Outbreak report: nosocomial transmission of measles through an unvaccinated healthcare worker-implications for public health.

BACKGROUND: Nosocomial transmission of measles is a near avoidable event with the potential for serious sequelae. Those who acquire infection in hospitals may be particularly susceptible to serious disease. UK guidance recommends measles, mumps, rubella vaccine (MMR) vaccination for healthcare workers (HCWs) as a key preventative measure against nosocomial transmission. We report an incident of transmission of measles from a patient to an unvaccinated HCW, with subsequent onward transmission to a patient in a paediatric unit. METHODS: Response to the incident was undertaken in accordance with guidance from the Health Protection Agency (now Public Health England) and UK Department of Health. RESULTS: The index case had travelled to France, where there was an ongoing outbreak. There were 110 contacts identified for this HCW, of whom 61 were advised to have MMR and 5 were given immunoglobulin. All three cases were found to have the same D4 genotype. CONCLUSIONS: The report highlights the large number of potential contacts in a hospital setting and the time and resource implications involved to prevent further cases. It also highlights the importance of timely identification of measles, early public health notification and complete contact tracing. Such incidents are nearly avoidable given the availability of an efficacious vaccine.

The burden and impact of measles among the Gypsy-Traveller communities, Thames Valley, 2006-09.

BACKGROUND: Outbreaks of measles in Gypsy-Traveller communities are well recognized. Their contribution to the overall burden of disease is less clear. METHODS: Measles case-management information was collated retrospectively for the Thames Valley population comprising 2.2 million people over the 4-year period from 2006 to 09. Suspected cases notified by general practitioners and hospital clinicians were sent a saliva testing kit. Cases were defined as those whose measles IgM was positive. Risk factor information was collected and collated including vaccination and membership of the Gypsy-Traveller communities. RESULTS: Of 142 cases of laboratory confirmed measles, 63% were in Gypsy-Traveller communities. These included 10 family clusters and outbreaks confined to the Gypsy-Traveller communities and one with a wider spread. The pattern was consistent across the 4 years studied. Among the Gypsy-Traveller communities 27 of 55 cases eligible for measles, mumps and rubella (MMR) vaccination had received one MMR vaccination. Overall seven cases were admitted to hospital with either pneumonia or dehydration. CONCLUSION: These findings showed a more than 100-fold higher incidence in the Gypsy-Traveller communities than the rest of the population. The high burden of disease in the Gypsy-Traveller communities highlights the importance of targeting immunization resources towards these communities.