Just over a month into 2019, the Centers for Disease Control and Prevention has identified 79 measles cases in the U.S. That total is more than 20% of the 372 cases identified during all of 2018.
The CDC has reported that four of the locations - Washington State, Texas, New York State and New York City - are defined as a measles outbreak, which is three or more cases in a single place. The Association of Professionals in Infection Control and Epidemiology said recent outbreaks of measles and mumps in the U.S. call for the importance of integrated infection prevention response.
Minnesota measles outbreak research
In research released last summer at APIC's 45th annual conference in Minneapolis, the association studied the response to a 2017 measles outbreak in Minnesota, which involved 75 confirmed cases. HealthPartners, which includes Methodist Hospital and Park Nicollet Health Services' 20-plus clinics, cared for 24 of the cases in Minnesota. During the outbreak, APIC noted that HealthPartners activated a system-wide command center that allowed infection preventionists to collaborate as an integrated system. Interventions facilitated through the command center included creating standard patient and visitor messaging in multiple languages and leveraging the integrated electronic health record to support active measles surveillance, symptom-based patient triage and timely precaution initiations.
"Every time you have an event like this, there's an opportunity to apply what you've learned as a system to other situations," Amy Priddy, DNP, RN, CIC, lead study author and the infection prevention senior manager at Park Nicollet Health Services, said in the APIC news release. "Our integrated response allowed us to share information in real time and adjust prevention strategies in a timely way."
Vaccinations, according to researchers, played an important role in stemming the outbreak. Park Nicollet reported no cases of healthcare-associated measles transmission. A total of 9,731 patients and healthcare staff received the measles vaccine. That total was a 118% increase over the same time period a year earlier.
Texas measles outbreak outcomes
In 2017, Texas experienced the largest mumps outbreak in 20 years. Infection preventionists noted that long-term care facilities lacked the recommended vaccinations for healthcare workers that are common at acute care facilities. A study of the Texas outbreak revealed that 67% of long-term care facilities lacked a designated infection preventionist, and many of those facilities were not familiar with mumps testing recommendations.
- Public health officials issued health advisories in Texas that shared general mumps information, along with testing guidelines.
- They also advised unvaccinated healthcare workers at facilities with mumps cases present to stay home from work.
- In addition, public health workers called facilities with diagnosed mumps cases to share proper application of infection control guidelines and standards.
"Many of the providers were unfamiliar with mumps because they've never seen it before," said Thi Dang, MPH, CHES, CIC, lead author of the study. "This gap, and others we identified, provides valuable information for any outbreaks that we might be faced with in the future." Both studies, according to APIC 2018 President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, highlighted the need for infection prevention and control preparedness during outbreaks in the community. Key components identified to successfully eradicate measles and mumps outbreaks included encouraging vaccinations and education around symptoms.
"Infection preventionists play a critical role in the public health response to outbreak situations by communicating and implementing control measures," Haas said in the release. "These case studies show clearly that comprehensive strategies in the face of outbreak situations go a long way toward preventing further spread of infection and disease."
Take these courses to learn about measles outbreaks and vaccination:
Measles: How to Approach Parents About Vaccination (1 contact hr) Measles is primarily a disease of childhood, but it can also occur in adolescents and adults. It is one of the most highly infectious human pathogens known. With exposure, up to 90% of susceptible individuals develop the disease. Measles is transmitted directly person-to-person via contact with respiratory droplets. Airborne transmission via aerosolized droplet nuclei has also been documented in closed areas (e.g., examination rooms), where the virus can remain suspended in the air for several hours. This module provides information for RNs, APNs, and physicians about measles and parental concerns regarding the safety of the MMR vaccine for their children. Childhood and Adolescent Immunization Update (1 contact hr) The 2014 measles outbreak in the U.S. brought home the challenges healthcare providers face in meeting Healthy People 2020 goals for prevention of infectious diseases related to living in a mobile society where diseases do not stop at geographical borders. Regular updates are made to the U.S. immunization schedule with an ongoing need for educating parents and the public. This updated CE module provides the background information needed to increase understanding about current recommendations and vaccination information needed to immunize children and adolescents appropriately. Adult Immunizations: Growing Needs, Growing Numbers (1 contact hr) Vaccine-preventable diseases strike millions of adults annually. Not long ago, what nurses needed to know about immunizations was simple: Infants and young children received most of the vaccines, and adult immunizations could be counted on one hand, with a few fingers left over. However, recently the number of recommended immunizations for people of all ages has increased to a level not seen before, and the number of vaccines keeps rising. This module addresses various vaccine formulations and indications and provides resources for healthcare professionals to stay up to date on vaccine recommendations.
