Measles outbreaks among health workers in a university hospital admission ward in Northeastern Thailand in 2019: reflections on the occupational health management system

Subsookumnuay P; Chaiear N; Chanpho P; Pithak P

Authors

Subsookumnuay P Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
Chaiear N Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
Chanpho P Occupational Health and Safety Office, Faculty of Medicine, Khon Kaen University, Thailand
Pithak P Communicable Disease Control Unit, Faculty of Medicine, Khon Kaen University, Thailand

Keywords:

measles, health workers, occupational health management system, outbreak investigation, hospital setting

Abstract

Objectives This study examined a measles outbreak among health workers in a university hospital admission ward and details of the existing occupational health management system.

Methods Secondary data was obtained from two sources: 1) from the Occupational Health and Safety Office outbreak investigation report a post-exposure immunity evaluation which is completed after a measles, mumps, or rubella outbreak and 2) from the medical records of the individual cases. In addition, the Occupational Health and Safety Office guidelines were reviewed and a descriptive epidemiological investigation was conducted.

Results A total of 75 health workers in the university hospital admissions ward who were potentially exposed were included in the study, of whom three were diagnosable as measles based on a positive immunoglobulin M (IgM) test. The three health workers who were identified as confirmed cases were nursing assistants; two worked in the admissions ward 4A, and one worked in the cardiac care unit. We found evidence that a propagated source caused the outbreak. The occupational health management system in the hospital at that time had only exposure and post-exposure protocols, but no pre-exposure protocol.

Conclusion None of the health workers who were diagnosable as measles had been examined for measles immunity during their pre-placement health examination. The occupational health management system should revise the policy for ensuring the immunity to measles of health workers before allowing them to begin work and conducting a respirator fit test before using an N95 respirator.

References

Bureau of General Communicable Disease Measles [Internet]. 2015. [cited 2019 March 24]. Available from: https://bit.ly/2UKG88w (in Thai)

World Health Organization. Measles [Internet]. 2020. [cited 2020 May 20]. Available from: https://bit.ly/3p4tm0S

Centers for Disease Control and Prevention (U.S.). Transmission of measles [Internet]. 2018. [cited 2019 March 24]. Available from: https://bit.ly/3k852Yd

White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, Mumps, and Rubella. Clin Obstet Gynecol. 2012;55:550–9.

Centers for Disease Control and Prevention (U.S.). Measles complications [Internet]. 2020. [cited 2019 March 24]. Available from: https://bit.ly/2IjC2zR

Centers for Disease Control and Prevention (U.S.). Global control and regional elimination of measles, 2000-2011. MMWR Morb Mortal Wkly Rep. 2013;62: 27–31.

Coughlin MM, Beck AS, Bankamp B, Rota PA. Perspective on global measles epidemiology and control and the role of novel vaccination strategies. Viruses [Internet]. 2017. [cited 2019 March 24];9(1):[about 1 p.]. Available from: https://www.mdpi.com/1999-4915/9/1/11

World Health Organization. Measles and rubella surveillance data [Internet]. 2019. [cited 2019 Mar 24]. Available from: https://bit.ly/3eFrgzE

Occupational Safety and Health Administration. Control and prevention [Internet]. 2020. [cited 2020 Jul y1]. Available from: https://bit.ly/3eHOZPG

Centers for Disease Control and Prevention (U.S.). Measles vaccination [Internet]. 2019. [cited 2020 July 1]. Available from: https://bit.ly/3lc1ndv

World Health Organization. The next frontier. In: Immunization achievements in South-East Asia: the platform for measles elimination. World Health Organization. Regional Office for South-East Asia; 2017. p. 33–40.

World Health Organization. Reported estimates of MCV1 coverage [Internet]. 2019. [cited 2020 May 22]. Available from: https://bit.ly/3eMokBt

World Health Organization. Reported estimates of MCV2 coverage [Internet]. 2019. [cited 2020 May 22]. Available from: https://bit.ly/3kjnqxG

Unahalekhaka A. Vaccine preventable diseases among hospital. Nurs J. 2013;40 Suppl:90–6. (in Thai)

Chaiear N, Charerntanyarak L, Kanjanarach T, Kongpeth C, Phachanid S. Sickness absence among nursing staff of Srinagarind hospital. Srinagarind Med J. 2002;17:171–9. (in Thai)

Bureau of Occupational and Environmental Diseases (Public Organization). Work risk assessment guide for health worker. Nonthaburi: The Institute; 2011. p. 5–8. (in Thai)

Atkinson WL, Markowitz LE, Adams NC, Seastrom GR. Transmission of measles in medical settings–United States, 1985-1989. Am J Med. 1991;91:320S-24S.

Atkinson WL. Measles and healthcare workers. Infect Control Hosp Epidemiol. 1994;15:5–7.

Berry L, Palmer T, Wells F, Williams E, Sibal B, Timms J. Nosocomial outbreak of measles amongst a highly vaccinated population in an English hospital setting. Infect Prev Pract. 2019;1:100018.

Occupational Safety and Health Administration. Measles: control and prevention [Internet]. N.d. [cited 2019 Mar 24]. Available from: https://bit.ly/2I9v94o

Centers for Disease Control and Prevention (U.S.). Interim measles infection prevention recommendations in healthcare settings [Internet]. 2019. [cited 2019 March 24]. Available from: https://bit.ly/3n3eQEQ

WorkSafe Victoria. Occupational health and safety management systems [Internet]. 2020. [cited 2020 July 1]. Available from: https://bit.ly/3kdm9I4

Occupational Safety and Health Administration. Introduction. Washington DC: The Institute; 2013. p. 3–4.

Work Safe British Columbia. Measles [Internet]. 2020. [cited 2020 Jul 1]. Available from: https://bit.ly/32saBL5

Advisory Committee on Immunization Practices, Center for Disease Control and Prevention. Immunization of health care personnel: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2011;60:1-45.

Jittpoonkuson T, Wongcong W. Occupational Communicable Diseases, Immunity Status Study and Immunization Program Arrangement for the BMA General Hospital Health Care Personnel. Vajira Med J. 2015;59: 15–24.

Centers for Disease Control and Prevention (U.S.). Measles signs and symptoms [Internet]. 2019. [cited 2020 Jul 1]. Available from: https://bit.ly/36dr5b8

Healthcare Accreditation Institute (Public Organization). Organization management overview. In: Hospital and healthcare standards. 4th ed. Nonthaburi: The Institute; 2019. p. 9–50. (in Thai)

Healthcare Accreditation Institute (Public Organization). Key hospital systems. In: Hospital and healthcare standards. 4th ed. Nonthaburi: The Institute; 2019. p. 51–132. (in Thai)

Grammens T, Schirvel C, Leenen S, Shodu N, Hutse V, Mendes da Costa E, et al. Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges. Euro Surveill. 2017;22:1-5

Werber D, Hoffmann A, Santibanez S, Mankertz A, Sagebiel D. Large measles outbreak introduced by asylum seekers and spread among the insufficiently vaccinated resident population, Berlin, October 2014 to August 2015. Euro Surveill. 2017;22:1-8

Novotny T, Jennings CE, Doran M, March CR, Hopkins RS, Wassilak SG, et al. Measles outbreaks in religious groups exempt from immunization laws. Public Health Rep. 1988;103:49–54.

Centers for Disease Control and Prevention (U.S.). Healthcare professionals: clinical resources [Internet]. 2018. [cited 2019 March 24]. Available from: https://bit.ly/36kLuLh

Tharmaphornpilas P. Thailand’s measles elimination project in accordance with the international commitment. In: Tharmaphornpilas P, Chompook P, Leelathorn L, editors. Guidelines for disease surveillance, outbreak control, treatment, and laboratory diagnosis in accordance with the international commitment to the elimination of measles. Bangkok: Bureau of General Communicable Disease; 2012. p. 1–6. (in Thai)

Bunyan D, Ritchie L, Jenkins D, Coia JE. Respiratory and facial protection: a critical review of recent literature. Journal of Hospital Infection. 2013;85:165–9.

Winter S, Thomas JH, Stephens DP, Davis JS. Particulate face masks for protection against airborne pathogens – one size does not fit all: an observational study. Crit Care Resusc. 2010;12:24–7.