Skip to main content Accessibility help
×
Home
Hostname: page-component-564cf476b6-z65vl Total loading time: 0.519 Render date: 2021-06-22T17:22:20.071Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

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
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
Corresponding
E-mail address:

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
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below.

References

Moss, WJ. Measles. Lancet 2017;390:24902502.CrossRefGoogle ScholarPubMed
Seroprevalence rates of measles virus antibodies. Centre for Health Protection. Department of Health. The Government of the Hong Kong Special Administrative Region. https://www.chp.gov.hk/en/statistics/data/10/641/701/3536.html. Accessed May 18, 2019.Google Scholar
Jost, M, Luzi, D, Metzler, S, Miran, B, Mutsch, M. Measles associated with international travel in the region of the Americas, Australia and Europe, 2001–2013: a systematic review. Travel Med Infect Dis 2015;13:1018.CrossRefGoogle ScholarPubMed
Bitzegeio, J, Majowicz, S, Matysiak-Klose, D, Sagebiel, D, Werber, D. Estimating age-specific vaccine effectiveness using data from a large measles outbreak in Berlin, Germany, 2014/15: evidence for waning immunity. Euro Surveill 2019;24.CrossRefGoogle Scholar
Nic Lochlainn, L, Mandal, S, de Sousa, R, et al. A unique measles B3 cluster in the United Kingdom and The Netherlands linked to air travel and transit at a large international airport, February to April 2014. Euro Surveill 2016;21.CrossRefGoogle Scholar
Coleman, MS, Burke, HM, Welstead, BL, et al. Cost analysis of measles in refugees arriving at Los Angeles International Airport from Malaysia. Hum Vaccin Immunother 2017;13:10841090.CrossRefGoogle ScholarPubMed
Vega, JS, Escobedo, M, Schulte, CR, et al. Notes from the field: measles transmission at a domestic terminal gate in an international airport—United States, January 2014. MMWR Morb Mortal Wkly Rep 2014;63:1211.Google Scholar
Banerjee, E, Hickman, C, Engels, K, Kenyon, C, for the Centers for Disease Control and Prevention. Notes from the field: measles transmission in an international airport at a domestic terminal gate—April–May 2014. Morb Mortal Wkly Rep 2015;64:679.Google Scholar
Watanabe, A, Kobayashi, Y, Shimada, T, et al. Exposure to H1 genotype measles virus at an international airport in Japan on 31 July 2016 results in a measles outbreak. West Pac Surveill Response J 2017;8:3739.CrossRefGoogle Scholar
Botelho-Nevers, E, Gautret, P, Biellik, R, Brouqui, P. Nosocomial transmission of measles: an updated review. Vaccine 2012;30:39964001.CrossRefGoogle Scholar
Cheng, VC, Lau, SK, Woo, PC, Yuen, KY. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev 2007;20:660694.CrossRefGoogle ScholarPubMed
Cheng, VC, Tai, JW, Wong, LM, et al. Prevention of nosocomial transmission of swine-origin pandemic influenza virus A/H1N1 by infection control bundle. J Hosp Infect 2010;74:271277.CrossRefGoogle ScholarPubMed
Cheng, VC, To, KK, Tse, H, Hung, IF, Yuen, KY. Two years after pandemic influenza A/2009/H1N1: what have we learned? Clin Microbiol Rev 2012;25:223263.CrossRefGoogle ScholarPubMed
Cheng, VC, Chan, JF, To, KK, Yuen, KY. Clinical management and infection control of SARS: lessons learned. Antiviral Res 2013;100:407419.CrossRefGoogle ScholarPubMed
Cheng, VC, Tai, JW, Lee, WM, et al. Infection control preparedness for human infection with influenza A H7N9 in Hong Kong. Infect Control Hosp Epidemiol 2015;36:8792.CrossRefGoogle ScholarPubMed
Cheng, VC, Lee, WM, Sridhar, S, Ho, PL, Yuen, KY. Prevention of nosocomial transmission of influenza A (H7N9) in Hong Kong. J Hosp Infect 2015;90:355356.CrossRefGoogle Scholar
Ventilation for acceptable indoor air quality. Standard 62.1 of The American Society of Heating, Refrigerating and Air-Conditioning Engineers website. https://ashrae.iwrapper.com/ViewOnline/Standard_62.1-2016, Published 2016. Accessed May 18, 2019.Google Scholar
Outbreak of measles infection at airport concluded. The Government of the Hong Kong Special Administrative Region website. https://www.info.gov.hk/gia/general/201905/17/P2019051700868.htm. Accessed May 18, 2019.Google Scholar
van Binnendijk, RS, Hahne, S, Timen, A, et al. Air travel as a risk factor for introduction of measles in a highly vaccinated population. Vaccine 2008;26:57755777.CrossRefGoogle Scholar
Anderson, RM, May, RM. Directly transmitted infections diseases: control by vaccination. Science 1982;215:10531060.CrossRefGoogle ScholarPubMed
Moss, WJ, Strebel, P. Biological feasibility of measles eradication. J Infect Dis 2011;204 suppl 1:S47S53.CrossRefGoogle ScholarPubMed
Measles in Japan from 1st to 7th epidemiological week, 2019 (as of February 20, 2019). National Institute of Infectious Diseases website. https://www.niid.go.jp/niid/en/survei/2292-idwr/idwr-article-en/8654-idwrc-1907.html. Accessed Jun 29, 2019.Google Scholar
Remington, PL, Hall, WN, Davis, IH, Herald, A, Gunn, RA. Airborne transmission of measles in a physician’s office. JAMA 1985;253:15741577.CrossRefGoogle Scholar
Bloch, AB, Orenstein, WA, Ewing, WM, et al. Measles outbreak in a pediatric practice: airborne transmission in an office setting. Pediatrics 1985;75:676683.Google Scholar
Bischoff, WE, McNall, RJ, Blevins, MW, et al. Detection of measles virus RNA in air and surface specimens in a hospital setting. J Infect Dis 2016;213:600603.CrossRefGoogle Scholar
Cheng, VCC, Wong, SC, Wong, SCY, Yuen, KY. Directly observed hand hygiene—from healthcare workers to patients. J Hosp Infect 2019;101:380382.CrossRefGoogle ScholarPubMed
Haralambieva, IH, Kennedy, RB, Ovsyannikova, IG, Whitaker, JA, Poland, GA. Variability in humoral immunity to measles vaccine: new developments. Trends Mol Med 2015;21:789801.CrossRefGoogle ScholarPubMed
Defay, F, De Serres, G, Skowronski, DM, et al. Measles in children vaccinated with 2 doses of MMR. Pediatrics 2013;132:e1126e1133.CrossRefGoogle ScholarPubMed
Rosen, JB, Rota, JS, Hickman, CJ, et al. Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis 2014;58:12051210.CrossRefGoogle ScholarPubMed
Hahne, SJ, Nic Lochlainn, LM, van Burgel, ND, et al. Measles outbreak among previously immunized healthcare workers, The Netherlands, 2014. J Infect Dis 2016;214:19801986.CrossRefGoogle ScholarPubMed
Haralambieva, IH, Ovsyannikova, IG, O’Byrne, M, Pankratz, VS, Jacobson, RM, Poland, GA. A large observational study to concurrently assess persistence of measles specific B-cell and T-cell immunity in individuals following two doses of MMR vaccine. Vaccine 2011;29:44854491.CrossRefGoogle ScholarPubMed
Mathias, RG, Meekison, WG, Arcand, TA, Schechter, MT. The role of secondary vaccine failures in measles outbreaks. Am J Public Health 1989;79:475478.CrossRefGoogle ScholarPubMed
Cardemil, CV, Dahl, RM, James, L, et al. Effectiveness of a third dose of MMR vaccine for mumps outbreak control. N Engl J Med 2017;377:947956.CrossRefGoogle ScholarPubMed
Marlow, MA, Marin, M, Moore, K, Patel, M. CDC Guidance for use of a third dose of MMR vaccine during mumps outbreaks. J Public Health Manag Pract 2019. doi: 10.1097/PHH.0000000000000962.CrossRefGoogle Scholar
Fiebelkorn, AP, Coleman, LA, Belongia, EA, et al. Measles virus neutralizing antibody response, cell-mediated immunity, and immunoglobulin G antibody avidity before and after receipt of a third dose of measles, mumps, and rubella vaccine in young adults. J Infect Dis 2016;213:11151123.CrossRefGoogle ScholarPubMed
Basu, S, Giri, P, Adisesh, A, Mc, NR. Healthcare workers and measles-mumps-rubella (MMR) status: how worried should we be about further outbreaks? Epidemiol Infect 2014;142:16881694.CrossRefGoogle ScholarPubMed
Shakoor, S, Mir, F, Zaidi, AK, Zafar, A. Hospital preparedness in community measles outbreaks-challenges and recommendations for low-resource settings. Emerg Health Threats J 2015;8:24173.CrossRefGoogle ScholarPubMed
Centers for Disease C, Prevention. Hospital-associated measles outbreak—Pennsylvania, March–April 2009. Morb Mortal Wkly Rep 2012;61:3032.Google Scholar
Porretta, A, Quattrone, F, Aquino, F, et al. A nosocomial measles outbreak in Italy, February–April 2017. Euro Surveill 2017;22.CrossRefGoogle Scholar
Baxi, R, Mytton, OT, Abid, M, et al. Outbreak report: nosocomial transmission of measles through an unvaccinated healthcare worker-implications for public health. J Public Health (Oxf) 2014;36:375381.CrossRefGoogle ScholarPubMed
Supplementary material: File

Cheng et al. supplementary material

Cheng et al. supplementary material

Download Cheng et al. supplementary material(File)
File 15 KB
4
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *