Doctors call for better management of suspected measles casesBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1127 (Published 19 February 2013) Cite this as: BMJ 2013;346:f1127
With measles at its highest level in England and Wales for 18 years, a group of public health doctors are calling for more rigorous isolation of people with suspected measles in the waiting rooms of general practices and hospitals and for trusts to ensure that all staff members have received the MMR (mumps, measles, and rubella) vaccination.
There were 2016 confirmed cases of measles in England and Wales during 2012, the highest annual total since 1994. In northwest England 918 cases of measles have been confirmed since January 2012, with an ongoing outbreak in the Morecambe Bay area of Lancashire. Last month a measles outbreak was reported in northeast England, and last year prolonged outbreaks occurred in Merseyside and Sussex, with several smaller outbreaks occurring in traveller communities across England and Wales.
Writing in the BMJ this week, (BMJ ref needs to be added) Kenneth Lamden, consultant in health protection at Cumbria and Lancashire Health Protection Unit, and health protection colleagues from Liverpool and Manchester say a failure to isolate patients with a rash of possible infective origin in waiting rooms has led to a considerable number of secondary cases and to labour intensive contact tracing exercises in the northwest outbreak. Measles is highly infectious and anyone in close proximity to an infected person for just 15 minutes—for example, in a general practice or hospital waiting area—needs risk assessment for immunoglobulin prophylaxis.
Dr Lamden told the BMJ: “We recognise that isolation can be a problem if large numbers of children present with possible infective rash illness, but triage systems and clear procedures should be in place, including in general practice out of hours centres.”
The public health doctors also write that in their experience few acute or community trusts have robust MMR vaccination programmes in place for their staff: “They don’t appear to consider MMR an essential vaccination, and when they do, occupational health departments are stretched to deliver it.” They add that in primary care, occupational health provision is primitive, with neither general practitioners nor primary care trusts seeming to see MMR vaccination as their responsibility. As a result, in the current northwest outbreak at least 16 healthcare workers have developed measles and a substantial number of staff have been excluded from work.
It is difficult to establish the level of MMR coverage among healthcare workers as it is not reportable through occupational health departments. However, it is in national guidelines that all healthcare workers should have had MMR vaccination or be able to show that they have had measles in the past and are immune.
Dr Lamden told the BMJ: “Initially we might have expected low awareness of MMR vaccination among hospital and community trusts, but vaccination is national policy and it is frustrating how long it has taken for this message to be heard. The situation is particularly acute for [general practice] staff where it is difficult to find ownership for MMR vaccination.”
He added: “We have had situations, for example, where community staff whose responsibility it is to vaccinate during an outbreak have not known if they are immune to measles—either through two documented MMR vaccinations or measles IgG in serum.”
Cite this as: BMJ 2013;346:f1127