1171. Measles Exposure in a Neonatal Intensive Care Unit and Labor and Delivery Ward California, January 2015
Session: Poster Abstract Session: Public Health
Friday, October 9, 2015
Room: Poster Hall
Background: Since December 2014, California has experienced a widespread measles outbreak. On January 27, 2015, California Department of Public Health was notified that a person diagnosed with measles had visited the labor and delivery, post-partum, and neonatal intensive care units (NICU) at Hospital A across 4 days while infectious. Neonates and pregnant women without evidence of immunity are at high risk for severe measles complications, including pneumonia, miscarriage, encephalitis, and death. We investigated to identify contacts and prevent cases in Hospital A.

Methods: We reviewed Hospital A inpatients and staff records to identify persons who might have shared airspace with the visitor (contacts). Neonates, pregnant women, and immunocompromised contacts were considered at high risk for measles complications. Contacts at high risk without documented immunity were offered measles immunoglobulin postexposure prophylaxis (PEP). We assessed Hospital A’s infection control practices including visitor screening procedures.

Results: We identified 112 contacts at high risk. Among 14 pregnant contacts, all 4 without documented immunity received PEP. Among 98 infant contacts, 70 (71%) received PEP; 23 (23%) guardians declined PEP on behalf of their infant; and 5 (5%) were lost to follow-up. Among 237 hospital staff contacts, 8 lacked documented immunity and were furloughed; none were at high risk. NICU inpatients sharing the room visited by the infectious visitor were cohorted in an airborne infection isolation area. No other cases were identified. Observed infection control and screening practices were insufficient to prevent the symptomatic visitor from entering the NICU and labor and delivery ward. 

Conclusion: Infection control and visitor screening practices should be properly implemented. Targeted education of patient guardians and providers is necessary to increase adherence to measles PEP recommendations for contacts at high risk for measles complications.

Patrick Ayscue, DVM1, Amanda Kamali, MD2, Jared Rutledge, PhD3, Jennifer Zipprich, MS, PhD4, Mary Morrisson, RN, MSN, PHN5, Kathleen Harriman, PhD, MPH, RN4 and Ken Bird, MD, MPH5, (1)California Department of Public Health, Division of Communicable Disease Control, Richmond, CA, (2)Epidemic Intelligence Service, Centers for Disease Control and Prevention; Los Angeles County Department of Public Health Acute Communicable Disease Control Program, Los Angeles, 90012, Los Angeles, CA, (3)Communicable Diseases, Fresno County Department of Public Health, Fresno, CA, (4)Immunization Branch, California Department of Public Health, Richmond, CA, (5)Fresno County Department of Public Health, Fresno, CA

Disclosures:

P. Ayscue, None

A. Kamali, None

J. Rutledge, None

J. Zipprich, Pfizer: Spouse works at Pfizer , Salary

M. Morrisson, None

K. Harriman, None

K. Bird, None

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