A hospital-associated measles outbreak in health workers in Beijing: Implications for measles elimination in China, 2018

Abstract

Background: Since the National Action Plan for Measles Elimination 2006-2012 was released in 2006, China has entered into an era of accelerated measles elimination. Despite substantial decline, measles outbreak continued to occur mainly in a non-targeted population, in particular health workers due to occupational exposure. We investigated a measles outbreak in a Chinese medicine hospital, Beijing, in March 2018. Methods: Descriptive analysis was performed on epidemiology of the outbreak, clinical and laboratory evaluations, vaccination status of cases, and public health response. A case-control study was also conducted to identify the associated risk factors for measles. Results: From March 13, 2018, through March 27, 2018, a total of 11 measles cases in health workers were reported in Hospital X, Beijing. The median age of cases was 26 years (range, 21-53) and 4 (36.4%) were male. Of the 11 cases, ten had not been vaccinated or had unknown vaccination status; two occurred in emergency departments. No inpatients became infected, 141 (83.9%) of whom in affected departments were 55 years of age or older. The outbreak was confirmed by laboratory testing; the virus strain was genotype H1. The response activities included isolation of cases, and enhanced health surveillance of health workers and inpatients, particularly in affected departments. A total of 2234 doses of measlescontaining vaccines (MCVs) were administered, covering 93.3% of susceptible health workers, in addition to 973 doses to the susceptible individuals in household and community. Lack of documentation of MCV vaccination before the outbreak was identified as a risk factor for measles (odd ratio: 3.333, 95% confidence interval: 1.295-8.621). Conclusions: High coverage of outbreak response immunization activities contributed largely to limit the spread of measles and might provide an indirect protection for inpatients. 2-Dose measles-containing vaccination of personnel in healthcare settings is warranted to prevent potential nosocomial transmission of measles.

Infecciones transmitidas por pacientes al personal de salud. Síntesis de evidencia

“…en el denominador se hace constar la población expuesta según las características del brote, expresada habitualmente como un porcentaje. la dificultad para interpretarla reside precisamente en la definición de población expuesta, que en un brote en el establecimiento de salud puede seguir distintos criterios (22,32,33).…”

“…además de las tres revisiones sistemáticas, se identificaron cinco estudios primarios con diversos orígenes y métodos (33,(120)(121)(122)(123):…”

“…• un estudio descriptivo de brotes en establecimientos de salud en Beijing (china), publicado en el 2019 por fu et al (33). • un estudio sobre datos de vigilancia de cataluña (españa) y transmisión relacionada en establecimientos de salud, publicado en el 2015 por torner et al (120).…”

“…los estudios de casos y controles realizados en abidján (côte d'ivoire) y estados unidos de américa (117) sobre la transmisión del sarampión mostraron que la asistencia a una sala de emergencias hospitalarias dos semanas antes de la aparición de la erupción era un factor de riesgo significativo. en el estudio de casos y controles de fu et al (33) sobre brotes de sarampión en china en el personal que trabaja en los establecimientos de salud, los resultados no ajustados mostraron que haber visitado el servicio de urgencias de una a tres semanas antes, y no tener documentada alguna vacunación contra el sarampión, eran factores asociados al contagio. por otro lado, un estudio de casos y controles en Burundi no confirmó este hallazgo (127).…”

Measles outbreak in an office building in the crowded Metropolis of Beijing, China

“…Adults had become the high risk population of measles in Beijing and similar areas [3, 5, 18, 22–26], suggesting that there are immunity gaps to measles among adults. During outbreaks, ORI can effectively close immunity gaps among children [34, 35], as well as among adults in China [36, 37]. In addition, there is no guideline of adult vaccinations for measles in Beijing.…”