Hospital bundle prevented patient exposures during measles outbreak

Key takeaways:

• Measles exposures decreased following a coordinated response from a team at Nationwide Children’s Hospital.
• “Despite the outbreak, we continued to witness parental vaccine hesitancy.”

SEATTLE — An epidemiologist whose hospital responded to a recent measles outbreak described how the hospital was able to eliminate patient exposures with an intervention bundle that used electronic medical records.

Unvaccinated children were at the center of the outbreak in central Ohio, which was declared over in February. In all, 80 of the 85 children infected in the outbreak were unvaccinated against measles.

Katia C. Halabi, MD, associate medical director of hospital epidemiology at Nationwide Children’s Hospital in Columbus, described the hospital’s response to the outbreak in a presentation at the Society for Healthcare Epidemiology of America Spring Conference.

“We wanted to share our experience to remind people to think about measles in their differential diagnosis, highlight the resurgence of vaccine vaccine-preventable infections, describe the challenges we encountered — especially as the outbreak occurred [during a] peak of respiratory illness and high patient volumes — and share the learning points that might assist any other institution that might face a similar outbreak,” Halabi told Healio.

At the start of the outbreak, Nationwide Children’s formed a multidisciplinary team to create a coordinated response to the outbreak and develop ways of avoiding secondary transmission at the hospital’s main campus, offsite EDs, regional urgent care centers and in its primary care network.

They identified preliminary risk factors for measles by reviewing the charts of initial cases, including vaccine status, zip code of residence and known day care or household exposure. The risk factors were used to guide an intervention bundle that comprised enhanced screening at registration and triage, creation of electronic medical record alerts to identify at-risk patients, increased clinician education and expanded community messaging.

The researchers tracked patient exposures and calculated relative exposure scores — an internal metric that used the vaccine status of exposed patients and ventilation at the site of exposure to assess likelihood of secondary cases occurring from an exposure.

According to Halabi and colleagues, 65 patients with measles were seen at Nationwide Children’s facilities between Oct. 29 and Dec. 8, 2022. They divided the outbreak response into four time periods: cases identified retrospectively before the first diagnosis, between Oct. 29 and Nov. 7; initial case discovery, between Nov. 8 and 14; implementation of the prevention bundle, from Nov. 15 to 28; and a period after updates were made to the initial response — including updated EMR alerts and ongoing vaccination efforts — from Nov. 29 to Dec. 8.

The authors found that ambulatory health care exposures and the incidence of secondary cases decreased over the outbreak periods in response to implementation of the prevention bundle. Specifically, median patient exposures per ambulatory encounter decreased from 56.5 in the initial time period to zero in the last two time periods, after the bundle was rolled out.

Halabi said that “despite the outbreak, we continued to witness parental vaccine hesitancy.”

“The misconceptions around MMR, the limited resources in many countries, along with the added burden of the pandemic and the challenges it has imposed have decreased vaccination rates globally and as such we do expect to see more measles if we do not prevent it,” Halabi said. “Many physicians have never seen a case of measles before. With the resurgence, we have to maintain a high level of suspicion.”

References:

City of Columbus. Measles case summary: Central Ohio outbreak. https://public.tableau.com/app/profile/columbus/viz/MeaslesPublicReport/MeaslesPublicReport. Updated Feb. 10, 2023. Accessed April 14, 2023.

Halabi K, et al. Preventing measles transmission in ambulatory pediatric settings during peak respiratory viral season. Presented at: Society for Healthcare Epidemiology of America Spring Conference; April 11-14, 2023; Seattle.