Measles investigation: A moving target
Measles investigation: A moving target
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DOI：
10.1016/j.ajic.2014.04.024
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发表时间：
2014-08-01
影响因子：
4.9
通讯作者：
Pauze, Denis R.
中科院分区：
文献类型：
--
作者：
Helmecke, Megan R.;Elmendorf, Sarah L.;Pauze, Denis R.
麻疹是一种高度传染性的呼吸道感染，具有重大传播风险，曾被认为即将消除。欧洲的爆发导致了麻疹的死灰复燃;然而，美国的麻疹经验有限。我们描述了2011年5月在急诊科就诊的2例麻疹病例的影响。确定并修订了接触标准。编写并分发了指导文件。疑似病例被蒙面押送至负压。缺乏及时的IgM和聚合酶链反应检测导致疾病确诊延迟。建立了计算机化的旗帜系统。对接触者进行筛查，以确定是否需要预防。计算了调查费用。共有171名患者和访客以及94名员工符合暴露标准。雇员有麻疹免疫力证明。其中，43名患者和来访者返回接受预防治疗。没有发生后续传输。这些调查的保守费用为63 176.39美元。查明了多重挑战。对麻疹缺乏经验可能导致重大疫情。虽然在另一个机构确实发生了传播，但由于病例识别迅速、隔离、卫生保健工作者免疫和多学科反应，在我们的机构得以预防。卫生保健感染控制实践咨询委员会和麻疹控制公共卫生指南之间的不一致造成了不必要的挑战。版权所有（C）2014由感染控制和流行病学专业人员协会，Inc.爱思唯尔公司出版All rights reserved.
Measles is a highly contagious respiratory infection with significant transmission risk once thought to be on the verge of elimination. Outbreaks in Europe have resulted in resurgence; however, experience with measles is limited in the United States. We describe the impact of 2 measles cases presenting to our emergency department in May 2011. Exposure criteria were defined and revised. Guidance documents were developed and distributed. Suspect cases were masked and escorted to negative pressure. Lack of prompt IgM and polymerase chain reaction testing resulted in delayed disease confirmation. Computerized flagging systems were established. Exposed individuals were screened to determine the need for prophylaxis. Investigation costs were calculated. A total of 171 patients and visitors and 94 employees met exposure criteria. Employees had proof of immunity to measles. Of these, 43 patients and visitors returned for prophylaxis. No subsequent transmission occurred. The conservative cost for these investigations was $63,176.39. Multiple challenges were identified. Inexperience with measles can result in significant outbreaks. Although transmission did occur at another facility, it was prevented at our facility because of rapid case recognition, isolation, health care worker immunity, and multidisciplinary response. Discordance between the Healthcare Infection Control Practices Advisory Committee and public health guidelines for measles control created unnecessary challenges. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.