Outbreak report: nosocomial transmission of measles through an unvaccinated healthcare worker-implications for public health

Nosocomial transmission of measles is a near avoidable event with the potential for serious sequelae. Those who acquire infection in hospitals may be particularly susceptible to serious disease. UK guidance recommends measles, mumps, rubella vaccine (MMR) vaccination for healthcare workers (HCWs) as a key preventative measure against nosocomial transmission. We report an incident of transmission of measles from a patient to an unvaccinated HCW, with subsequent onward transmission to a patient in a paediatric unit. Response to the incident was undertaken in accordance with guidance from the Health Protection Agency (now Public Health England) and UK Department of Health. The index case had travelled to France, where there was an ongoing outbreak. There were 110 contacts identified for this HCW, of whom 61 were advised to have MMR and 5 were given immunoglobulin. All three cases were found to have the same D4 genotype. The report highlights the large number of potential contacts in a hospital setting and the time and resource implications involved to prevent further cases. It also highlights the importance of timely identification of measles, early public health notification and complete contact tracing. Such incidents are nearly avoidable given the availability of an efficacious vaccine.