Costs associated with measles in healthcare personnel during the 2017–2018 epidemic in Greece: a real-world data cost-of-illness analysis

doi:10.1016/j.jhin.2019.12.006

Journal of Hospital Infection

Volume 105, Issue 1, May 2020, Pages 91-94

https://doi.org/10.1016/j.jhin.2019.12.006 Get rights and content

Summary

Measles represents an occupational risk for healthcare personnel (HCP). A total of 117 cases of measles among HCP were notified in Greece during 2017–2018. We were able to contact 46 of them. Most of those contacted had a serious clinical course with complications, necessitating hospitalization in 67% of cases. All HCP reported absenteeism, for a mean duration of 21.2 working days (range: 3–60 days); 54.3% of HCP reported being at work while symptomatic for a mean duration of 2.3 working days (range: 1–7 days). The average total cost-of-illness was €4,739 per HCP. The total direct and indirect costs of the 117 notified cases among HCP amount to €554,494, which is likely to be an underestimate of the true cost.

Introduction

Vaccination programmes against measles have been in place for almost four decades in Europe, yet a large measles epidemic affected almost all European countries with a toll of 44,074 cases and 84 deaths from January 1^st, 2016 to March 31^st, 2019 [1]. Healthcare personnel (HCP) constitute a high-risk group for acquisition of measles and for getting serious illness [2]. During the recent measles epidemic in Europe, HCP were affected disproportionately, which is explained by lack of immunity and occupational risk of infection [[3], [4], [5], [6]]. Recently we described 117 cases of measles among HCP notified during the 2017–2018 epidemic in Greece [4]. In particular, we estimated that HCP accounted for 4.2% of all notified cases, with a notification rate of 1429 cases per one million HCP, which was 5.6 times greater than in the general population [4]. Similarly, HCP accounted for 7% of cases of measles notified in Italy [3]. In our report, 30.8% of HCP with measles had at least one serious complication, compared with 14.3% among the general population which was attributed to the increased age of the former group [2,4]. In this study we estimated the direct and indirect costs associated with measles among HCP during the 2017–2018 epidemic in Greece.

Section snippets

Methods

We reviewed the notification forms of the 117 measles cases among HCP identified through the National Notification System [4]. A phone number was available in 73 cases; 46 (63%) of these were available for a telephone survey. A structured questionnaire was used to collect the following data through telephone interviews: demographics, comorbidities, professional characteristics, and use of healthcare services, including outpatient visits, hospitalizations, laboratory investigations, imaging

Results

The study sample consisted of 46 HCP out of the 117 notified cases of measles among HCP (39.3%). Their characteristics are shown in Table I. Thirty-one cases (67.4%) were admitted to the hospital for an average of 7.32 days (range: 1–30 days; SD: 6.52), including three cases (aged 38, 42, and 43 years) with major respiratory complications admitted in the intensive care unit (ICU) for 20, 12, and 3 days, respectively. One of the cases admitted in ICU had a history of bone marrow transplantation

Discussion

Measles virus spreads very easily and transmission can occur as early as four days before rash eruption and thus before clinical suspicion and implementation of appropriate infection control measures [2]. During the recent measles epidemics in Europe, healthcare facilities and especially emergency departments were well-recognized sites of transmission of measles, resulting in hundreds of contacts and several generations of cases [[2], [3], [4], [5], [6],10]. It has been estimated that HCP have

Conflict of interest statement

None declared.

Funding sources

None.

References (15)

H.C. Maltezou et al.
Measles in health-care settings
Am J Infect Control
(2013)
H.C. Maltezou et al.
Measles in healthcare workers during the ongoing epidemic in Greece, 2017–2018
J Hosp Infect
(2018)
N.H. Fefferman et al.
Dangers of vaccine refusal near the herd immunity threshold: a modelling study
Lancet Infect Dis
(2015)
U. Hiller et al.
Hospital outbreaks of measles – evaluation and costs of 10 occupational cases among healthcare workers in Germany, February to March 2017
Vaccine
(2019)
Risk assessment.
Who is at risk for measles in the EU/EEA?
(28 May 2019)
A. Filia et al.
Ongoing outbreak with well over 4,000 measles cases in Italy from January to end August 2017 – what is making elimination so difficult?
Euro Surveill
(2017)
E. Botelho-Nevers et al.
Measles among healthcare workers: a potential for nosocomial outbreaks
Euro Surveill
(2011)

There are more references available in the full text version of this article.

Cited by (3)

Trend of immunity against measles and varicella zoster virus in healthcare workers in Korea
2023, Vaccine
To examine the seroprevalence of measles and varicella zoster virus (VZV) among healthcare workers (HCW) and evaluate the concordance between self-reported history of previous disease or vaccination and seropositivity.
A seroprevalence study and survey.
A university-affiliated tertiary care hospital.
All HCWs working in high-risk services in 2017 underwent serologic tests and survey; all new HCWs employed in the subsequent years, serologic tests only.
A serologic study was conducted using chemiluminescence immunoassay (2017) or enzyme immunoassays (2018 and later). HCWs who underwent serological testing in 2017 completed a self-administered questionnaire on their history of infection and vaccination.
A total of 10,278 and 9607 HCWs underwent serologic tests for measles and VZV IgG, respectively, from 2017 to 2022. The overall seropositivity rates for measles and VZV were 78.1 % and 92.8 %, respectively. Measles seropositivity declined gradually from >90 % in the HCWs born in the 1960s to <80 % in those born in the 1990s. There was a significant difference in measles seropositivity between the birth cohorts (BCs) 1967–1984 and 1985–1999 (P < 0.001; odds ratio, 1.16; 95 % confidence interval, 1.14–1.18). The seropositivity for VZV was stable, at >90 % in all BCs. The self-reported vaccination history was not independently associated with seropositivity, and the negative predictive value of the survey was very low (9.6 % and 13.1 %, respectively).
Measles seropositivity showed a substantial decline among HCWs born in 1985 or later, while varicella seropositivity remained high. The self-reported vaccination history was not sufficiently reliable for screening HCWs.
Sex and age as determinants of the seroprevalence of anti-measles IgG among European healthcare workers: A systematic review and meta-analysis
2022, Vaccine
Citation Excerpt :
In the emergency state in which the world currently finds itself, quick and firm decisions must be taken. The reduction of susceptible HCWs would reduce the risk of a measles outbreak and therefore measles-related morbidity and mortality, absenteeism, and their direct and indirect costs [35,53-55,287]. Other, perhaps more difficult to solve problems for international public health institutions are the management of HCWs vaccinated with at least two doses of vaccine but who remain sero-susceptible and the decrease in circulating antibody over time among the vaccinated.
The international literature shows good evidence of a significant rate of measles susceptibility among healthcare workers (HCWs). As such, they are an important public health issue.
We conducted a systematic review and meta-analysis to estimate the prevalence of susceptible HCWs in EU/EEA countries and in the UK and to explore the characteristics (sex and age differences) and management of those found to be susceptible.
Nineteen studies were included in the meta-analysis. The prevalence of measles-susceptible HCWs was 13.3% (95 %CI: 10.0–17.0%). In a comparison of serosusceptible female vs. male HCWs, the RR was 0.92 (95 %CI = 0.83–1.03), and in a comparison of age classes (born after vs. before 1980) the RR was 2.78 (95 %CI = 2.20–3.50). The most recent studies proposed the mandatory vaccination of HCWs.
According to our meta-analysis, the prevalence of serosusceptible European HCWs is 13%; HCWs born in the post-vaccination era seem to be at higher risk. Healthcare professionals susceptible to measles are a serious epidemiological concern. Greater efforts should therefore be made to identify those who have yet to be vaccinated and actively encourage their vaccination.
Seroprevalence of measles antibodies in healthcare professionals in a Central Hospital in Portugal
2021, Acta Medica Portuguesa

View full text

Short reportCosts associated with measles in healthcare personnel during the 2017–2018 epidemic in Greece: a real-world data cost-of-illness analysis

Summary

Introduction

Section snippets

Methods

Results

Discussion

Conflict of interest statement

Funding sources

Am J Infect Control

J Hosp Infect

Lancet Infect Dis

Vaccine

Risk assessment.

Who is at risk for measles in the EU/EEA?

Ongoing outbreak with well over 4,000 measles cases in Italy from January to end August 2017 – what is making elimination so difficult?

Euro Surveill

Measles among healthcare workers: a potential for nosocomial outbreaks

Euro Surveill

Short report
Costs associated with measles in healthcare personnel during the 2017–2018 epidemic in Greece: a real-world data cost-of-illness analysis