Field Service, National Infection Service, Public Health England, UK.
Field Service, National Infection Service, Public Health England, UK.
Public Health. 2020 Jun;183:55-62. doi: 10.1016/j.puhe.2020.02.015. Epub 2020 May 17.
We described the epidemiology and healthcare exposures during a measles outbreak in London and identified factors associated with isolation on arrival to healthcare premises.
We conducted a cohort study including all confirmed measles cases in London residents from February 1, 2016, to June 30, 2016, and semistructured interviews with two infection prevention and control teams (IPCTs).
We described the outbreak and conducted a multilevel mixed-effects analysis to assess the relationship between sociodemographic and clinical factors and isolation on arrival to healthcare premises. We summarised the interviews.
There were 182 cases, mostly aged 17-35 years (46%; 84). Excluding cases younger than one year, 76% (92/120) were unvaccinated, including two healthcare workers. The majority presented with rash (97%; 174), and 42% (70/166) required hospitalisation. Of the recorded cases, 93% of cases (164/178) had visited a healthcare setting during their infectious period (median number of visits = 2). In 33% (59/178) of the visits, the case was isolated on arrival; when not isolated, four healthcare exposures resulted in further transmission. Presenting to the hospital as opposed to a general practitioner (GP) was associated with higher odds of isolation (odds ratio = 2.23, 95% confidence interval = 1.1-4.4) when adjusted for age, gender and presenting with a cough. The IPCT identified measles training using standardised risk assessments by triage nurses in accident and emergency and intelligence regarding measles activity in the community as positive measures to prevent healthcare exposures.
We recommend opportunistic immunisation of unvaccinated young adults by GPs and that occupational health departments ensure their staff are protected against measles. Raising measles awareness in healthcare settings via training or regular sharing of current measles surveillance activity from public health to the IPCT and GP may improve triage and isolation of cases on arrival to healthcare premises.
我们描述了伦敦麻疹暴发期间的流行病学和医疗保健暴露情况，并确定了与抵达医疗保健场所时隔离相关的因素。
我们进行了一项队列研究，纳入了 2016 年 2 月 1 日至 6 月 30 日期间伦敦居民中所有确诊的麻疹病例，并对两个感染预防和控制小组（IPC 小组）进行了半结构化访谈。
我们描述了暴发情况，并进行了多水平混合效应分析，以评估社会人口统计学和临床因素与抵达医疗保健场所时隔离的关系。我们总结了访谈内容。
共有 182 例病例，主要为 17-35 岁（46%；84 例）。排除年龄小于 1 岁的病例，76%（92/120）未接种疫苗，其中包括 2 名医务人员。大多数病例表现为皮疹（97%；174 例），42%（70/166）需要住院治疗。在所记录的病例中，93%（164/178）的病例在感染期间曾去过医疗保健机构（中位数就诊次数为 2 次）。在 178 例就诊中，33%（59/178）的病例抵达时被隔离；如果未被隔离，有 4 次医疗保健暴露导致了进一步的传播。与就诊于全科医生（GP）相比，就诊于医院（校正年龄、性别和就诊时咳嗽后）与隔离的可能性更高相关（比值比=2.23，95%置信区间=1.1-4.4）。IPC 小组确定了通过分诊护士在急症和紧急情况下使用标准化风险评估进行麻疹培训，以及关于社区麻疹活动的情报，这是预防医疗保健暴露的积极措施。
我们建议 GP 对未接种疫苗的年轻成年人进行机会性免疫接种，并建议职业健康部门确保其工作人员免受麻疹感染。通过培训或定期分享公共卫生部门向 IPC 小组和 GP 提供的当前麻疹监测活动，提高医疗保健环境中的麻疹意识，可能会改善对抵达医疗保健场所的病例的分诊和隔离。
