Susan J M Hahné1, Laura M Nic Lochlainn1,2, Nathalie D van Burgel3, Jeroen Kerkhof1, Jussi Sane1,2, Kioe Bing Yap4, Rob S van Binnendijk1. 1. Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven. 2. European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden. 3. Haga Hospital. 4. Municipal Health Service Haaglanden, the Hague, The Netherlands.
Abstract
BACKGROUND: We investigated a measles outbreak among healthcare workers (HCWs) by assessing laboratory characteristics, measles vaccine effectiveness, and serological correlates for protection. METHODS: Cases were laboratory-confirmed measles in HCWs from hospital X during weeks 12-20 of 2014. We assessed cases' severity and infectiousness by using a questionnaire. We tested cases' sera for measles immunoglobulin M, immunoglobulin G, avidity, and plaque reduction neutralization (PRN). Throat swabs and oral fluid samples were tested by quantitative polymerase chain reaction. We calculated attack rates (ARs) by vaccination status and estimated measles vaccine effectiveness as 1 - [ARvaccinated/ARunvaccinated]. RESULTS: Eight HCWs were notified as measles cases; 6 were vaccinated with measles vaccine twice, 1 was vaccinated once, and 1 was unvaccinated. All 6 twice-vaccinated cases had high avidity and PRN titers. None reported severe measles or onward transmission. Two of 4 investigated twice-vaccinated cases had pre-illness PRN titers of >120 mIU/mL. Among 106 potentially exposed HCWs, the estimated effectiveness of 2 doses of measles vaccine was 52% (95% confidence interval [CI], -207%-93%). CONCLUSIONS: Measles occurred in 6 twice-vaccinated HCWs, despite 2 having adequate pre-exposure neutralizing antibodies. None of the twice-vaccinated cases had severe measles, and none had onward transmission, consistent with laboratory findings suggesting a secondary immune response. Improving 2-dose MMR coverage among HCWs would have likely reduced the size of this outbreak.
BACKGROUND: We investigated a measles outbreak among healthcare workers (HCWs) by assessing laboratory characteristics, measles vaccine effectiveness, and serological correlates for protection. METHODS: Cases were laboratory-confirmed measles in HCWs from hospital X during weeks 12-20 of 2014. We assessed cases' severity and infectiousness by using a questionnaire. We tested cases' sera for measles immunoglobulin M, immunoglobulin G, avidity, and plaque reduction neutralization (PRN). Throat swabs and oral fluid samples were tested by quantitative polymerase chain reaction. We calculated attack rates (ARs) by vaccination status and estimated measles vaccine effectiveness as 1 - [ARvaccinated/ARunvaccinated]. RESULTS: Eight HCWs were notified as measles cases; 6 were vaccinated with measles vaccine twice, 1 was vaccinated once, and 1 was unvaccinated. All 6 twice-vaccinated cases had high avidity and PRN titers. None reported severe measles or onward transmission. Two of 4 investigated twice-vaccinated cases had pre-illness PRN titers of >120 mIU/mL. Among 106 potentially exposed HCWs, the estimated effectiveness of 2 doses of measles vaccine was 52% (95% confidence interval [CI], -207%-93%). CONCLUSIONS: Measles occurred in 6 twice-vaccinated HCWs, despite 2 having adequate pre-exposure neutralizing antibodies. None of the twice-vaccinated cases had severe measles, and none had onward transmission, consistent with laboratory findings suggesting a secondary immune response. Improving 2-dose MMR coverage among HCWs would have likely reduced the size of this outbreak.
Authors: Ashley N Nelson; Wen-Hsuan W Lin; Rupak Shivakoti; Nicole E Putnam; Lisa Mangus; Robert J Adams; Debra Hauer; Victoria K Baxter; Diane E Griffin Journal: JCI Insight Date: 2020-02-13
Authors: Kyunghyun Song; Ju Mi Lee; Eun Ju Lee; Bo Ram Lee; Ji Young Choi; Jihee Yun; Se Na Lee; Mi Young Jang; Han Wool Kim; Han-Sung Kim; Song Mi Moon; Yong Kyun Kim Journal: Eur J Clin Microbiol Infect Dis Date: 2022-01-09 Impact factor: 3.267
Authors: Heather Venkat; Graham Briggs; Shane Brady; Ken Komatsu; Clancey Hill; Jessica Leung; Manisha Patel; Eugene Livar; Chia-Ping Su; Ahmed Kassem; Sun B Sowers; Sara Mercader; Paul A Rota; Diana Elson; Evan Timme; Susan Robinson; Kathryn Fitzpatrick; Jabette Franco; Carole Hickman; Paul A Gastañaduy Journal: Clin Infect Dis Date: 2019-05-30 Impact factor: 9.079
Authors: Mark Muscat; Myriam Ben Mamou; Simarjit Singh; Catharina de Kat; Dragan Jankovic; Shahin Huseynov; Sergei Deshevoi; Siddhartha Datta; Patrick O'Connor Journal: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz Date: 2019-04 Impact factor: 1.513
Authors: Wen-Hsuan W Lin; Eileen Moran; Robert J Adams; Robert E Sievers; Debra Hauer; Steven Godin; Diane E Griffin Journal: Sci Transl Med Date: 2020-04-01 Impact factor: 17.956