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Measles outbreak from Hong Kong International Airport to the hospital due to secondary vaccine failure in healthcare workers

Published online by Cambridge University Press:  07 October 2019

Vincent C.C. Cheng ,
Shuk-Ching Wong ,
Sally C.Y. Wong ,
Siddharth Sridhar ,
Jonathan H.K. Chen ,
Cyril C.Y. Yip ,
Derek L.L. Hung ,
Xin Li ,
Vivien W.M. Chuang  and
Owen T.Y. Tsang
...Show all authors
Vincent C.C. Cheng
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Shuk-Ching Wong
Affiliation:
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Sally C.Y. Wong
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Siddharth Sridhar
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Jonathan H.K. Chen
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Cyril C.Y. Yip
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Derek L.L. Hung
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Xin Li
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Vivien W.M. Chuang
Affiliation:
Quality & Safety Division (Infection, Emergency, and Contingency), Hospital Authority, Hong Kong Special Administrative Region, China
Owen T.Y. Tsang
Affiliation:
Infectious Disease Center, Hospital Authority, Hong Kong Special Administrative Region, China
Gibson K.S. Woo
Affiliation:
Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
Shuk-Kwan Chuang
Affiliation:
Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
Kwok-Yung Yuen*
Affiliation:
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
*
Author for correspondence: Kwok-Yung Yuen, E-mail: kyyuen@hku.hk
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Abstract

Objective:

To report an outbreak of measles with epidemiological link between Hong Kong International Airport (HKIA) and a hospital.

Methods:

Epidemiological investigations, patients’ measles serology, and phylogenetic analysis of the hemagglutinin (H) and nucleoprotein (N) genes of measles virus isolates were conducted.

Results:

In total, 29 HKIA staff of diverse ranks and working locations were infected with measles within 1 month. Significantly fewer affected staff had history of travel than non–HKIA-related measles patients [10 of 29 (34.5%) vs 28 of 35 (80%); P < .01]. Of 9 airport staff who could recall detailed exposure history, 6 (66.7%) had visited self-service food premises at HKIA during the incubation period, where food trays, as observed during the epidemiological field investigation, were not washed after use. Furthermore, 1 airport baggage handler who was admitted to hospital A before rash onset infected 2 healthcare workers (HCWs) known to have 2 doses of MMR vaccination with positive measles IgG and lower viral loads in respiratory specimens. Infections in these 2 HCWs warranted contact tracing of another 168 persons (97 patients and 71 HCWs). Phylogenetic comparison of H and N gene sequences confirmed the clonality of outbreak strains.

Conclusion:

Despite good herd immunity with overall seroprevalence of >95% against measles, major outbreaks of measles occurred among HKIA staff having daily contact with many international pssengers. Lessons from severe acute respiratory syndrome (SARS) and measles outbreaks suggested that an airport can be a strategic epidemic center. Pre-exanthem transmission of measles from airport staff to HCWs with secondary vaccine failure poses a grave challenge to hospital infection control.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1407 - 1415
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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