Health Care-Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact
Health Care-Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact
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DOI：
10.1093/infdis/jir115
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发表时间：
2011-06-01
影响因子：
6.4
通讯作者：
Seward, Jane F.
中科院分区：
文献类型：
--
作者：
Chen, Sanny Y.;Anderson, Shoana;Seward, Jane F.
背景2008年2月12日，一名受感染的瑞士旅行者访问了亚利桑那州图森市的A医院，并引发了一场主要与卫生保健相关的麻疹疫情，涉及14例病例。我们调查了可能导致卫生保健相关传播的危险因素，并评估了与暴发相关的医院费用。流行病学资料通过病例访谈和病历回顾获得。对医护人员（HCP）的免疫记录进行审查，以确定非麻疹免疫HCP。估计2家医院的暴发相关费用。在14例确诊病例中，7例（50%）年龄≥ 18岁，4例（29%）住院，7例（50%）在卫生保健机构获得麻疹，所有（100%）患者均未接种疫苗或疫苗接种状况不明。在11例（79%）在感染时接受过医疗服务的患者中，1例（9%）在皮疹发作后立即进行了盲法和隔离。来自2家医院的HCP麻疹免疫数据证实，7195名HCP中有1776名（25%）缺乏麻疹免疫证据。在这些HCP中，1583例中有139例（9%）麻疹免疫球蛋白G检测呈血清阴性，包括1例麻疹患者。这两家医院花费了799，136美元，在这些设施中应对并控制了7例病例。怀疑麻疹是一种诊断，建立立即的空气传播隔离，并确保HCP快速检索麻疹免疫记录，对于预防医疗保健相关传播和最大限度地减少医院暴发响应成本至关重要。
Background. On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care-associated transmission and assessed outbreak-associated hospital costs.Methods. Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non-measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals.Results. Of 14 patients with confirmed cases, 7 (50%) were aged >= 18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities.Conclusions. Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs.