Successful Response to a Measles Exposure in a Pediatric Clinic Utilizing Measles, Mumps, and Rubella (MMR) Vaccine Prophylaxis

Abstract

Background: To be effective, postexposure prophylaxis (PEP) must be administered promptly after measles exposure. MMR vaccine is recommended within 72 hours of exposure. Immunoglobulin (IG) is recommended for infants aged <6–12 months, susceptible individuals, and severely immunocompromised people within 6 days of exposure. MMR vaccine is readily available, less expensive, and more easily administered than IG, and it provides long-term immunity. However, due to delays in diagnosis of measles cases, it is often not possible to administer MMR PEP to contacts within 72 hours. We describe an unvaccinated infant with fever and rash after recent international travel who presented to a pediatric outpatient clinic. Measles was promptly suspected, and specimens were collected for measles polymerase chain reaction (PCR) testing at the California Department of Public Health (CDPH) laboratory. PCR results confirming measles were obtained within 24 hours of the patient visit. Methods: A multidisciplinary team of medical, employee health, nursing, pharmacy and infection prevention staff was assembled. Electronic health records (EHRs) were used to identify exposed patients based on registration times, as well as to determine their MMR vaccination status and to identify any immunocompromising conditions. Exposed patients were notified either by e-mail or phone. Adult caretakers were interviewed to determine who accompanied the child to the clinic. Caretakers were questioned regarding their MMR vaccination status and the high risk to accompanying persons. The use of EHRs with data integration from other healthcare system helped validate and supplement vaccine statuses and medical histories of exposed family members. Results: In total, 128 persons were exposed; 31 staff (24%), 46 patients (36%) and 51 family members (40$). All 128 patients (100%) and family members were notified within 24 hours of case confirmation, and 44 of 128 (34%) required PEP. All staff had documentation of measles immune status. However, 1 of 31 staff (3%) needed PEP due to immunosuppression. MMR vaccine was given to 35 of 36 eligible persons (97%), except for 1 sibling who received IG due to delay in exposure identification. An additional 8 of 44 persons (18%) required IG due to age or immunosuppression. There were no secondary cases. Conclusions: MMR vaccine was used as primary PEP due to prompt suspicion for measles, early laboratory confirmation, and swift coordinated response using a multidisciplinary team. Leveraging EHRs helped rapidly identify exposed persons, validate measles immunity status and risk factors, order prophylaxis, and track outcomes.

Funding: None

Disclosures: None