Measles outbreak, Montenegro January – July 2018: lesson learned

Background: Measles is a highly contagious virus that reemerged in 2019 with the highest number of reported cases in the United States since 1992. Beginning in March 2019, The Johns Hopkins Hospital (JHH) responded to an influx of patients with concern for measles as a result of outbreaks in Maryland and the surrounding states. We report the JHH Department of Infection Control and Hospital Epidemiology (HEIC) response to this measles outbreak using a multidisciplinary measles incident command system (ICS). Methods: The JHH HEIC and the Johns Hopkins Office of Emergency Management established the HEIC Clinical Incident Command Center and coordinated a multipronged response to the measles outbreak with partners from occupational health services, microbiology, the adult and pediatric emergency departments, marketing and communication and local and state public health departments. The multidisciplinary structure rapidly developed, approved, and disseminated tools to improve the ability of frontline providers to quickly identify, isolate, and determine testing needs for patients suspected to have measles infection and reduce the risk of secondary transmission. The tools included a triage algorithm, visitor signage, staff and patient vaccination guidance and clinics, and standard operating procedures for measles evaluation and testing. The triage algorithms were developed for phone or in-person and assessed measles exposure history, immune status, and symptoms, and provided guidance regarding isolation and the need for testing. The algorithms were distributed to frontline providers in clinics and emergency rooms across the Johns Hopkins Health System. The incident command team also distributed resources to community providers to reduce patient influx to JHH and staged an outdoor measles evaluation and testing site in the event of a case influx that would exceed emergency department resources. Results: From March 2019 through June 2019, 37 patients presented with symptoms or concern for measles. Using the ICS tools and algorithms, JHH rapidly identified, isolated, and tested 11 patients with high suspicion for measles, 4 of whom were confirmed positive. Of the other 26 patients not tested, none developed measles infection. Exposures were minimized, and there were no secondary measles transmissions among patients. Conclusions: Using the ICS and development of tools and resources to prevent measles transmission, including a patient triage algorithm, the JHH team successfully identified, isolated, and evaluated patients with high suspicion for measles while minimizing exposures and secondary transmission. These strategies may be useful to other institutions and locales in the event of an emerging or reemerging infectious disease outbreak.Funding: NoneDisclosures: Aaron Milstone reports consulting for Becton Dickinson.

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After Action Review of the 2019 measles outbreak in Clark County, Washington, U.S.A

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.598 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Stoto ◽

R Piltch-Loeb ◽

R Wolfe ◽

R Albrandt ◽

A Melnick

Keyword(s):

Public Health ◽

Religious Community ◽

Local Health ◽

Mutual Aid ◽

Social Distancing ◽

Clark County ◽

After Action Review ◽

Measles Outbreak ◽

Health Practitioners ◽

Public Health Practitioners

Abstract Issue Clark County experienced a measles outbreak that challenged public health authorities. Description of the practice: We conducted a formal After Action Review with state and local health officials, school officials, and others to identify lessons for public health practitioners facing future outbreaks. Results Following the early identification of measles in a child who had recently arrived from Ukraine, active surveillance identified 71 confirmed cases, most in unvaccinated persons under 18 years of age. 4,138 contacts were traced and public health personnel made daily monitoring calls to 816. 53 potential exposure sites in healthcare facilities, schools and other public places were identified and communicated to the public. As a social distancing measure, unvaccinated students, teachers, and staff were excluded from schools in which exposure had occurred. Ascertaining susceptibility status was challenging. The national anti-vaccination sentiment and a parallel outbreak in a New York religious community created challenges in representing community risk while avoiding stigmatization of a community in which the first reported case was identified. Rather than respond to every false claim on social media, the health department developed talking points about emerging issues and engaged the community in dialogue. Lessons Responding to the measles outbreak required innovative approaches to surveillance and contact tracing, social distancing (school exclusions), and emergency risk communication. The response required extensive coordinated efforts of the county and state health departments, school systems, and many other organizations. Mutual aid enabled an influx of resources but managing the surge of responders proved challenging. Key messages Public health emergencies require effective emergency management practices. Carefully conducted After Action Reviews of health emergencies can help public health practitioners identify challenges and innovative practices.

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Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.814 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s253-s253

Author(s):

Silvia Fonseca ◽

Ivana Lucca ◽

Franceliana Sgobi ◽

Andre Fioravante ◽

Alexandre Celia ◽

...

Keyword(s):

Tertiary Care ◽

Maculopapular Rash ◽

Sao Paulo ◽

Suspected Case ◽

Care Hospital ◽

São Paulo ◽

Measles Outbreak ◽

Hospital Infection Control ◽

Hospital Preparedness ◽

Measles Vaccination

Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None

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The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

BMC Medicine ◽

10.1186/s12916-021-01906-9 ◽

2021 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

C. N. Mburu ◽

◽

J. Ojal ◽

R. Chebet ◽

D. Akech ◽

...

Keyword(s):

Vaccination Coverage ◽

Herd Immunity ◽

African Region ◽

Population Immunity ◽

Measles Outbreak ◽

Increased Risk ◽

Measles Vaccination ◽

Serological Data ◽

Measles Outbreaks ◽

Measles Vaccination Coverage

Abstract Background The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. Methods Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. Results In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. Conclusion While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.

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Epidemiological and molecular characteristics of a measles outbreak in northern Vietnam, 2013–2014

Journal of Clinical Virology ◽

10.1016/j.jcv.2021.104840 ◽

2021 ◽

pp. 104840

Author(s):

Do Phuong Loan ◽

Trieu Thi Thanh Van ◽

Nguyen Thi Mai Duyen ◽

Pham Van Khang ◽

Pham Quang Thai ◽

...

Keyword(s):

Molecular Characteristics ◽

Northern Vietnam ◽

Measles Outbreak

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Who are the children at risk? Lessons learned from measles outbreaks

Epidemiology and Infection ◽

10.1017/s095026881100238x ◽

2011 ◽

Vol 140 (9) ◽

pp. 1578-1588 ◽

Cited By ~ 12

Author(s):

C. STEIN-ZAMIR ◽

H. SHOOB ◽

N. ABRAMSON ◽

G. ZENTNER

Keyword(s):

Immunization Coverage ◽

Lessons Learned ◽

Significant Shift ◽

Risk Markers ◽

Peak Incidence ◽

Young Infants ◽

Measles Outbreak ◽

Baby Clinic ◽

Measles Outbreaks ◽

Control Study

SUMMARYWe investigated a measles outbreak in the Jerusalem district in 2007–2008 (992 cases). Most cases (72·6%) were aged <15 years, 42·9% aged <5 years, and 12·8% were infants aged <1 year. The peak incidence rate was in infants aged 6–12 months (916·2/100 000). This represents a significant shift from former outbreaks in 2003–2004, where the peak incidence was in the 1–4 years age group. Of children aged <5 years the proportion aged 6–12 months tripled (7·7% vs. 25·6%). In a case-control study (74 cases, 148 controls) children who developed measles were less likely to be registered in a well-baby clinic and had lower overall immunization coverage. The differences in proportions for registration, DTaP3 and MMR1 coverage were 35·1%, 48·6% and 80·8%, respectively (all P<0·001). Rising birth order of cases and their siblings was associated with non-registration and non-compliance with MMR immunization. The vulnerability of young infants and the risk markers noted above should be taken into account in planning intervention programmes.

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