Hospital exposure as a risk factor for the transmission of measles: A case-control study in Turkey.

Year 2016, , 13 - 22, 04.05.2016

Serap Çetin Çoban , Selmur Topal Fehminaz Temel Muharrem Öncül Bao-ping Zhu Levent Akın

https://doi.org/10.20518/thsd.67473

Cited By: 1

Abstract

Objective: During a nationwide measles epidemic in 2013, we conducted an investigation in Sanliurfa province to assess risk factors for measles infections. Methods: In a case-control design, we compared the history of hospital exposures for 189 randomly selected laboratory-confirmed patients (aged <15 years) residing in the central district and control-individuals matched for neighbourhood and age. We estimated the effectiveness of the vaccine (VE). Results:For infants from 0-11 months, 53.8% of the case and 23.8% of the controls had visited a hospital during one the month prior to the onset of the case’s rash (ORadj=3.7, 95% CI=1.6–8.6). For children from 1–6 years, 48.2% of the cases  and 14.3% of the controls visited a hospital during one month prior to the onset case’s rash (ORadj=5.5,95% CI=2.5–12.8) and  59.7% of cases had not completed one dose of measles vaccine  by 12 months, compared with 

14.7% of controls (ORadj=7.4,95% CI=2.1–26.9; VE=86%,95% CI=52-96%). For children from 7– 14 years, 53.8% of the cases had not completed one dose of measles vaccination by age 12 months, compared with 15.4%  of controls (ORadj=6.7,95% CI=1.7–26.6; VE=85%, 95% CI=41-96%). Conclusion: We conclude that the hospitals facilitated measles transmission during this epidemic. We recommend triage febrile patients and patients with a rash in healthcare settings, and strengthening measles vaccination programme..

Keywords: Measles; Measles Vaccine; Nosocomial Infections; Risk Factors; Case Control Study

 

Keywords

Measles, Measles vaccine, Nosocomial infections, Case-control studies

Kızamık bulaşında bir risk faktörü olarak hastane maruziyeti: Vaka-kontrol çalışması, Türkiye

Abstract

Özet

Amaç: Türkiye’de 2013 yılında kızamık vakalarında artış görülmüştür. Bu çalışma, vakaların en sık görüldüğü Şanlıurfa ilinde kızamık hastalığını etkileyen risk faktörlerini değerlendirmek için yapılmıştır. Yöntem: Bu vaka-kontrol çalışmasında, merkez ilçede yaşayan ve rasgele seçilen, 15 yaş altı, laboratuvarda doğrulanmış 189 vaka ile komşu ve yaş eşleştirmesi yapılan kontrolleri karşılaştırılmıştır. Aşı etkililiği (AE) hesaplanmıştır. Bulgular: Döküntü başlamadan bir ay öncesinde herhangi bir sağlık kuruluşuna başvuranlar; 0–11 aylık yaş grubunda vakaların %53.8’i, kontrollerin %23.8’i (TRR_adj=3.7, %95 GA=1.6–8.6) 1–6 yaş grubunda vakaların % 48.2’i, kontrollerin %14.3 (TRR_adj=5.5, %95 GA=2.5–12.8),  7–14 yaş grubunda ise vakaların %22.5’i, kontrollerin %12.8’idir (TRR_adj=1.9, %95 GA=0.5–8.3). 12. aydaki kızamık aşı dozunu yaptırmayanlar; 1–6 yaş grubunda vakaların %59.7’si, kontrollerin %14.7’si (TRR_adj=7.4, 95% GA=2.1–26.9; AE=%86, %95 GA=%52-96), 7– 14 yaş grubunda ise vakaların %53.8’i, kontrollerin %15.4’üdür (TRR_adj=6.7,%95 GA=1.7–26.6; AE=%85, %95 GA=%41-96). Sonuç: Bu salgında hastanelerin kızamık bulaşını kolaylaştırdığı saptanmıştır. Çalışma sonuçlarına göre; ateş ve döküntülü vakalara triaj uygulanması ve kızamık aşı programının güçlendirilmesi önerilmiştir.

Anahtar kelimeler: Kızamık, kızamık aşısı, hastane kaynaklı enfeksiyonlar, risk faktörleri, vaka kontrol çalışması.

Keywords

Kızamık, kızamık aşısı, hastane kaynaklı enfeksiyonlar, risk faktörleri, vaka kontrol çalışması

References

• 1. Measles. World Health Organization website. Available at: http://www.who.int/immunization/topics/ measles/en/index.html. Accessed February 18, 2014.
• 2. Global eradication of measles. Report by the Secretariat. World Health Organization website. Available at: http://apps.who.int/gb/ebwha/pdf_files/w ha63/a63_18-en.pdf. Accessed February 26, 2014.
• 3. Eliminating measles and rubella: framework for the verification process in the WHO European Region. World Health Organization, Regional Office for Europe website. Available at: http://www.euro.who.int/en/healthtopics/communicable-diseases/measlesandrubella/publications/2012/eliminatingmeasles-and-rubella-framework-for-theverification-process-in-the-who-europeanregion. Accessed February 18, 2014.
• 4. Circular on measles, rubella and congenital rubella surveillance 2010. Public Health Institute of Turkey, Ministry of Health of Turkey website. Available at: http://www.saglik.gov.tr/TR/belge/1- 10232/kizamik-kizamikcik-ve-konjenitalkizamikcik-kks-surveya-.htlm. Accessed February 18, 2014.
• 5. Republic of Turkey Ministry of Health. Health Statistics Yearbook, 2008. Ministry of Health of Turkey website. Accessed February 18, 2014.
• 6. General Directorate of Primary Health Care Services: 2001 Statistical Yearbook. Ministry of Health of Turkey website. Available at: http://www.saglik.gov.tr/TR/belge/1- 3020/eski2yeni.html. Accessed February 18, 2014.
• 7. Annual Epidemiological Report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. European Centre for Disease Prevention and Control, Stockholm: ECDC website. Available at: http://ecdc.europa.eu/en/publications/Pub lications/Annual-Epidemiological-Report- 2012.pdf. Accessed February 24, 2014.
• 8. Measles Report. Turkish Society of Public Health Specialist (Halk Sağlığı Uzmanları Derneği). (Kızamık Raporu Mart, 2013) (Turkish). Available at: http://xa.yimg.com/kq/groups/13740820/ 620990780/name/HASUDER_KIZAMIK_RA PORU.pdf. Accessed November 12, 2015.
• 9. Public Health Instution of Turkey. National Measles Surveillance. Unpublished data. Accessed April 14, 2013. 10. Orenstein WA, Bernier RH, Dondero TJ, Hinman AR, Marks JS, Bart KJ, et al. Field evaluation of vaccine efficacy. Bull World Health Organ 1985;63(6):1055–1068.
• 11. Weinberg GA, Szilagyi PG. Vaccine Epidemiology: Efficacy, Effectiveness, and he Translational Research Roadmap. J Infect Dis 2010;201(11):1607–1610.
• 12. Measles outbreaks in Europe. World Health Organization website. Available at: http://www.who.int/csr/don/2011_04_21/ en/. Accessed March 4, 2014.
• 13. Akramuzzaman SM, Cutts FT, Hossain MJ, Wahedi OK, Nahar N, Islam D, et al. Measles vaccine effectiveness and risk factors for measles in Dhaka, Bangladesh. Bull World Health Organ 2002;80(10):776– 782.
• 14. Heymann DL. Control of communicable diseases manual. Washington, DC: American Public Health Association, 2008.
• 15. Biellik RJ, Clements CJ. Strategies for minimizing nosocomial measles transmission. Bull World Health Organ 1997;75(4):367–375.
• 16. Marshall TM, Hlatswayo D, Schoub B. Nosocomial outbreaks-a potential threat to the elimination of measles. J Infect Dis 2003;187(s1):97–101.
• 17. Navarro E, Mochon M, Galicia M, Marin I, Laguna J. Study of a measles outbreak in Granada with preventive measures applied by the courts, Spain, 2010 to 2011. Euro Surveill 2013;18(43):pii=20612. DOI: http://dx.doi.org/10.2807/1560- 7917.ES2013.18.43.20612
• 18. Chen E, He H-Q, Li Q. [Case-control study on epidemiology factors of measles in Zhejiang Province in 2008]. Zhongguo Yi Miao He Mian Yi 2010;16(1):11–14.
• 19. Gao J, Chen E, Wang Z, Shen J, He H, Ma H, et al. Epidemic of measles following the nationwide mass immunization campaign. BMC Infect Dis 2013;13(1):1–6.
• 20. Choi WS, Sniadack DH, Jee Y, Go U-Y, So JS, Cho H, et al. Outbreak of measles in the Republic of Korea, 2007: importance of nosocomial transmission. J Infect Dis 2011;204(suppl 1):483–490.
• 21. Low C, Thoon KC, Lin R, Chua A, Hishamuddin P, Taya J, et al. Possible nosocomial transmission of measles in unvaccinated children in a Singapore public hospital. West Pac Reg 2012;3(4):7-11.
• 22. Republic of Turkey Ministry of Health. Public Health Information System, unpublished data. Accessed April 14, 2013.
• 23. Kidd S, Ouedraogo B, Kambire C, Kambou JL, McLean HQ, Kutty PK. Measles outbreak in Burkina Faso, 2009: A case– control study to determine risk factors and estimate vaccine effectiveness. Vaccine 2012;30(33):5000–5008.
• 24. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013. Center for Diseases Control and Prevention website. Available at: http://www.cdc.gov/mmwr/preview/mmw rhtml/rr6204a1.htm?s_cid=rr6204a1_w#Ta b1.available%20. Accessed February 26, 2014.
• 25. Sudfeld CR, Navar AM, Halsey NA. Effectiveness of measles vaccination and vitamin A treatment. Int J Epidemiol 2010;39(suppl 1):i48–i55. DOİ: 10.1093/ije/dyq021.
• 26. Uzicanin A, Zimmerman L. Field effectiveness of live attenuated measlescontaining vaccines: a review of published literature. J Infect Dis 2011;204(suppl 1):133–149.
• 27. McDonnell LF, Jorm LR, Patel MS. Measles outbreak in western Sydney. Vaccine failure or failure to vaccinate. Med J Aust 1995;162(9):471–475.