Trabajadores de la salud contagiados de SARS-CoV-2 durante sus funciones asistenciales en una institución hospitalaria / Health workers contaminated with SARS-CoV-2 during their assistance functions in a hospital institution

Introducción: La preservación de los profesionales sanitarios es siempre prioritaria, especialmente en situaciones de epidemia. Objetivo: Caracterizar a trabajadores de la salud que enfermaron de COVID-19 durante el ejercicio de su profesión. Métodos: Se efectuó un estudio observacional, descriptivo y transversal de serie de casos, con recogida de la información en forma retrospectiva, en 12 trabajadores del Hospital Docente Infantil Sur Dr. Antonio María Béguez César de Santiago de Cuba, quienes se contagiaron del SARS-CoV-2 mientras realizaban sus funciones asistenciales en el primer semestre del año 2021. Resultados: En la serie predominaron el sexo femenino (91,7 %) y el grupo etario de 30 a 39 años (33,3 %); la mayoría de los trabajadores laboraban en los servicios de Miscelánea (41,7 %) y Microbiología (16,7 %) y fundamentalmente eran médicos. También sobresalieron los que no tenían antecedentes patológicos personales (66,7 %) y los que no mostraron complicación alguna asociada al proceso infeccioso. En cuanto a los factores de riesgo laboral, todos habían estado expuestos al virus y algunos habían tenido contacto con presuntos infectados o con pacientes que padecían la enfermedad. Entre los síntomas de la COVID-19 que les aquejaban resultaron más frecuentes la fiebre, la tos, la cefalea y el malestar general. Conclusiones: El bajo número de trabajadores que contrajo el coronavirus durante su desempeño asistencial en esa etapa se debió, en gran medida, a la eliminación de brechas en el cumplimiento de las normas de bioseguridad establecidas para la atención a los presuntos infectados por el SARS-CoV-2 y a los enfermos de la COVID-19, así como a las prácticas seguras del personal sanitario.

Introduction: The preservation of health professionals is always high-priority, especially in epidemic situations. Objective: To characterize health workers that got sick with COVID-19 during the exercise of their profession. Methods: An observational, descriptive and cross-sectional serial cases study with retrospective collection of the information was carried out in 12 workers of Dr. Antonio María Béguez Cesar Southern Teaching Children Hospital in Santiago de Cuba who caught the SARS-CoV-2 while they carried out their assistance functions in the first semester of the year 2021. Results: In the series there was a prevalence of the female sex (91.7 %) and the 30 to 39 age group (33.3 %); most of the workers worked in the miscellany (41.7 %) and microbiology services (16.7 %) and they were mainly doctors. Those that didn't have personal pathological history were also notable (66.7 %) and those that didn't show any complication associated with the infectious process. As for the labor risk factors, all had been exposed to the virus and some had had contact with presumed infected or with patients that suffered from the disease. Among the symptoms of the COVID-19 that they suffered, fever, cough, migraine and diffuse discomfort were more frequent. Conclusions: The few number of workers that caught the coronavirus during their assistance performance in that phase was to a large extent due to the elimination of breaches in the execution of biosecurity norms established for the care to the presumed infected by the SARS-CoV-2 and to the sick persons of the COVID-19, as well as to the secure practices of the health staff.

The impact of the COVID-19 pandemic on dental practice in Brazil / O impacto da pandemia de COVID-19 na prática odontológica no Brasil

INTRODUCTION: Dentists are at high risk of contamination by COVID-19 due to the proximity to the patients' oral cavity and airways. OBJECTIVE: To elucidate thebehaviors and adversities experienced by dentists because of the COVID-19 pandemic. METHODS: This descriptive study invited 1.811 dentists affiliated with professional associations, dental cooperatives, and health insurance providers from São Paulo State, Brazil, in 2020 of which 473 agreed to participate. The data collection, using Google Forms, included the variables: sociodemographic conditions; characteristics of dental work; level of healthcare and sources of information about the pandemic; changes in the work process, financial impact with personal protective equipment (PPE) andbiosafety measures; and consequences of the pandemic in the professional practice. RESULTS: The 473 dentists (40.36±13.44 years), were mostly women (52.22%), had a specialty (55.60%), and were self-employed professionals (73.36%). It was observed that 78.01% of professionals had a reduction in their monthly income. The average ofpatients treated daily decreased by 35.48%. It was found that 30.44% of professionalshad difficulty with the use of PPE, 3.59% contracted COVID-19, and 53.03% decided to postpone the appointment if the patient with suspected or confirmed COVID-19 sought treatment, even in emergencies. The use of high-speed handpieces was reported by most professionals (n=428; 90.48%). CONCLUSION: Behaviors: dentists used PPE and assigned very high or high levels of precaution about COVID-19. Adversities: dentists reported an increase in operating costs, changes in the work process, a decrease in appointments, and a reduction in the monthly income.

INTRODUÇÃO: Os cirurgiões-dentistas apresentam alto risco de contaminação pelo COVID-19 devido à proximidade com a cavidade oral e vias aéreas dos pacientes. OBJETIVO: Elucidar os comportamentos e adversidades vivenciados por cirurgiões-dentistas devido à pandemia de COVID-19. MÉTODOS: A pesquisa descritiva envolveu 1.811 cirurgiões-dentistas de associações profissionais, cooperativas odontológicas e convênios do Estado de São Paulo, Brasil, em 2020, dos quais 473 concordaram em participar. A coleta de dados, por meio do Formulários Google, incluiu as variáveis: condições sociodemográficas; características do trabalho odontológico; nível de atenção e fontes de informação sobre a pandemia; mudanças no processo de trabalho, impacto financeiro com equipamentos de proteção individual (EPI) e medidas de biossegurança; e consequências da pandemia na prática profissional. RESULTADOS: Dos 473 dentistas (40,36±13,44 anos), a maioria era mulher (52,22%), especialista (55,60%) e trabalhava como autônomo (73,36%). Observou-se que 78,01% dos profissionais apresentaram redução na renda mensal. A média de pacientes atendidos diminuiu 35,48%. Constatou-se que 30,44% dos profissionais tiveram dificuldade com o uso de EPI, 3,59% contraíram COVID-19 e 53,03% postergaram o atendimento de paciente com suspeita ou confirmação de COVID-19, mesmo em emergências. O uso de peça de alta rotação foi relatado pela maioria dos profissionais (n=428; 90,48%). CONCLUSÃO: Como comportamentos: os dentistas usaram EPI e atribuíram níveis muito altos ou altos de cuidados sobre o COVID-19. Como adversidades: os dentistas relataram aumento nos custos operacionais, mudanças no processo de trabalho, diminuição no atendimento e redução na renda mensal.

COVID-19 among workers assisting homeless and socially vulnerable people

ABSTRACT Objective To describe the profile of professionals assisting homeless and socially vulnerable populations tested for COVID-19, and to determine potential associations with exposure at the workplace, on the way to work, or at home, among infected professionals. To describe disease symptoms and progression and to investigate potential associations with age, sex and exposure at the workplace, on the way to work, or at home. Methods A retrospective analysis of data of 173 workers employed by Serviço Franciscano de Solidariedade tested for SARS-CoV-2. Between May 20 and June 2, 2020, professionals and volunteers were tested for anti-SARS-CoV-2 IgG and IgM antibodies, by means of qualitative rapid chromatographic immunoassay in whole blood. A questionnaire was used to collect data on demographic characteristics and working conditions, history and date of onset of symptoms and risk factors. Quantitative variables were expressed as mean and standard deviation, or median, maximum, and minimum values. Data normality was investigated using the Kolmogorov-Smirnov test. Results A total of 46 (26.6%) participants had positive serologic tests. Of participants with negative serologic test results, 109 (85.8%) were asymptomatic. History of symptoms was the most significant independent factor associated with positive serology. Serologic test results and symptoms differed significantly according to housing (p=0.045) and working (p<0.001) conditions. More than half of participants (52.4%) living in shared households tested positive, compared to 23% of participants living in family households. Participants working remotely from home did not test positive. In seropositive participants, onset of symptoms was associated with workplace exposure and shared housing conditions. Conclusion History of symptoms was associated with positive serology for COVID-19. Shared housing conditions tended to be associated with higher risk of infection. Onset of symptoms was associated with higher levels of workplace exposure and shared housing conditions in seropositive participants.

La práctica estomatológica en tiempos de coronavirus en Cuba / Dental practice in times of coronavirus disease 2019 in Cuba

RESUMEN La COVID-19 es causada por el nuevo coronavirus (SARS-CoV-2) y su brote ha sido declarado una emergencia de salud pública internacional. La transmisión interhumana ha sido documentada incluso entre trabajadores de la salud; se cree que los procedimientos generadores de aerosoles pueden tener un papel crucial en la diseminación de la enfermedad. El propósito de esta investigación fue ofrecer una actualización sobre la práctica estomatológica en tiempos de coronavirus, y proporcionar recomendaciones de cuidados específicos que deben seguir los profesionales. Los estomatólogos y técnicos se exponen a un enorme riesgo de infección debido a la comunicación cara a cara y la exposición a la saliva, la sangre y otros fluidos corporales. Para mitigar la propagación de esta afección es necesario conocer medidas de prevención adecuadas. Es de vital importancia realizar una capacitación a los profesionales sobre la práctica estomatológica segura en tiempo de coronavirus.

ABSTRACT COVID-19 is caused by the new coronavirus (SARS-CoV-2) and its outbreak has been declared an international public health emergency. Interhuman transmission has been documented even among health workers; aerosol-generating procedures are believed to play a crucial role in the spread of the disease. The purpose of this research was to offer an update on dental practice in times of coronavirus disease 2019 and to provide specific care recommendations to be followed by professionals. Dentists and technicians expose themselves to an enormous risk of infection due to face-to-face communication and exposure to saliva, blood, and other body fluids. It is necessary to know adequate prevention measures in order to mitigate the spread of this condition. It is also important to train professionals on the safe dental practice in times of this coronavirus.

Actitud ante la COVID-19 en la práctica dental rutinaria / Attitude towards COVID-19 in routine dental practice

RESUMEN Introducción: el principal modo de transmisión de la pandemia de la COVID-19, causada por el nuevo coronavirus SARS-CoV-2, lo constituyen las pequeñas gotas de saliva expulsadas al respirar, hablar, toser o estornudar. El profesional estomatólogo está expuesto al contagio y propagación de la infección al trabajar directamente con las mucosas. Objetivo: describir el manejo de los pacientes en la consulta de Estomatología. Desarrollo: se revisaron 165 artículos publicados entre enero y marzo del 2020, en PubMed y guías de la Comisiones Nacionales de Salud. Se tomaron en cuenta criterios relacionados con la atención odontológica. La información obtenida concuerda en que, la mejor forma evitar el contagio y la propagación es la prevención a través de una adecuada identificación del paciente, protección personal, limpieza, desinfección y manejo de desechos. Conclusiones: el profesional estomatólogo juega un papel importante en la prevención de la transmisión mediante el correcto empleo de normas de bioseguridad y protección.

ABSTRACT Introduction: the main way of transmission of the COVID-19 pandemic, caused by the novel SARS-CoV-2 coronavirus, is through small droplets of saliva expelled when breathing, speaking, coughing or sneezing. The dental professional is exposed to the spread of infection by working directly with the mucous membranes. Objective: to describe the management of patients in the dental surgery. Development: 165 articles published between January and March 2020 in PubMed and National Health Commission guidelines were reviewed. Considering the criteria related to dental care. The information obtained agrees that the best way to avoid contagion and spread is prevention through the adequate identification of patient, personal protection, cleaning, disinfection and waste management. Conclusions: the dental professional plays an important role in preventing transmission by the correct procedures of biosecurity and protection standards.

Riesgos y retos para los profesionales de las disciplinas estomatológicas ante la COVID-19 / Risks and challenges for dental professionals in addressing COVID-19

RESUMEN Introducción: Los procedimientos estomatológicos implican exposición frecuente a saliva, sangre y otros fluidos, por lo que existe riesgo de infección nosocomial con COVID-19. Objetivo: describir la transmisión de la COVID-19, medidas y situación actual en estomatología. Material y Métodos: se realizó una revisión bibliográfica en abril de 2020. Se evaluaron fundamentalmente revistas de la Web of Sciences. Todas las publicaciones incluidas fueron de 2020 en inglés y español. Se emplearon descriptores como: "coronavirus infections" y "transmission". Desarrollo: la enzima convertidora de angiotensina II tiene un nivel de expresión en tejidos bucales y es mayor en la lengua. La saliva es un medio de transmisión. Muchos trabajadores sanitarios se han contagiado y fallecido durante la pandemia. Los pacientes y profesionales de estomatología pueden exponerse a virus que infectan la cavidad bucal y el tracto respiratorio y las medidas recomendadas incluyen el cese de las actividades electivas, uso de elementos de barrera y control de aerosoles. Conclusiones: la saliva es el medio de transmisión principal por COVID-19 en estomatología y los aerosoles originados en la atención aumentan el riesgo de contaminación. Las medidas recomendadas incluyen emplear medios de protección y desinfección de superficies. Muchos países suspendieron la atención estomatológica, a excepción de la urgente.

ABSTRACT Introduction: Dental procedures involve frequent exposure to saliva, blood and other fluids, so there is a risk of nosocomial infection with COVID-19. Objective: To describe the transmission of COVID-19, measurements and current situation in dentistry. Material and methods: A bibliographic review was carried out in April, 2020. Journals from the Web of Sciences were fundamentally evaluated. All publications included were from 2020, in English and Spanish. Descriptors such as: "coronavirus infections" and "transmission" were used. Development: The angiotensin-II converting enzyme has a level of expression in oral tissues that is higher in the tongue. Saliva is a means of transmission. Many health workers have been infected and died during the pandemic. Dental patients and professionals can be exposed to viruses that infect the oral cavity and the respiratory tract; therefore, recommended measures include cessation of elective activities, use of barrier elements, and aerosol control. Conclusions: Saliva is the main means of transmission by COVID-19 in dentistry and the aerosols originated in the care increase the risk of contamination. Recommended measures include using means of protection and carrying out surface disinfection. Many countries suspended dental care, except for urgent care.

Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015 / 한국역학회지

OBJECTIVES: During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC. METHODS: We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure. RESULTS: The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR. CONCLUSIONS: The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015 / 한국역학회지

OBJECTIVES: During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC.METHODS: We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure.RESULTS: The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR.CONCLUSIONS: The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

Positive tuberculin test and risk of infection by Mycobacterium tuberculosis in a tuberculosis clinic settled in an upright building, in Minas Gerais, Brazil / Reactividad a tuberculina en trabajadores de la salud de un centro de referencia de tuberculosis

Background: Occupational Tuberculosis (TB) can lead to work absenteeism and a negative professional impact. Knowing the reactivity of the tuberculin test and the risk of M. tuberculosis infection among healthcare professionals is essential for the revision and reinforcement of control measures against TB transmission. Aim: To assess the reactivity of tuberculin test and risk of M. tuberculosis infection among healthcare professionals working in an upright building, in which a TB Reference Clinic is placed. Subjects and Methods: A tuberculosis Skin Test (TST) was done to 251 staff members of a TB clinic that did not have a previous history or suspicion of TB and that did not have a previous TST done. Among subjects with absence of reaction, repeated tests were carried out to assess booster reaction. Results: Fifty one percent of studied subjects (129) had a positive tuberculin test. The booster phenomenon was evidenced in 35.7% (68/190). The seroconversion among non-reactive subjects, subjected to a new TST after one year, was 5.1%. The infection risk was 1.4. Conclusions: This study indicates an important occupational risk of infection in healthcare settings exposed to high TB incidence, and should be used to better allocate resources for infection control.

Antecedentes: La tuberculosis ocupacional causa ausentismo laboral. Conocer la reactividad tuberculínica de los trabajadores de la salud ayuda a mejorar las medidas de control para evitar la infección laboral con M. tuberculosis. Objetivo: Estudiar la reactividad tuberculínica de un grupo de trabajadores de la salud de un centro de referencia de tuberculosis que está ubicado en una edificación vertical. Material y Métodos: Se realizó una prueba de tuberculina a 251 empleados de una clínica de tuberculosis, que no tenían antecedentes o sospecha de tuberculosis y quienes no habían sido sometidos previamente a la prueba. Aquellos sujetos que no respondieron a tuberculina fueron sometidos a una nueva prueba para evaluar la reacción de refuerzo. Resultados: El 51% de los sujetos estudiados tuvieron una reacción tuber-culínica positiva. El fenómeno de refuerzo se observó en 69 de 190 sujetos (35,7%). La tasa de seroconversión en aquellos sujetos con una tuberculina negativa en que se repitió la prueba la cabo de un año, fue de 5,1%. Conclusiones: En este grupo de trabajadores de la salud expuestos a M. tuberculosis, hay una alta tasa de reactividad negativa a tuberculina.

Reducción de infecciones por autocontaminación en cirugía de columna / Redução de infecções por autocontaminação em cirurgia de coluna vertebral / Reducing infections by auto-contamination in spine surgery

OBJETIVO: Evaluar en forma prospectiva las infecciones en cirugía de columna que fueron provocadas por contaminación del cirujano o algún miembro del equipo quirúrgico. MÉTODOS: Luego de haber tenido 2 infecciones seguidas en cirugía de columna y de detectar que el germen encontrado en los cultivos de las muestras coincidía con el colonizado en la nariz de uno de los miembros del equipo, decidimos tomar una serie de medidas (en relación al lavado de manos y manejo del barbijo quirúrgico) en forma prospectiva. Evaluamos 120 pacientes que operamos de columna vertebral en forma prospectiva desde enero de 2007 a diciembre de 2009. Como criterios de inclusión fueron cirugías de columna por vía posterior realizadas por el mismo equipo quirúrgico cumpliendo las medidas que serán presentadas. Como criterios de exclusión fueron pacientes operados por vía anterior, cirugías laparoscópicas y vertebroplastías así como aquellas cirugías en que no estuvo alguno del equipo quirúrgico en estudio. RESULTADOS: De las 120 columnas operadas tuvimos infección en tres casos en los que se realizó la toilette correspondiente y el cultivo y antibiograma de la muestra y de la nariz de los miembros del equipo quirúrgico. En ninguno de los casos el germen que produjo la infección coincidió con los gérmenes hallados en las narices del equipo quirúrgico, o sea 0 por ciento de contaminación provocada por el cirujano. CONCLUSIONES: Creemos que las medidas adoptadas en quirófano, con relación al lavado de manos y manejo del barbijo, pueden reducir la infección en cirugía de columna provocada por el propio cirujano.

OBJECTIVE: To carry out a prospective evaluation of spine surgery infections caused by contamination by the surgeon or some other member of the surgical team. METHODS: After seeing two infections in a row during spine surgery, and detecting that the germ found in the sample cultures coincided with that found in the nose of one of the members of the surgical team, we decided to prospectively implement a series of measures related to scrubbing and handling the surgical mask. We carried out a prospective evaluation from January 2007 to December 2009 of 120 patients who underwent spine surgery carried out by our team. Criteria for inclusion were spine surgery by the posterior route carried out by the same surgical team complying with the measures to be presented. Criteria for exclusion were patients who underwent surgery by the anterior route, laparoscopic and vertebroplasty surgeries, and surgeries in which no member of the surgical team in question was present. RESULTS: Of the 120 spines operated on, infection occurred in three cases in which the corresponding hygiene practices and cultivation and antibiogram of the samples and noses of the members of the surgical team were carried out. In none of the cases was the germ that produced the infection the same as the germ found in the nasal sample of the members of the surgical team. In other words 0 percent of the contamination was caused by the surgeon. CONCLUSIONS: We believe that the measures adopted in the operating room in relation to scrubbing and handling the surgical mask can reduce spine surgery infections caused by the surgeon.

OBJETIVO: Avaliar prospectivamente as infecções em cirurgia de coluna que foram provocadas por contaminação do cirurgião ou algum membro da equipe cirúrgica. MÉTODOS: Depois de ter tido duas infecções seguidas em cirurgia de coluna e de detectar que o microrganismo encontrado nas culturas das amostras coincidia com o colonizado no nariz de um dos membros da equipe, decidimos tomar uma série de medidas (com relação à escovação das mãos e manipulação da máscara cirúrgica) de forma prospectiva. Avaliamos 120 pacientes nos quais operamos a coluna vertebral prospectivamente de janeiro de 2007 a dezembro de 2009. Os critérios de inclusão foram cirurgias de coluna por via posterior realizadas pela mesma equipe cirúrgica, de acordo com as medidas apresentadas a seguir. Os critérios de exclusão foram pacientes operados por via anterior, cirurgias laparoscópicas e vertebroplastias, assim como as cirurgias nas quais não havia ninguém da equipe cirúrgica em estudo. RESULTADOS: Das 120 colunas operadas houve infecção em três casos, nos quais se realizou a limpeza correspondente e a cultura e antibiograma da amostra e do nariz dos membros da equipe cirúrgica. Em nenhum dos casos, o microrganismo que produziu a infecção coincidiu com os encontrados no nariz da equipe cirúrgica, ou seja, 0 por cento de contaminação provocada pelo cirurgião. CONCLUSÕES: Acreditamos que as medidas adotadas na sala de cirurgia, a saber, escovação das mãos e manipulação da máscara cirúrgica, podem reduzir a infecção nas cirurgias de coluna provocada pelo próprio cirurgião.

Measles Outbreaks and Infection Control in a Tertiary Hospital / 병원감염관리

BACKGROUND: Both the Korean Society of Infectious Diseases and The Korean Center for Diseases Control recommended MMR (measles, mumps, rubella) vaccination to health care workers (HCWs) but this had rarely been applied mainly due to economic reasons. In this paper, we report a measles outbreak initiated by two inpatients and then spread to other nine infants and three HCWs. We also report that this outbreak was successfully contained by active infection control measures. METHODS: Measles cases were determined according to CDC clinical criteria and confirmed by the level of the measles-specific IgM antibody. Suspected patients were isolated in aeration-limited areas. After measles cases in HCWs were detected, people in 26 pediatric wards were screened for measles-specific IgG antibody. MMR (measle, rubella, mumps) vaccination was applied to HCWs who were negative for measles-specific antibodies or HCWs who were exposed but not sure of their vaccination status. RESULTS: From April 21 to June 4 in 2007, measles-infected patients consisted of eleven infants (11 months old in median age) and three HCW women. Antibody screening revealed that only 73% (19 out of 26) in pediatric wards were positive for measles-specific IgG. After a medical doctor was confirmed as measles-infected, health care worker exposed to measles patients were all vaccinated without antibody test. CONCLUSION: The precise level of anti-measles antibody in adults has to be revealed by further studies involving multiple organizations. This result could be helpful for establishing a proper health care policy of MMR vaccination.