Nancy A. Melville

May 29, 2015

LEIPZIG, Germany — A series of measles outbreaks involving healthcare workers in Europe has some experts calling for mandatory measles, mumps, and rubella (MMR) vaccination for nurses and doctors.

"Transmission of measles in healthcare settings is an under-recognized problem," said Tarik Derrough, PharmD, from the European Centre for Disease Prevention and Control (ECDC) in Stockholm.

"Unvaccinated healthcare workers represent an avoidable risk factor for transmission of measles and other vaccine-preventable diseases in healthcare settings," he said here at the 33rd Annual Meeting of the European Society for Paediatric Infectious Diseases. "We strongly believe mandatory vaccination is the way to go — for doctors and nurses alike."

In the United States, the virus was declared eliminated in 2000, but there has been an alarming increase in cases. In 2013, there were 200 cases of measles, and in 2014, there were 668 cases, according to the Centers for Disease Control and Prevention (CDC).

In Europe, which has much higher rates of infection, the struggle for eradication continues. From March 2014 to February 2015, there were 3760 cases, according to the ECDC.

Eight Outbreaks in 4-Year Period

Dr Derrough and his team analyzed data on measles outbreaks involving healthcare workers in Europe from 2010 and 2014. They identified eight outbreaks involving 719 cases of measles, 205 (28%) of which involved healthcare workers and staff involved in the care of patients who were either index cases or part of the transmission chain.

"Some of the healthcare workers with very severe infections were admitted and they transmitted some infection to patients," Dr Derrough reported.

Unvaccinated healthcare workers pose a risk in any setting involving contact with patients, but risk is particularly high in waiting rooms of emergency departments, he said. "These settings have a high number of infants seeking care who may be too young to have been vaccinated."

Despite the risk posed by unvaccinated workers, most agree that the implementation of mandatory vaccination policies is difficult, he pointed out. A common argument against the policy is that there is no guarantee that it would truly increase the number of vaccinated healthcare workers.

Mandatory vaccination policies involving the general public in places like the United Kingdom have not worked well, Dr Derrough explained. However, "in Italy, vaccines that are mandatory are perceived as being more important and are prioritized over those that are only recommended," he said.

"What is likely to make a difference is the offer, delivery, convenience, and information provided to healthcare workers," he told Medscape Medical News.

 
How can we increase the vaccination rate in the general population if we have to battle to get healthcare workers vaccinated?
 

In the past year, 64.8% of all European cases of measles in the general public occurred in Germany — it's 1239 cases were attributed largely to asylum seekers — and in Italy, which had 1199 cases.

Of the 3760 cases in Europe, 73% involved people who were unvaccinated. With such figures, the need for vaccination among healthcare workers is all the more important, Dr Derrough said.

"Doctors and other healthcare providers are regarded as the most reliable sources of information from parents," he said. "How can we increase the vaccination rate in the general population if we have to battle to get healthcare workers vaccinated?"

Situation in the United States

In the United States, the main focus has been to get healthcare workers vaccinated for influenza, and the battle is just as hard, said Gregory Poland, MD, director of the Vaccine Research Group at the Mayo Clinic in Rochester, Minnesota, who is a spokesperson for the Infectious Diseases Society of America.

In Europe and the United States, "we have put individual rights above the welfare of our patients," he told Medscape Medical News.

"We have this terrible dilemma of allowing healthcare workers, regardless of their level of education or expertise, to make decisions that can and do affect the lives and the welfare of patients we are privileged to care for," he explained.

At the Mayo Clinic, the mission statement is clear: "The needs of the patient come first," Dr Poland reported. The vaccination of healthcare workers is verified as part of employment. Workers who have not received the influenza vaccine are required to wear a mask.

But such requirements are far from universal in the United States, and nurses unions are among the most vocal opponents of mandatory vaccination.

"This is surprising, considering that nurses spend the most face-to-face time with patients," Dr Poland said. "It's a pitiful state of affairs that, nationally and internationally, professions have not accepted this mantle of responsibility."

According to the CDC, 10 states currently have laws requiring hospitals to ensure that their employees have the MMR vaccination.

Dr Derrough has disclosed no relevant financial relationships. Dr Poland reports financial relationships with Merck, CSL Biotherapies, Avianax, Sanofi Pasteur, Dynavax, Novartis Vaccines and Therapeutics, PAXVAX Inc., Emergent Biosolutions, Adjuvance, and Vaxess, and holds two patents related to vaccinia and measles peptide research.

33rd Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID). Presented May 15, 2015.

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