title: Health care-associated measles outbreak in the United States after an importation: challenges and economic impact.
abstract: BACKGROUND
  On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care-associated transmission and assessed outbreak-associated hospital costs.
  
  
  METHODS
  Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non-measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals.
  
  
  RESULTS
  Of 14 patients with confirmed cases, 7 (50%) were aged ≥ 18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities.
  
  
  CONCLUSIONS
  Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs.
authors.affiliation: Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sanny Y
authors.initials: SY
authors.lastname: Chen
authors.forename: Shoana
authors.initials: S
authors.lastname: Anderson
authors.forename: Preeta K
authors.initials: PK
authors.lastname: Kutty
authors.forename: Francelli
authors.initials: F
authors.lastname: Lugo
authors.forename: Michelle
authors.initials: M
authors.lastname: McDonald
authors.forename: Paul A
authors.initials: PA
authors.lastname: Rota
authors.forename: Ismael R
authors.initials: IR
authors.lastname: Ortega-Sanchez
authors.forename: Ken
authors.initials: K
authors.lastname: Komatsu
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Armstrong
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sunenshine
authors.forename: Jane F
authors.initials: JF
authors.lastname: Seward
mesh_terms: D000328:Adult; D001130:Arizona / Q000453:epidemiology; D002675:Child, Preschool; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D008875:Middle Aged; D013557:Switzerland / Q000208:ethnology; D014195:Travel