Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York University Langone Health, New York, NY.
Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York University Langone Health, New York, NY.
Am J Obstet Gynecol MFM. 2021 May;3(3):100309. doi: 10.1016/j.ajogmf.2021.100309. Epub 2021 Jan 13.
In October 2018, a measles (rubeola) outbreak was identified in New York City and Rockland County, and a public health campaign and hospital policy changes were made to increase awareness of the importance of vaccination and increase vaccination rates.
We describe the prevalence of rubeola immunity in pregnant women and the change in uptake of postpartum measles, mumps, and rubella vaccination before and during the measles outbreak.
A multipronged intervention was developed by the health system with the intent of raising awareness of the outbreak, identifying patients at risk of contracting measles during pregnancy, and limiting exposure of inpatients to the disease. This was a quality improvement study to assess the impact of the intervention and public health policy on the rates of documentation of rubeola immunity and rubeola vaccination rates in nonimmune women. Women who delivered at New York University Langone Health before the outbreak July 1, 2016 to July 1, 2017 were compared with women who delivered during the outbreak July 1, 2018 to July 1, 2019. The primary outcome was acceptance of measles, mumps, and rubella vaccination in nonimmune women during the postpartum period. Analysis was conducted using logistic regression and chi-square tests, and alpha was set at 0.05.
A total of 19,585 patients were analyzed; 9162 women delivered before the outbreak and 10,423 delivered during the outbreak. Of these, 2589 (13.2%) were documented as living in a high-risk zone improvement plan code, which were areas at the epicenter of the measles outbreak. Notably, 14,731 women (75.2%) were tested for rubeola immunity and 3270 of those tested (22.2%) were not immune. In the year of the outbreak, a higher proportion of women had rubeola immunity documented with serum titers than in the year before the outbreak (81% vs 69%; P<.001). Inpatient compliance with postpartum measles, mumps, and rubella administration was greater during the outbreak than before it (76% vs 59%; P<.001) for patients from both low-risk and high-risk zone improvement plan codes.
The New York City and Rockland County measles outbreak, together with the implementation of a health system-wide education program and a change in public health policy, led to an increase in the proportion of pregnant women being screened for rubeola immunity. It also led to an increase in uptake of the immediate postpartum measles, mumps, and rubella vaccine.
2018 年 10 月，纽约市和罗克兰县爆发麻疹（风疹）疫情，随后开展了一项公共卫生运动，并修改了医院政策，以提高人们对接种疫苗重要性的认识，并提高疫苗接种率。
我们描述了孕妇麻疹免疫力的流行情况，并在麻疹疫情爆发前后，观察了产后麻疹、腮腺炎和风疹疫苗接种率的变化。
医疗系统制定了一项多管齐下的干预措施，旨在提高对疫情的认识，确定孕妇在怀孕期间感染麻疹的风险，并限制住院患者感染该疾病的风险。这是一项质量改进研究，旨在评估干预措施和公共卫生政策对记录麻疹免疫力和未免疫妇女麻疹疫苗接种率的影响。我们比较了 2016 年 7 月 1 日至 2017 年 7 月 1 日和 2018 年 7 月 1 日至 2019 年 7 月 1 日在纽约大学朗格尼健康中心分娩的妇女，分别接受了麻疹、腮腺炎和风疹疫苗接种。主要结局是未免疫妇女在产后期间接受麻疹、腮腺炎和风疹疫苗接种的情况。采用逻辑回归和卡方检验进行分析，α 值设为 0.05。
共分析了 19585 名患者，其中 9162 名妇女在疫情爆发前分娩，10423 名妇女在疫情爆发后分娩。其中，2589 名（13.2%）患者被记录为居住在高风险区域改进计划代码区，这些区域是麻疹疫情的中心地带。值得注意的是，有 14731 名妇女（75.2%）接受了麻疹免疫力检测，其中 3270 名（22.2%）检测结果为未免疫。在麻疹爆发年，接受麻疹血清滴度检测的妇女中有更高比例具有麻疹免疫力（81%比 69%；P<.001）。无论是低风险区还是高风险区改进计划代码区的患者，在疫情爆发期间，住院患者接受麻疹、腮腺炎和风疹疫苗接种的比例均高于疫情前（76%比 59%；P<.001）。
纽约市和罗克兰县的麻疹疫情，以及开展的一项医疗系统范围的教育计划和公共卫生政策的改变，导致接受麻疹免疫力筛查的孕妇比例增加。它还导致了产后立即接种麻疹、腮腺炎和风疹疫苗的比例增加。
