Nosocomial measles infection in a pediatric hospital during a community-wide epidemic

Martha Elisa Rivera, MD. Wilbert Henry Mason, MD. Lawrence Alan Ross. MD, and Harry Tucker Wright Jr. MD. MPH

From the Department of Pediatrics, Division of Infectious Dis­eases, Children's Hospital of Los Angeles and University of Southern California School of Medicine, Los Angeles, 1991, J. Ped. V. 119, № 2.

From Jan. 1, 1988, through Dec. 31, 1988, a total of 89 cases of measles were observed at Children's Hospital in Los Angeles, and 37 patients were admitted to the hospital. Of the 37 patients, six were not initially thought to have measles, which resulted in exposure of 107 patients and 24 personnel. Of the exposed patients, measles developed in four. One nospcomially infected infant died of pneumonia. Another ex­posed patient was subsequently admitted to another hospital with unrecognized measles, which led to exposure of an additional eight patients. Of seven employees in whom measles developed, two required hospitalization because of pneumonia. Two hundred eleven employee days were lost because of

Measles exposure or infection. Infection control interventions included prophylaxis of exposed patients, employee education, and measles immunization for susceptible personnel. Of 1103 hospital personnel considered susceptible to measles, 800 received monovalent measles vaccine. No secondary cases of measles occurred in hospital personnel who received appropriate prophylaxis. We conclude that infection control programs aimed at mandating measles immunity in hospital employees at risk should be instituted. (J. Pediatr, 1991; 119; 183-6.)

Despite the introduction of measles vaccine in the United States in 1963, outbreaks continue to occur, especially in large urban areas. Such an outbreak has occurred in Los Angeles County since 1988. Although measles transmission in recent years has occurred mainly in schools or at home, as many as 3% to 5% of cases have resulted from nosocomial transmission to susceptible patients and employees in a variety of medical settings. We describe the impact of a measles epidemic in Los Angeles County on a children's hospital and how infection control measures were implemented to impede the spread of measles to both susceptible patients and employees.