- Health Protection Agency, Metropolitan Area of Milan, Milan, Italy
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Rome, Italy
| | - Danilo Cereda
- DG Salute, UO Governo della prevenzione e tutela sanitaria, Lombardy Region, Milan, Italy
| | - Maria Gramegna
- DG Salute, UO Governo della prevenzione e tutela sanitaria, Lombardy Region, Milan, Italy
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Rome, Italy
| | - Fabio Magurano
- National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta Tanzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Coordinated Research Center 'EpiSoMI', University of Milan, Milan, Italy
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46
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Porretta A, Quattrone F, Aquino F, Pieve G, Bruni B, Gemignani G, Vatteroni ML, Pistello M, Privitera GP, Lopalco PL. A nosocomial measles outbreak in Italy, February-April 2017. ACTA ACUST UNITED AC 2018; 22:30597. [PMID: 28840827 PMCID: PMC5572940 DOI: 10.2807/1560-7917.es.2017.22.33.30597] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/10/2017] [Indexed: 01/09/2023]
Abstract
We describe a nosocomial outbreak of measles that occurred in an Italian hospital during the first months of 2017, involving 35 persons and including healthcare workers, support personnel working in the hospital, visitors and community contacts. Late diagnosis of the first case, support personnel not being promptly recognised as hospital workers and diffusion of the infection in the emergency department had a major role in sustaining this outbreak.
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Affiliation(s)
- Andrea Porretta
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Quattrone
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Aquino
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulio Pieve
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Beatrice Bruni
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulia Gemignani
- Medical Direction, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Mauro Pistello
- Retrovirus Center and Virology Section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gaetano Pierpaolo Privitera
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pier Luigi Lopalco
- Hygiene and Epidemiology section, Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Ge YL, Zhai XW, Zhu YF, Wang XS, Xia AM, Li YF, Zeng M. Measles Outbreak in Pediatric Hematology and Oncology Patients in Shanghai, 2015. Chin Med J (Engl) 2018; 130:1320-1326. [PMID: 28524832 PMCID: PMC5455042 DOI: 10.4103/0366-6999.206358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Despite substantial progress toward measles control are making in China, measles outbreaks in immunocompromised population still pose a challenge to interrupt endemic transmission. This study aimed to investigate the features of measles in pediatric hematology and oncology patients and explore the reasons behind the outbreak. Methods: We collected demographic, epidemiological, and clinical data of immunocompromised measles children. All suspected measles cases were laboratory-confirmed based on the presence of measles IgM and/or identification of measles RNA. The clinical data were statistically analyzed by t-test for continuous variables and Fisher's exact test for categorical variables. Results: From March 9 to July 25 in 2015, a total of 23 children with malignancies and post hematopoietic stem cell transplantation (post-HSCT) were notified to develop measles in Shanghai. Of these 23 patients with the median age of 5.5 years (range: 11 months–14 years), 20 (87.0%) had received 1–3 doses of measles vaccine previously; all patients had fever with the median fever duration of 8 days; 21 (91.3%) had cough; 18 (78.3%) had rash; 13 (56.5%) had Koplik's spot; 13 (56.5%) had complications including pneumonia and acute liver failure; and five (21.7%) vaccinated patients died from severe pneumonia or acute liver failure. Except the first patient, all patients had hospital visits within 7–21 days before measles onset and 20 patients were likely to be exposed to each other. Conclusions: The outcome of measles outbreak in previously vaccinated oncology and post-HSCT pediatric patients during chemotherapy and immunosuppressant medication was severe. Complete loss of protective immunity induced by measles vaccine during chemotherapy was the potential reason. Improved infection control practice was critical for the prevention of measles in malignancy patients and transplant recipients.
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Affiliation(s)
- Yan-Ling Ge
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xiao-Wen Zhai
- Department of Hematology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yan-Feng Zhu
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xiang-Shi Wang
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Ai-Mei Xia
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yue-Fang Li
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
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RICCÒ M, VEZZOSI L, GUALERZI G, SIGNORELLI C. Knowledge, attitudes and practices (KAP) towards vaccinations in the school settings: an explorative survey. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E266-E278. [PMID: 29707657 PMCID: PMC5912794 DOI: 10.15167/2421-4248/jpmh2017.58.4.673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 11/16/2017] [Indexed: 01/05/2023]
Abstract
Background Past researches have shown that schoolteachers’ (STs) interventions maximize the consent for vaccination programs. European data regarding knowledge, attitudes and practices of STs towards vaccination are otherwise lacking. Objectives The aim of this study was therefore to evaluate knowledge and attitudes of STs regarding vaccinations in a sample from North Italy. Material and methods In this cross sectional study, 154 STs from Lombardy region (Northern Italy) responded to a specific questionnaire assessing their attitude towards vaccination and vaccine related knowledge. Results In general, 88.3% of subjects were somehow favourable to vaccinations. The main reason for declining vaccination was the risk of side effects whereas the main reason to be vaccinated was to avoid to be infected by VPDs (67.6%). Main information sources were health professionals (75.3%), and new media (13.1%), and the latter were STs more frequently associated with a negative attitude towards vaccinations (p < 0.001). Eventually, regression analysis identified risk perception as positively associated with propensity towards vaccinations, both for Students- and STs-recommended vaccinations (B = 0.372, 95% CI 0.247 to 0.496 and B = 0.005, 95%CI 0.004 to 0.006, respectively). Conclusions Our results are consistent with previous reports suggesting a significant knowledge gap in STs, with the risk perception of infectious diseases as the main predictor for vaccine propensity. Moreover, the better knowledge of official vaccination recommendations and policies among STs identifying Health Professionals as information source enlightens the role of the School Physicians and Occupational Physicians, whose intervention may ultimately increase the vaccination acceptance and vaccination rates.
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Affiliation(s)
- M. RICCÒ
- Provincial Agency for Health Services of the Autonomous Province of Trento, Department of Prevention, Occupational Health and Safety Unit (UOPSAL)
- Local Health Unit of Reggio Emilia, Department of Public Health; Occupational Health and Safety Service
- * Correspondence: Matteo Riccò, Department of Public Health, Local Health Unit of Reggio Emilia, via Amendola2, 42122 Reggio Emilia, Italyì - E-mail:
| | - L. VEZZOSI
- University of Parma, Department Medicine and Surgery, School of Medicine and Surgery
| | - G. GUALERZI
- University of Parma, Department Medicine and Surgery, Section of Hygiene and Public Health
| | - C. SIGNORELLI
- University of Parma, Department Medicine and Surgery, Section of Hygiene and Public Health
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49
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Hagan JE, Takashima Y, Sarankhuu A, Dashpagma O, Jantsansengee B, Pastore R, Nyamaa G, Yadamsuren B, Mulders MN, Wannemuehler KA, Anderson R, Bankamp B, Rota P, Goodson JL. Risk Factors for Measles Virus Infection Among Adults During a Large Outbreak in Postelimination Era in Mongolia, 2015. J Infect Dis 2017; 216:1187-1195. [PMID: 29040627 DOI: 10.1093/infdis/jix449] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background In 2015, a large nationwide measles outbreak occurred in Mongolia, with very high incidence in the capital city of Ulaanbaatar and among young adults. Methods We conducted an outbreak investigation including a matched case-control study of risk factors for laboratory-confirmed measles among young adults living in Ulaanbaatar. Young adults with laboratory-confirmed measles, living in the capital city of Ulaanbaatar, were matched with 2-3 neighborhood controls. Conditional logistic regression was used to estimate adjusted matched odds ratios (aMORs) for risk factors, with 95% confidence intervals. Results During March 1-September 30, 2015, 20 077 suspected measles cases were reported; 14 010 cases were confirmed. Independent risk factors for measles included being unvaccinated (adjusted matched odds ratio [aMOR] 2.0, P < .01), being a high school graduate without college education (aMOR 2.6, P < .01), remaining in Ulaanbaatar during the outbreak (aMOR 2.5, P < .01), exposure to an inpatient healthcare facility (aMOR 4.5 P < .01), and being born outside of Ulaanbaatar (aMOR 1.8, P = .02). Conclusions This large, nationwide outbreak shortly after verification of elimination had high incidence among young adults, particularly those born outside the national capital. In addition, findings indicated that nosocomial transmission within health facilities helped amplify the outbreak.
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Affiliation(s)
| | - Yoshihiro Takashima
- Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | | | - Roberta Pastore
- Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Mick N Mulders
- Vaccine Preventable Diseases Laboratory Network, World Health Organization, Geneva, Switzerland
| | | | - Raydel Anderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bettina Bankamp
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Grammens T, Schirvel C, Leenen S, Shodu N, Hutse V, Mendes da Costa E, Sabbe M. Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges. ACTA ACUST UNITED AC 2017; 22:30524. [PMID: 28488998 PMCID: PMC5434888 DOI: 10.2807/1560-7917.es.2017.22.17.30524] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 11/20/2022]
Abstract
We describe characteristics of an ongoing measles outbreak in Wallonia, Belgium, and difficulties in control measures implementation. As at 12 March 2017, 177 measles cases were notified, of which 50% were 15 years and older, 49% female. Atypical clinical presentation and severe complications, mainly among adults, in combination with late notification, low or unknown vaccination coverage of contacts, infected healthcare workers and increased workload due to contact tracing, are the main concerns for outbreak management.
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Affiliation(s)
- Tine Grammens
- Service of Epidemiology of Infectious Diseases, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Carole Schirvel
- Infectious Disease Surveillance Unit, Agence pour une Vie de Qualité (AVIQ), Walloon region, Charleroi, Belgium
| | - Sylvie Leenen
- Infectious Disease Surveillance Unit, Agence pour une Vie de Qualité (AVIQ), Walloon region, Charleroi, Belgium
| | - Nathalie Shodu
- Infectious Disease Surveillance Unit, Agence pour une Vie de Qualité (AVIQ), Walloon region, Charleroi, Belgium
| | - Veronik Hutse
- National Reference Centre for measles, mumps and rubella, Service of Viral Diseases, Scientific Institute of Public Health, Brussels, Belgium
| | - Elise Mendes da Costa
- Service of Epidemiology of Infectious Diseases, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Martine Sabbe
- Service of Epidemiology of Infectious Diseases, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
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