Fiebelkorn Amy Parker, Seward Jane F, Orenstein Walter A
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Vaccine. 2014 Aug 27;32(38):4823-39. doi: 10.1016/j.vaccine.2013.11.005. Epub 2013 Nov 24.
Measles transmission has been well documented in healthcare facilities. Healthcare personnel who are unvaccinated and who lack other evidence of measles immunity put themselves and their patients at risk for measles. We conducted a systematic literature review of measles vaccination policies and their implementation in healthcare personnel, measles seroprevalence among healthcare personnel, measles transmission and disease burden in healthcare settings, and impact/costs incurred by healthcare facilities for healthcare-associated measles transmission. Five database searches yielded 135 relevant articles; 47 additional articles were found through cross-referencing. The risk of acquiring measles is estimated to be 2 to 19 times higher for susceptible healthcare personnel than for the general population. Fifty-three articles published worldwide during 1989-2013 reported measles transmission from patients to healthcare personnel; many of the healthcare personnel were unvaccinated or had unknown vaccination status. Eighteen articles published worldwide during 1982-2013 described examples of transmission from healthcare personnel to patients or to other healthcare personnel. Half of European countries have no measles vaccine policies for healthcare personnel. There is no global policy recommendation for the vaccination of healthcare personnel against measles. Even in countries such as the United States or Finland that have national policies, the recommendations are not uniformly implemented in healthcare facilities. Measles serosusceptibility in healthcare personnel varied widely across studies (median 6.5%, range 0-46%) but was consistently higher among younger healthcare personnel. Deficiencies in documentation of two doses of measles vaccination or other evidence of immunity among healthcare personnel presents challenges in responding to measles exposures in healthcare settings. Evaluating and containing exposures and outbreaks in healthcare settings can be disruptive and costly. Establishing policies for measles vaccination for healthcare personnel is an important strategy towards achieving measles elimination and should be a high priority for global policy setting groups, governments, and hospitals.
麻疹传播在医疗机构中已有充分记录。未接种疫苗且缺乏其他麻疹免疫证据的医护人员会使自己和患者面临感染麻疹的风险。我们对医护人员的麻疹疫苗接种政策及其实施情况、医护人员中的麻疹血清流行率、医疗机构中的麻疹传播及疾病负担，以及医疗机构因医护相关麻疹传播所产生的影响/成本进行了系统的文献综述。五项数据库检索共得到135篇相关文章；通过交叉引用又发现了47篇文章。据估计，易感染的医护人员感染麻疹的风险比普通人群高2至19倍。1989 - 2013年期间全球发表的53篇文章报道了麻疹从患者传播给医护人员的情况；许多医护人员未接种疫苗或疫苗接种状态不明。1982 - 2013年期间全球发表的18篇文章描述了麻疹从医护人员传播给患者或其他医护人员的事例。一半的欧洲国家没有针对医护人员的麻疹疫苗接种政策。对于医护人员接种麻疹疫苗，没有全球政策建议。即使在美国或芬兰等有国家政策的国家，这些建议在医疗机构中也未得到统一实施。不同研究中，医护人员的麻疹血清易感性差异很大（中位数为6.5%，范围为0 - 46%），但年轻医护人员中的易感性始终较高。医护人员中两剂麻疹疫苗接种记录或其他免疫证据的缺失给应对医疗机构中的麻疹暴露带来了挑战。评估和控制医疗机构中的暴露及疫情可能会造成干扰且成本高昂。制定医护人员麻疹疫苗接种政策是实现消除麻疹的一项重要策略，应成为全球政策制定团体、政府和医院的高度优先事项。
