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J Pediatr Infect Dis 2022; 17(06): 303-307
DOI: 10.1055/s-0042-1758054
Original Article

Prevention of Health Care–Associated Measles Transmission in a Pediatric Clinic

Ayşe Kaman 
1   Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
,
Melahat Melek Oğuz
2   Department of Social Pediatrics, Dr. Sami Ulus Maternity and Children's Research and Training Hospital, Ankara, Turkey
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Abstract

Objective Preventive measures in the setting of a suspected measles case in a hospital setting are important to stop the secondary spread. In this report, we evaluated the prevention attempts after two suspected cases of measles were reported in a pediatric clinic.

Methods We evaluated prevention interventions including isolation, intravenous immunoglobulin, or measles–mumps–rubella (MMR) vaccine after two patients were diagnosed with maculopapular rash compatible with measles in the pediatric clinic.

Results There were 50 patients (29 were outpatients, 21 were inpatients), 19 health care personnel (HCP), and 50 caregivers who were in contact with index cases. All of the HCP and 40 of the caregivers were immune to measles. Additional dose of MMR vaccine was recommended to five of the outpatients by phone. A total of 12 patients who were being followed up as inpatients (8 patients aged 6–12 months, 4 patients aged ≥ 12 months) were vaccinated with one dose of MMR vaccine. Only a 12-year-old male patient was admitted due to complaints suggesting measles after 14 days from discharge. It was learned that he had received a single dose of vaccine before so he was recommended an additional dose of MMR vaccine by the phone, but he did not go to the health institution on the day of the call.

Conclusion Postexposure prophylaxis is effective to prevent measles transmission. Although young infants have the highest risk for transmission of measles in a health care–associated outbreak, adolescents and older children who are single vaccinated also have high risk for clinical measles.

Keywords

measles - prevention - children


Publication History

Received: 26 May 2022

Accepted: 15 September 2022

Article published online:
07 November 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Maldonado YA, Shetty AK. Rubeola virus: measles and subacute sclerosing panencephalitis. In: Long SS, Ficher M, Prober CG. eds. Principles and Practice of Pediatric Infectious Diseases. 5th ed.. Philadelphia, PA: Elsevier; 2018: 1169-1175
    Google Scholar
  • 2 Drutz J. Measles. Pediatr Rev 2016; 37 (05) 220-221
    CrossrefPubMedGoogle Scholar
  • 3 Centers for Disease Control and Prevention. Advances in global measles control and elimination: summary of the 1997 international meeting. MMWR Recomm Rep 1998; 47 (RR-11): 1-23
    PubMedGoogle Scholar
  • 4 Patel MK, Dumolard L, Nedelec Y. et al. Progress toward regional measles elimination worldwide, 2000–2018. MMWR Morb Mortal Wkly Rep 2019; 68 (48) 1105-1111
    CrossrefPubMedGoogle Scholar
  • 5 Emek M, Islek D, Atasoylu G. et al. Association between seroprevalence of measles and various social determinants in the year following a measles outbreak in Turkey. Public Health 2017; 147: 51-58
    CrossrefPubMedGoogle Scholar
  • 6 Metin O, Tanir G, Oz FN. et al. Evaluation of 44 pediatric measles cases detected in Ankara, Turkey during 2012-2013 epidemic and molecular characterization of the viruses obtained from two cases [in Turkish]. Mikrobiyol Bul 2014; 48 (02) 259-270
    CrossrefPubMedGoogle Scholar
  • 7 Karaayvaz S, Oğuz MM, Beyazova U. et al. Evaluation of measles immunity in Turkey: is it still a threat?. Turk J Med Sci 2019; 49 (01) 336-340
    CrossrefPubMedGoogle Scholar
  • 8 Surveillance Report. Annual Epidemiological Report for 2019. Measles. [Cited October 10, 2020]. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/measles-2019-aer.pdf
    PubMedGoogle Scholar
  • 9 Tapisiz A, Polat M, Kara SS, Tezer H, Simsek H, Aktas F. Prevention of measles spread on a paediatric ward. Epidemiol Infect 2015; 143 (04) 720-724
    CrossrefPubMedGoogle Scholar
  • 10 Hubiche T, Brazier C, Vabret A, Reynaud S, Roudiere L, Del Giudice P. Measles transmission in a fully vaccinated closed cohort: data from a nosocomial clustered cases in a teenage psychiatric unit. Pediatr Infect Dis J 2019; 38 (09) e230-e232
    CrossrefPubMedGoogle Scholar
  • 11 Bitzegeio J, Bukowski B, Hausner M. et al. Two measles clusters in connection with short inner-European air travels indicating impediments to effective measles control: a cluster analysis. Travel Med Infect Dis 2020; 33: 101542
    CrossrefPubMedGoogle Scholar
  • 12 Microimmune. Measles IgG capture EIA: Cat. No: MeVG011, UK. Available at: http://www.microimmune.co.uk/new/measles_IgG_cap.htm
    PubMed
  • 13 World Health Organization. Global measles and rubella strategic plan, 2012–2020. Geneva, Switzerland: World Health Organization; 2012. Accessed October 10, 2020 at http://www.who.int/immunization/newsroom/Measles_Rubella_StrategicPlan_2012_2020.pdf
    PubMedGoogle Scholar
  • 14 Thole S, Kalhoefer D, An der Heiden M, Nordmann D, Daniels-Haardt I, Jurke A. Contact tracing following measles exposure on three international flights, Germany, 2017. Euro Surveill 2019; 24 (19) 1800500
    CrossrefPubMedGoogle Scholar
  • 15 Chen SY, Anderson S, Kutty PK. et al. Health care-associated measles outbreak in the United States after an importation: challenges and economic impact. J Infect Dis 2011; 203 (11) 1517-1525
    CrossrefPubMedGoogle Scholar
  • 16 American Academy of Pediatrics. Measles. In: Kimberlin DW. ed. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed.. Elk Grove Village, IL: American Academy of Pediatrics; 2018: 537-550
    Google Scholar
  • 17 Berkovich S, Starr S. Use of live-measles-virus vaccine to abort an expected outbreak of measles within a closed population. N Engl J Med 1963; 269: 75-77
    CrossrefPubMedGoogle Scholar
  • 18 Ruuskanen O, Salmi TT, Halonen P. Measles vaccination after exposure to natural measles. J Pediatr 1978; 93 (01) 43-46
    CrossrefPubMedGoogle Scholar
  • 19 Science M, Savage R, Severini A. et al. Measles antibody levels in young infants. Pediatrics 2019; 144 (06) e20190630
    CrossrefPubMedGoogle Scholar
  • 20 Cinicola B, Conti MG, Terrin G. et al. The protective role of maternal immunization in early life. Front Pediatr 2021; 9: 638871
    CrossrefPubMedGoogle Scholar
  • 21 Young MK, Nimmo GR, Cripps AW, Jones MA. Post-exposure passive immunisation for preventing measles. Cochrane Database Syst Rev 2014; (04) CD010056
    PubMedGoogle Scholar
  • 22 Kohlmaier B, Holzmann H, Stiasny K. et al. Effectiveness and safety of an intravenous immune globulin (IVIG) preparation in post-exposure prophylaxis (PEP) against measles in infants. Front Pediatr 2021; 9: 762793
    CrossrefPubMedGoogle Scholar
  • 23 Modrof J, Tille B, Farcet MR. et al. Measles virus neutralizing antibodies in intravenous immunoglobulins: is an increase by revaccination of plasma donors possible?. J Infect Dis 2017; 216 (08) 977-980
    CrossrefPubMedGoogle Scholar
  • 24 T.C. Ministry of Health. Public Health Institution of Turkey - Department of Vaccine Preventable Diseases. Measles Elimination Program. Official letter dated 20.04.2017 and numbered 21001706. Accessed October 10, 2020, at: https://hsgm.saglik.gov.tr/dosya/mevzuat/genel_nitelikli_yazilar/asi_db/kizamik_eliminasyon_programi_67643.pdf
    PubMedGoogle Scholar