Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy; Hygiene Unit, San Martino Polyclinic Hospital, Largo Rosanna Benzi 10, Genoa, 16132, Italy.
Department of Health Sciences, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy.
J Infect Public Health. 2020 Apr;13(4):619-624. doi: 10.1016/j.jiph.2019.08.016. Epub 2019 Sep 24.
From January 2017 to June 2018 more than 7000 measles cases were reported in Italy, of which more than 400 among unvaccinated healthcare workers. We described a measles outbreak occurred in Western Liguria, Italy, characterized by a high involvement of healthcare workers and hospital visitors.
Suspected measles cases and data regarding vaccination status and clinical management of the patients were collected by reviewing 3 different surveillance systems: the routine mandatory notification system, the National Integrated Surveillance System for Measles and Rubella and the regional reference laboratory for measles diagnosis.
Thirty-six cases were reported, with a median age of 31 years and >95% in unvaccinated subjects. One death occurred, 15 cases were hospitalized. Hospital transmission was confirmed or suspected in 12 cases; amongst this cases, 5 were healthcare workers (a gynaecologist, an obstetric nurse, a radiologist, a physiotherapist and a nurse working in an infectious disease ward), all certified unvaccinated. Phylogenetic analysis revealed the circulation of a single B3 genotype variant.
Our experience highlighted the key role of nosocomial transmission and the need for targeted strategies, in particular (i) to implement a measles catch-up immunization campaign in susceptible groups, especially in healthcare workers, (ii) to intensify the check of immunisation status of healthcare workers and to offer vaccination for those who need it, (iii) to improve timeliness and completeness of surveillance systems. Efforts are needed to guarantee the safety of the hospital and the reliability of the healthcare workers. Only high vaccination coverage among HCWs can prevent the diffusion of measles in the hospital setting.
自 2017 年 1 月至 2018 年 6 月，意大利报告了超过 7000 例麻疹病例，其中超过 400 例发生在未接种疫苗的医护人员中。我们描述了意大利利古里亚西部发生的一起麻疹暴发，其特点是医护人员和医院访客高度参与。
通过审查 3 种不同的监测系统，收集疑似麻疹病例以及有关疫苗接种状况和患者临床管理的数据：常规强制性报告系统、国家麻疹和风疹综合监测系统和区域性麻疹诊断参考实验室。
报告了 36 例病例，中位年龄为 31 岁，95%以上的病例未接种疫苗。发生 1 例死亡，15 例住院。确认或疑似医院传播 12 例；在这些病例中，有 5 例是医护人员（一名妇科医生、一名产科护士、一名放射科医生、一名理疗师和一名传染病病房护士），均未经认证接种疫苗。系统发育分析显示存在单一 B3 基因型变体的传播。
我们的经验突出了医院内传播的关键作用，需要采取有针对性的策略，特别是（i）在易感人群中实施麻疹补种免疫运动，特别是医护人员，（ii）加强对医护人员免疫状况的检查，并为需要接种疫苗的人员提供疫苗接种，（iii）提高监测系统的及时性和完整性。需要努力确保医院的安全和医护人员的可靠性。只有医护人员的高疫苗接种覆盖率才能防止麻疹在医院环境中的传播。
