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How Measles Spreads in the Healthcare Setting

While most measles cases are transmitted in the community, those infected commonly seek medical care when their symptoms worsen, setting in motion a rapid chain of nosocomial transmission.

Here’s how an outbreak began in one Chinese city:

A woman with a fever — who was later diagnosed with measles — was treated at the hospital by a doctor. Around the same time, a man brought his daughter to see the same doctor and had a 10-minute conversation with another man. In addition, the man with the daughter ate lunch with a third man. All three of the men came down with measles.

In all, 8 of the 10 patients in this outbreak had visited the same hospital.

No healthcare workers were infected, but that’s unusual. In fact, the risk of acquiring measles may be 13 to 19 times higher for susceptible healthcare personnel than for the general population.

Dozens upon dozens of scientific papers have documented measles transmission from patients to healthcare personnel and/or transmission from healthcare personnel to patients or to other healthcare workers.

While news reports tend to highlight insular ethnic and religious communities sceptical of vaccines, in reality, huge numbers of healthcare workers remain unvaccinated, allowing outbreaks to accelerate.

“Half of European countries have no measles vaccine policies for healthcare personnel,” reports the CDC.

Belgium is among the 12 European countries where the measles vaccine is recommended for all susceptible healthcare workers, yet in a recent Belgian outbreak of 288 cases, 10% were healthcare workers.

Italy also recommends vaccination for healthcare workers, yet during one 8-month period, Italy reported over 4,400 measles cases — 7% of them healthcare workers. Among the 239 healthcare workers infected in that outbreak, 85% had never been vaccinated, and 10% had received just one of the recommended two doses.

In another 14-month period, Italian healthcare workers accounted for 11.6% of reported measles cases. In Italy, as in most countries, healthcare workers are not required to show evidence of measles immunity as a condition of employment.

How Hospitals Can Stop Measles Spread

By implementing new policies and new technology, hospitals can have a considerable impact in containing measles outbreaks.

Here’s what healthcare facilities can do:

Mandate measles vaccination among staff who have direct contact with patients.

In some regions, measles vaccine coverage among healthcare workers is dismal — just 23% in Greece, 43.6% in France, and 62.3% in Denmark, various studies have found.

Some healthcare workers oppose mandatory vaccination policies as a “breach of individual rights.” in fact, in a study of German healthcare personnel, only 47.9% surveyed supported mandatory measles vaccination.

Nonetheless, infection-control experts agree: healthcare workers must be vaccinated.

As one research team noted in Emerging Health Threats, vaccinated personnel should include housekeeping staff, receptionists phlebotomists, dietitians, language translators, pharmacists, and radiographers.

Even in countries with lax vaccination requirements, hospitals can implement their own, more stringent policies, requiring personnel to present documentation of immunity status or submit to testing.

Such policies “are needed in order to virtually set to zero the risk of acquiring and spreading measles in healthcare settings,” concluded an Italian team.

Better train healthcare workers to recognize measles symptoms.

As CDC researchers have observed, many nurses and physicians in emergency departments do not suspect measles, when patients present before the rash appears.

This is what happened when an Israeli visitor to the United States developed a fever and cough. The doctor who treated the man had never seen measles, misdiagnosed the symptoms as bronchitis, prescribed him antibiotics, and sent him on his way.

Before long, officials had traced 39 measles cases to this traveller.

Enforce isolation guidelines.

Healthcare facilities must immediately isolate patients suspected of measles and obtain laboratory confirmation of the diagnosis before admitting these patients to hospital wards.

Once admitted, a measles patient must be isolated to a single room until four days after the rash onset.

Improve ventilation and air purification.

When analyzing a measles outbreak at a Chinese hospital, investigators observed that the rooms where patients had become infected were poorly ventilated and that air dis-infection devices were not enabled.

Given the highly infectious nature of measles, air dis-infection — in isolation rooms and in common areas such as the emergency department — is particularly important.

HEPA filters have long been used in the healthcare setting, but they only trap pathogens rather than kill them. Ultra-low-energy plasma technology by Novaerus is more effective at destroying airborne pathogens.

Novaerus technology, deployed in hospitals worldwide, can be easily, safely, and affordably installed in a hospital via portable wall units.

Given the current measles surge, hospitals must take a proactive role in containing the virus. These efforts will help eradicate a disease that should have disappeared decades ago.