Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil

Abstract

Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None