Health care-associated measles outbreak in pediatric wards in a tertiary care hospital: Challenges and Swiss cheese model enforcement for patient safety

Abstract

IntroductionMeasles is one of the most contagious of all infectious diseases, for example, up to 9 out of 10 susceptible people with close contact to a measles patient will develop measles. In countries where measles is rare, transmissions in health care facilities have been a key factor in amplifying outbreaks ObjectivesDescribe the hospital transmission of measles among unvaccinated children in pediatric service, challenges faced and recommendations for health care settings by applying the Swiss cheese model. MethodBetween December 2019 and January 2020; multiple exposures to measles cases occurred. The incident and factors that led to the outbreak are described. The matrix and fusion genes, non-coding region sequence analysis was also conducted on the 3 strains isolated from the cases. ResultsThe outbreak extended from December 2019 to January 2020, which resulted in 110 exposed individuals (85 health care workers and 25 patients). Eleven (44%) children exposed were vaccinated, 14 (56%) were not yet vaccinated, and the measles status of 10 (11.8%) HCWs was not known at the time of the outbreak. Two infants acquired measles in the hospital, and both required ICU care. Three infants and one HCW received immunoglobulin. The phylogenetic tree of the matrix and fusion genes, non-coding region sequencing confirmed that all three cases had 100% identical measles strain. ConclusionsIn countries where measles elimination goals are achieved, a multifaceted approach to prevent measles transmission in health care is vital to maintain patient safety.