Measles

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Of note:  the physician had been vaccinated THREE times, yet contracted the measles; the spread of the measles was limited, despite the childrens’ apparent participation in a non-vaccinating community; and NOBODY was permanently disabled or dead (and the hospitalized child, apparently had mild symptoms) as a result of contracting the measles… http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/30764Measles Outbreak Shows Disease Still a ThreatDownload Complimentary Source PDFBy , North American Correspondent, MedPage TodayPublished: January 20, 2012Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine andDorothy Caputo, MA, RN, BC-ADM, CDE, Nurse PlannerActivate MedPage Today's CME feature and receive free CME credit on medical stories like this oneAction Points § This report documents the risk of measles transmission in a health care setting, as well as the role of international travel in transmission.§ The current recommendations at the hospital involved in this measles transmission state that hospital employees should have documented immunity to measles.A measles outbreak in a Pennsylvania hospital underlines the need for staff members to be immunized against the virus, the CDC said.And clinicians also need to include measles in the differential diagnosis of patients with a fever and a rash -- especially if they have a recent history of international travel, the agency said in the Jan. 2 issue of Morbidity and Mortality Weekly Report.In general, domestic measles transmission has been stopped, the agency noted, but " importations " continue.The March 2009 outbreak in Allegheny County, which involved six patients including a physician, is a case in point, the CDC noted: Investigation showed that the virus was imported from India early in March.A 10-year-old boy, with an unknown vaccination history, arrived in Pennsylvania on March 8, suffering from fever, conjunctivitis, and symptoms of a head cold. A rash appeared the next day, and the following day -- March 10 -- the boy was sent to the hospital's emergency room to rule out Kawasaki disease.While in the hospital, investigation showed, he was placed in an examination room that was adjacent to the rooms in which two other children were being seen for unrelated illnesses.The outbreak came to light March 28, when the index patient, a previously healthy 23-month-old with head cold symptoms, a rash, and a cough, was diagnosed with measles and was placed in airborne isolation at the hospital.The index patient's 4-year-old brother and his father both had exhibited signs consistent with measles, and their serum was measles-IgM-positive when they were tested after the index patient's diagnosis.The 4-year-old, investigation showed, had been in one of the examination rooms adjacent to the source patient on March 10.Two other cases were reported -- a physician who had treated the source patient on March 10 and an 11-month-old boy who also had been in an examination room adjacent to the source patient.Both had symptoms consistent with measles but neither was diagnosed directly; however, serum tested later was measles-IgM-positive, the CDC investigation showed.The physician had previously received three doses of a measles-containing vaccine, the agency noted.Contact tracing did not reveal any other cases, the CDC reported.Only the index patient was isolated, but despite that there was limited spread. The CDC suggested three possible reasons:A high rate of measles immunization in the communityThe infected children did not attend school or childcareIntense control efforts by public health officials and health care facilitiesNone of the three children who were secondary cases had been vaccinated -- the 11-month-old was too young and the older children had not been given routine immunization by parental choice.The hospital involved had required new employees to have documented measles immunity since 1997, but employees who started before that year were tested inconsistently.As a result of the outbreak, hospital officials reviewed records and required all those without documented serological immunity to be vaccinated.