Abstract
In October 2018 a measles (rubeola) outbreak was identified in New York City (NYC) & Rockland County (RC). A public health emergency was declared with a focus on increasing MMR (measles, mumps, and rubella) vaccination uptake. Childhood MMR vaccination is 97% effective but antibody titers decrease over time. Screening for immunity has not been a routine part of prenatal care. NYU Langone Health created a communication and prevention program at the start of the outbreak and non-immune women were encouraged to take the MMR vaccination postpartum during hospitalization. We aimed to describe the prevalence of rubeola immunity in pregnant women and the change in uptake of postpartum MMR vaccination before and during the measles outbreak. This was a retrospective cohort, quality improvement study. The control group was women who delivered at NYU Langone Health prior to the outbreak (PO) from 7/1/2016 to 7/1/2017. The study group was women who delivered during the outbreak (DO) from 7/1/18 to 7/1/19. Primary outcome was acceptance of MMR vaccination in non-immune women during the postpartum period. Serologic evidence of rubeola immunity was defined based on lab reference values. Statistical analysis was done using chi-square and T-test. 19585 patients were analyzed. 9,162 women delivered PO and 10,423 delivered DO. Of these, 2589 (13.2%) were documented as living in a high-risk ZIP code. 14,731 women (75.2%) were tested for rubeola immunity and 3270 (22.2%) of those tested were not immune. In the year DO, a higher proportion of women had rubeola immunity documented with serum titers than in the year PO (81% vs. 69%, p< 0.001). Inpatient compliance with postpartum MMR administration was greater DO than PO (100% v. 88.2%, p< 0.001). The NYC & RC measles outbreak, together with 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 measles immunity. It also led to an increase in uptake of the immediate postpartum MMR vaccine.
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