Wales sets up drop-in vaccination clinics to tackle measles outbreakBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2452 (Published 16 April 2013) Cite this as: BMJ 2013;346:f2452
All rapid responses
Response to the response from Dr Mearkle and colleagues:
Dear Dr Mearkle
I see that the staff are investigated for immune status in respect of Measles. Good. But what about rubella? Many staff, specially those from abroad and also men from these islands may be non-immune. You do not suggest investigating this group. May I ask , why?
Finally, if you can recommend investigating the immune status of the staff, should you not also offer a check of the immune status of the teenagers? Of course it would be costly. However, some parents may be willing to pay for the tests.
I would be glad of your thoughts. Perhaps the medical ethicists would also care to join in?
Competing interests: Looking for facts
The measles outbreak in Wales has highlighted the vulnerability of the UK population to measles virus due to low MMR uptake. Healthcare workers (HCW) are at risk of acquiring and transmitting the disease to their patients. We asked local trusts whether they assess measles susceptibility and offer MMR to their staff. The CMO called on trusts to ensure HCW are vaccinated with MMR (1) but a recent UK study shows that 3% of HCW were non-immune to measles. (2)
In December 2012-January 2013 the Surrey and Sussex Health Protection Unit undertook a survey of all 11 local provider trusts (acute and community). This involved telephone interviews with occupational health and infection control staff (response rate 100%) to ask about their policy around MMR in HCW.
All the trusts considered measles immunity of new starting staff, but vaccination with MMR was not mandatory in non-immune staff. Many trusts only routinely assessed measles immunity after the DH issued guidance in 2007 (3). Eight of the 11 trusts had undertaken retrospective work to existing staff in high risk areas, but only 1 trust was extending this to all existing staff. This suggests that many staff were working with unknown measles status and data shared by some trusts confirmed this. Hospitals where measles had previously caused infection control issues were more likely to report that measles immunity was considered after staff started with the trust. Hospitals with strict pre-employment testing felt their policies were successful and resulted in higher attendance rates.
Consequences for hospitals with susceptible HCW are potentially serious. Those known to be susceptible should not care for patients with measles, and if they have had contact, may need to be excluded from day 5 for up to 21 days after exposure (4) which is costly and can cause staffing difficulties. The high infectivity of measles means that transmission can occur when contact is as little as 15 minutes in the same room (less for the immunocompromised). (4) Patients are likely to have this level of contact with a wide variety of staff working for the trust, not just those in ‘high risk’ areas. Transmission from a staff member to a vulnerable patient could cause severe illness or death. These risks can be prevented by a programme of screening and immunising all HCW, beginning with those in high risk areas. Our survey suggests this is not yet a universal practice.
1. Davies, Sally. Vaccination of Healthcare workers against measles. 26th April 2013. Available from URL: https://www.cas.dh.gov.uk/ViewAndAcknowledgment/viewAlert.aspx?AlertID=1...
2. L. Pezzoli, K. Noakes, P. Gates, F. Begum and R. G. Pebody (2010). Can we know the immunization status of healthcare workers? Results of a feasibility study in hospital trusts, England, 2008. Epidemiology and Infection, 138, pp 4552
3. Department of Health. [Online] Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. March 2007 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_074981.pdf
4. The Health Protection Agency. [Online] HPA National Measles Guidelines, Local & Regional Services. October 2010. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1274088429847
Competing interests: No competing interests