Impact of a single measles presentation

Abstract

Introduction: The presentation of a patient at a busy emergency department (ED), later diagnosed with measles, lead to a cascade of events including contact tracing of staff, patients and those accompanying them. Methods: An 8 month old child had recently returned from overseas. They attended their GP with fever and sore throat and were treated with antibiotics. Several days later their GP referred them to the tertiary paediatric hospital with ongoing fevers and rash. Following triage they remained in the waiting room and open bay areas for six hours until measles was suspected. They were transferred to a negative pressure isolation area. Measles was later confirmed. Results: Extensive contact tracing was undertaken to assess measles immune status of 113 staff, 123 patients and those who accompanied them. A taskforce including Public Health Unit representation was established to coordinate and communicate this resource intensive activity. Australian immunisation record vaccination records confirmed vaccination for many children but the cohort included unimmunised and immunosuppressed children. MMR vaccination was required by staff, patients and families. Normal human immunoglobulin (NHIG) was indicated for several children. As the child had visited several community sites, additional children required assessment and treatment following community exposure. Those known to be immunosuppressed required administration of NHIG. Conclusion: Opportunities for improvement were highlighted: large volume intramuscular injection in children; accommodating patients needing NHIG administration in a busy ED, availability of staff immunisation records; staff awareness of their immunisation status and access to skilled staff to assist with assessment and vaccination.L20014665802019-01-28 <br />