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Easily accessed medical records key during measles outbreaks
Chen SY. J Infect Dis. 2011;doi:10.1093/infdis/jir115.
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Physicians must keep measles on the radar as a diagnosis and have quick access to vaccination records to minimize health care-associated spread, according to Sanny Y. Chen, PhD, and colleagues.
In the study, Chen and colleagues at the CDC and Arizona health authorities discussed the 2008 outbreak of measles in Tucson, Ariz., and demonstrated the high costs that hospitals may incur when responding to outbreaks such as these.
From Feb. 13 to July 21, 2008, there were 363 suspected, eight probable and 14 confirmed measles cases in Tucson after the admission of an infected Swiss traveler into a hospital there, the researchers said. All 14 confirmed case-patients were unvaccinated. Seven of the 14 cases were classified as health care-associated infections, and six of those cases occurred in a single hospital; seven patients were aged younger than 18 years.
As part of the investigation, health care facilities attempted to access records documenting evidence of measles immunity for 14,844 health care personnel at the involved hospitals. However, none of the hospitals maintained electronic records of health care personnel immunity status, so they were instead forced to review paper records.
Without readily accessible electronic records clearly showing immunity status, unnecessary serologic testing was conducted for some personnel who were immune to measles. A total of 4,448 health care personnel at the seven hospitals received immediate measles vaccinations because they lacked documentation of measles immunity.
The researchers said about 15,120 employee hours were lost in furloughs because of presumptive exposure, disease or lack of evidence of immunity. Overall, the estimated economic effect for just two of the hospitals was almost $800,000, with furloughs for health care personnel accounting for 56% of that cost.
To minimize these costs and to prevent the health care-associated spread of measles, the researchers said hospitals must: (1) ensure rapidly retrievable measles immunity records for health care personnel; (2) consider measles as a diagnosis, especially among patients presenting with fever, rash, and a recent history of international travel or contact with a person with a clinically consistent rash illness; and (3) institute immediate airborne isolation of patients with suspected and confirmed measles.
In an accompanying editorial, Stephen M. Ostroff, MD, of the Pennsylvania Department of Health, said the report is a wake-up call for health departments and hospitals across the country. Recounting the percentage of health care personnel who lacked immunity to measles in the Tucson outbreak, the same situation most likely exists among other US hospital personnel, Ostroff said, adding that international travel and the decision by some individuals to opt out of vaccination increase the risk for future outbreaks.
Disclosure: The researchers report no relevant financial disclosures.
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