Background

In 1988 a measles outbreak occurred in Los Angeles County; a provisional total of 513 cases was reported to the Los Angeles County Public Health Department .between Jan. 1, 1988, and December 31, 1988. Sixty-three percent of the patients reported were younger than 5 years, and 42% were 15 months of age or younger. At Children's Hospital of Los Angeles (CHLA), a 331-bed urban pediatric teaching hospital, 89 cases of measles were identified in 1988.

Methods

Epidemiologic investigation. Medical records of patients with suspected measles were reviewed for clinical or serologic confirmation of the diagnosis. Measles was diagnosed in patients having an acute febrile illness with morbilliform or maculopapular rash (per­sisting for 3 or more days), cough, coryza, conjunctivitis, or Koplik spots.

Patients and employees were considered susceptible to measles if they were born after 1956 and had not had physician-diagnosed measles or received live measles vaccine after 12 months of age. The same criteria for measles susceptibility were applied to patients who were immunodeficient as to those who were immunocompetent.

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A search of personnel records was undertaken to identify susceptible employees, that is, those born after 1956, with no documentation of immunization with live measles vaccine or physician-diagnosed measles.

Measles exposure was.considered to have occurred in patients and personnel when they were in contact with persons in whom measles was^! ultimately diagnosed and who were not in respiratory isolation at the time of- contact. Patients and employees present on the same ward area (including contiguous units) with a patient with measles were considered exposed.

After the first case of nosocomial measles was recognized, the hospital infection control officer and the department of quality assurance developed a protocol aimed at controlling the further spread of measles to susceptible patients and employees. Prophylaxis for exposed susceptible patients was carried out in three ways as recommended in the Report of the Committee on Infectious Disease of the American Academy of Pediatrics:

1. Monovalent measles vaccine was given to children 6 to 12 months of age.

2. Measles-mumps-rubella Vaccine was given to children older than 12 months.

3. Patients from birth to 6 months of age who were exposed received intramuscularly administered^ y-globulin.

4. When live vaccines were contraindicated, y-globulin was administered intramuscularly.

The infection control program for hospital employees included vaccination and education. Monovalent measles vaccine was recom­mended for exposed susceptible hospital personnel if exposure was within 72 hours. If the exposure was assessed to have been between 72 hours and 6 days, y-globulin was given intramuscularly in an effort to prevent or modify the infection. An extensive educational program was initiated that included instructions to hospital admitting personnel and ward staff on the recognition and appropriate isolation of patients with measles.