RESULTS

From Jan. 1, 1988, to Dec. 3_%1, 1988, a total of 89 cases of measles were observed at CHLA (Figure). Sixty-two percent of patients were <15 months of age (Table). The age and gender distribution, and ethnic background were similar to those in the community as reported by the Los Angeles County Department of Health Services. Thirty-seven patients were admitted to the hospital; of these, six were not recognized as having measles at the time of admission. The admitting diagnoses of these six patients were

sepsis, pneumonia, bacteremia, esophagitis, roseola infantum and mastoiditis. Lack of appropriate respiratory isolation of these patients led to exposure of susceptible patients and. employees.

Seventy-eight patients susceptible to measles were exposed to five of the six patients who were not appropriately isolated. An accurate assessment of exposures to the sixth patient was not available; this patient was first seen in the prodromal stage without rash, and many of the exposed patients were discharged home before the diagnosis of measles was established.

During the study period, seven hospital personnel had measles. Four cases resulted from exposure to patients, two occurred after household exposure, and a rotating surgical resident acquired the illness from an unknown source. A nurse had atypical measles after contact with a patient with acquired immunodeficiency syndrome with unrecognized measles, and a radiology technician was infected in the radiology suite by a child with unrecognized measles. These two hospital employees required hospitalization because of respi­ratory complications, including the nurse who had atypical measles. All hospital employees who acquired measles were born after 1956. The hospital employees who acquired measles subsequently exposed an additional 15 hospitalized patients, none of whom acquired measles.

A 10-morith-old girl hospitalized with intractable diarrhea of infancy was exposed in a waiting room area to a child with unrecognized measles. Measles-related pneumonia developed in the girl and she subsequently died. She exposed an additional 14 susceptible hospitalized patients, one of whom acquired measles. Therefore a total of 107 susceptible hospitalized patients are known to have been exposed to measles during 1988.

A teenage girl exposed to measles before discharge from CHLA was admitted to another hospital with fever and uncontrolled diabetes mellitus. Her febrile illness was subsequently diagnosed as measles, and during the admission she exposed eight additional patients.

Of оцг 107 exposed patients, 54 received prophylaxis: y-globulin was given intramuscularly to 31 patients, and measles vaccine, monovalent or combined with mumps and rubella va'ccines, was administered to 9 patients; an additional 14 patients received prophylaxis, but the type was not specified in the medical record. Measles was not recognized in the patients who received prophylaxis. Of the 53 patients who received no prophylaxis, 4 secondary cases of measles occurred, for an attack rate of 7.5%.

A hospital wide measles vaccination program was begun in September 1988. A complete search of personnel records revealed that 1108 employees were born after 1956, and these individuals

were interviewed regarding measles susceptibility. Approximately 800 doses of monovalent measles vaccine were administered to hospital personnel. Susceptible employees who received measles vaccination within 72 hours from the time of exposure were permitted to continue their regular work schedule; however, sus­ceptible employees were precluded from work if they did not receive active immunization within 72 hours. No secondary cases of measles occurred in personnel who received appropriate pro­phylaxis.

The major cost associated with measles control was related to removing the exposed employees (17) from work during the incubation period for measles (days 8 to 18 after exposure) or when they had acquired measles (7). Their job descriptions included nurse (13), Jab technician (2), radiology technician (2), clerical staff (5), respiralory therapist (1), and physician (1). Twenty-four hospital employees were furloughed from work either because of having measles or because of measles exposure and lack of appropriate prophylaxis. Two hundred eleven employee-days were lost because of measles exposure or acquisition of the disease.

The estimated cost to the hospital for time lost by employees who were susceptible to me'asles or who acquired measles was $18,000. The estimated cost of vaccine and gammaglobulin was $10,750.

After the hospital wide vaccination program and educational activities, 10 children were admitted with measles. Despite educational efforts, one patient was admitted with unrecognized measles and was not appropriately isolated. Thirty-two susceptible patients were exposed to measles, but no susceptible hospital personnel were exposed and no case of measles occurred with these exposures.