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Evidence to Support Expanding the Recommendations of the Immunization Practices Advisory Committee

Sandra Schwarcz, MD, MPH; Brigid McCaw, MD, MPH; Paula Fukushima, MS, MT

Arch Intern Med. 1992;152(7):1481-1483.

Abstract
Background.—
In 1989 and 1990, measles reached epidemic proportions in the United States, including several areas of California. Children's Hospital Oakland (Calif), a major health care provider for children in a measles epidemic area of California, reported 131 cases between 1989 and 1991, the largest number ever reported by that institution. In February 1990, four cases of measles were reported among hospital staff. Continued risk of nosocomial infection prompted the development of a program to ensure that all hospital staff were adequately protected against measles.

Methods.—
All hospital employees who were unable to document proof of measles immunity were required to be serologically screened for measles antibody and to be vaccinated against measles if they were determined to be nonimmune. Serologic screening was performed in-house with a commercially available enzyme-linked immunosorbent assay measles antibody test. Dates of birth were recorded for all employees screened. Individuals with negative or repeatedly equivocal results were considered to be nonimmune and were vaccinated with trivalent measles-mumps-rubella vaccine.

Results.—
Between March and June 1990, 1694 staff were serologically tested for measles antibody. Eighty-nine (5.3%) of the employees were considered to have inadequate immunity. Forty (45%) of these susceptible individuals were born before 1957.

Conclusions.—
We conclude that the recommendations of the Immunization Practices Advisory Committee should be expanded to include serologic screening or vaccination of hospital personnel who were born before 1957. Serologic screening of hospital staff may be a reasonable alternative to vaccination under certain circumstances.

(Arch Intern Med. 1992;152:1481-1483)

Author Affiliations
From the Children's Hospital Oakland (Calif) (Dr Schwarcz and Ms Fukushima) and the Department of Internal Medicine, Kaiser Permanente Medical Center, Oakland, Calif (Dr McCaw).

Footnotes
Accepted for publication January 17, 1992.

Presented in part at the American College of Physicians Northern California annual meeting, Monterey, Calif, October 14, 1991, and the American Public Health Association 119th annual meeting, Atlanta, Ga, November 12, 1991.

Reprints not available.

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