NYC health care facilities reduce risk for measles exposures
ATLANTA — Some outpatient health care facilities in New York City have implemented creative interventions to reduce measles exposures, researchers found.
Measles cases have surged worldwide due to gaps in vaccination coverage, and the CDC reported this week that cases in the United States have reached the highest level since 1994 — 6 years before the virus was declared eliminated in the country. The rise is being driven by an outbreak in New York City that began in September 2018 and includes 423 cases as of April 29.
The highly contagious measles virus can cause severe complications such as pneumonia, miscarriage and death, and can remain infectious in the air for 2 hours after an infected person coughs or sneezes.
“A person infected with measles can shed the virus for 4 days before rash onset, so the most important thing to prevent measles exposures in a clinical setting is to screen patients before they enter the building, either by telephone, with posters or with someone screening at the building entrance,” Karen A. Alroy, DVM, MPH, a CDC Epidemic Intelligence Service (EIS) officer in the New York City Department of Health and Mental Hygiene (DOHMH), told Infectious Disease News.
According to Alroy and colleagues, more than 2,000 people were exposed to measles in health care facilities in New York City during the study period, from Sept. 30 to Dec. 10, 2018. The DOHMH recommended that health care facilities screen for measles symptoms or exposures, educate patients and implement alternative isolation procedures when negative pressure rooms were unavailable.
Using a standard questionnaire, Alroy and colleagues conducted phone interviews over 3 days in December with infection control staff from 17 outpatient health care facilities that had measles exposures. The questionnaire included 14 questions about screening practices, facility infrastructure and procedures for seeing patients with suspected measles.
Alroy presented results from the investigation at the CDC’s annual EIS conference in Atlanta. According to the findings, 15 health care facilities responded, of which 87% (n = 13) reported screening for measles over the telephone while scheduling appointments. Furthermore, 73% (n = 11) reported screening at check-in and 100% said they posted signs about measles symptoms.
Although none of the surveyed health care facilities reported having a negative pressure room, 60% had written protocols to minimize exposure, Alroy and colleagues reported. Alternative isolation procedures that were “compatible with their clinic space and acceptable for staff” included separate entrances, outside examinations, after-hours examinations and at-home visits. The researchers reported that 87% (n = 13) of surveyed health care facilities implemented these alternative procedures for potentially infectious patients.
Alroy and colleagues said that preventing health care-associated measles exposures contributes to outbreak control, especially in a postelimination measles era.
“[Infectious disease doctors can] help increase staff awareness about measles and the importance of screening,” Alroy said. “Be prepared to address questions about measles and the vaccine to help allay the fears of patients and support colleagues who may ask for advice.” – by Marley Ghizzone
Alroy KA, et al. Interventions to reduce measles exposures in outpatient health care facilities — New York City, 2018. Presented at: Epidemic Intelligence Service conference; April 29-May 2, 2019; Atlanta.
NYC Health. Measles. https://www1.nyc.gov/site/doh/health/health-topics/measles.page. Accessed April 30, 2019.
Disclosures: The authors report no relevant financial disclosures.