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Vol. 22. Issue 1.
Pages 20-27 (January - April 2021)
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Vol. 22. Issue 1.
Pages 20-27 (January - April 2021)
Original article
Measles outbreak related to healthcare transmission
Brote de sarampión relacionado con trasmisión en centro sanitario
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N. Tornera,b, J. Ferràsb,
Corresponding author
joaquim.ferras@gencat.cat

Corresponding author.
, L. Curtob, J. Rebullc, J. Sold, J. Costae, M.M. Mosquerae, C. Izquierdob, A. Martíneza,b, M. Janéa,b
a CIBER Epidemiolgy and Public Health (CIBERESP), Spain
b Public Health Agency of Catalonia, Barcelona, Spain
c Department of Preventive Medicine and Public Health, Hospital Tortosa Verge de la Cinta, Tortosa, Spain
d Occupational Medicine, Basic Preventive Unit, Institut Català de la Salut-Terres de l’Ebre, Tortosa, Spain
e Microbiology Department, Hospital Clínic, Barcelona, Spain
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Tables (2)
Table 1. Clinical presentation and complications of cases according to immunization status.
Table 2. Distribution of MMR measles immunization, first and second dose, and laboratory results of cases immunized with 2 dose MCV.
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Abstract
Introduction

Measles has a high transmission rate among susceptible populations. Healthcare facilities can play an important role in measles transmission. The aim of this study is to describe a measles outbreak in a highly immunized community and the implication of healthcare workers in the transmission of the disease.

Methods

Descriptive study of measles outbreak linked to hospital setting with sociodemographic, clinical, virological and immunization variables studied. Cases were confirmed by RT-PCR in clinical specimens and genotyped by nucleotide sequencing. Association was assessed by chi2, Fisher's exact and z test. Statistical significance at p=0.05.

Results

47 suspected measles cases were reported from March to June 2018 at Terres de l’Ebre, Catalonia. Fourteen cases were confirmed, 8 cases (57%) were men; median age of cases 33y (range 16–46 y). Hospital associated transmission was confirmed in 13 (93%) cases, 8 (61.5%) were hospital staff. Five (38.5%) were healthcare workers (HCW), three (23%) non-healthcare workers (non-HCW) and 6 (46%) were patients attended at the hospital. Four cases (28.5%) were immunized with 2 doses of measles virus containing vaccine (MCV); 3 (75%) were HCW. No statistical difference observed among hospital staff and community cases as to immunization (OR 2.4 95%CI: 0.17–32.88; p=0.49). Genotype B3 MVs/Dublin.IRL/8.16-variant was obtained from confirmed cases.

Conclusion

Suspecting measles diagnosis, allows for immediate airborne isolation, and retrieving measles immunity records for healthcare facility employees and contacts. Vaccination of HCW and the adoption of good infection control will minimize nosocomial transmission and spreading of the virus to the community.

Keywords:
Measles
Outbreak
Nosocomial transmission
Immunization
Resumen
Introducción

El sarampión tiene una elevada tasa de transmisión entre poblaciones susceptibles. Los centros sanitarios pueden desempeñar un papel importante en la transmisión del sarampión. El objetivo de este estudio es describir un brote de sarampión en una población con elevada cobertura de inmunización y la implicación de los trabajadores sanitarios en la transmisión de la enfermedad.

Métodos

Estudio descriptivo de un brote de sarampión vinculado al entorno hospitalario. Se estudiaron variables sociodemográficas, clínicas, virológicas y de estado vacunal de los casos. Se confirmaron los casos por RT-PCR en muestras clínicas y posterior genotipado por secuenciación nucleotídica. Análisis estadístico mediante χ2, prueba exacta de Fisher y test z; nivel de significación estadística p<0,05.

Resultados

De marzo a junio de 2018 se notificaron un total de 47 casos sospechosos de sarampión en Terres de l’Ebre, Cataluña (España). Hubo 14 casos, y 8 (57%) eran hombres; mediana de edad, 33años (rango 16-46años). Se confirmó transmisión hospitalaria en 13 (93%) de los casos; 8 (61,5%) eran personal hospitalario. Cinco (38,5%) eran personal sanitario (PS), 3 (23%) Pno-S y 6 (46%) eran pacientes del hospital. Cuatro (28,5%) estaban vacunados con 2 dosis de vacuna antisarampión (TV), 3 de los cuales (75%) eran PS. No se observó diferencia significativa entre personal hospitalario y casos comunitarios sobre estado vacunal (OR: 2,4; IC95%: 0,17-32,88; p=0,49). Se identificó genotipo B3 MVs/Dublin.IRL/8.16-variant en los casos confirmados por PCR.

Conclusión

La sospecha de sarampión como diagnóstico permite el aislamiento inmediato de los casos y la revisión del estado vacunal frente al sarampión de personal y contactos de los centros sanitarios. La vacunación del personal sanitario y el seguimiento de buenas prácticas de control y prevención de la infección permiten disminuir el riesgo de transmisión nosocomial, así como la diseminación del virus y su repercusión en la comunidad.

Palabras clave:
Sarampión
Brote epidémico
Transmisión nosocomial
Inmunización

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