1887
  1. Home
  2. Eurosurveillance
  3. Volume 26, Issue 17, 29/Apr/2021
  4. Article
Research Open Access
Like 0
Download

Abstract

Background

Healthcare workers (HCW) have been identified as index cases in disease outbreaks of vaccine-preventable diseases (VPD) in hospitals.

Aim

We investigated whether Danish paediatric HCW were protected against selected serious VPD.

Methods

We included 90% of staff members from two paediatric departments. All 555 HCW (496 women) supplied a blood sample for serology and filled in a questionnaire. Antibodies were measured with enzyme immunoassay against measles, mumps, rubella (MMR), varicella zoster, pertussis toxin and diphtheria toxin.

Results

Protective levels of IgG were found for measles (90.3%), mumps (86.5%), rubella (92.3%), varicella (98.6%) and diphtheria (80.5%). We found seropositivity for all three MMR components in 421 (75.9%) HCW, lowest in those younger than 36 years (63.3%). Only 28 (5%) HCW had measurable IgG to pertussis. HCW with self-reported immunity defined as previous infection or vaccination, had protective levels of IgG against measles, mumps, rubella and varicella in 87.4–98.8% of cases, not significantly higher than in those not reporting immunity. Previous history of disease had a high positive predictive value (PPV) of 96.8–98.8%. The PPV for previous vaccination ranged from 82.5% to 90.3%. In contrast, negative predictive values of self-reported history of disease and vaccination were remarkably low for all diseases.

Conclusion

The immunity gaps found primarily in young HCW indicate a need for a screening and vaccination strategy for this group. Considering the poor correlation between self-reported immunity and seropositivity, efforts should be made to check HCW’s immune status in order to identify those who would benefit from vaccination.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2021.26.17.2001167
2021-04-29
2024-04-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2021.26.17.2001167
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/26/17/eurosurv-26-17-5.html?itemId=/content/10.2807/1560-7917.ES.2021.26.17.2001167&mimeType=html&fmt=ahah

References

  1. Statens Serum Institut (SSI). Udbrud af mæslinger i Danmark. [Measles outbreak in Denmark]. Copenhagen: SSI. [Accessed: 17 Apr 2021]. Danish. Available from: https://www.ssi.dk/aktuelt/sygdomsudbrud/arkiv/udbrud-af-maeslinger-i-danmark
  2. Eriksen J, Davidkin I, Kafatos G, Andrews N, Barbara C, Cohen D, et al. Seroepidemiology of mumps in Europe (1996-2008): why do outbreaks occur in highly vaccinated populations? Epidemiol Infect. 2013;141(3):651-66.  https://doi.org/10.1017/S0950268812001136  PMID: 22687578 
  3. Gidding HF, Quinn HE, Hueston L, Dwyer DE, McIntyre PB. Declining measles antibodies in the era of elimination: Australia’s experience. Vaccine. 2018;36(4):507-13.  https://doi.org/10.1016/j.vaccine.2017.12.002  PMID: 29269156 
  4. Koivisto K, Puhakka L, Lappalainen M, Blomqvist S, Saxén H, Nieminen T. Immunity against vaccine-preventable diseases in Finnish pediatric healthcare workers in 2015. Vaccine. 2017;35(12):1608-14.  https://doi.org/10.1016/j.vaccine.2017.02.018  PMID: 28233625 
  5. Aypak C, Bayram Y, Eren H, Altunsoy A, Berktaş M. Susceptibility to measles, rubella, mumps, and varicella-zoster viruses among healthcare workers. J Nippon Med Sch. 2012;79(6):453-8.  https://doi.org/10.1272/jnms.79.453  PMID: 23291844 
  6. Kumakura S, Shibata H, Onoda K, Nishimura N, Matsuda C, Hirose M. Seroprevalence survey on measles, mumps, rubella and varicella antibodies in healthcare workers in Japan: sex, age, occupational-related differences and vaccine efficacy. Epidemiol Infect. 2014;142(1):12-9.  https://doi.org/10.1017/S0950268813000393  PMID: 23574767 
  7. Andrew EC, Gibney KB, Denholm J, Leder K. Seroprotection to vaccine-preventable diseases among workers at a Victorian tertiary hospital. Aust N Z J Public Health. 2016;40(3):284-9.  https://doi.org/10.1111/1753-6405.12508  PMID: 27027875 
  8. Sá Machado R, Perez Duque M, Almeida S, Cruz I, Sottomayor A, Almeida I, et al. Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: challenges in the post-elimination era. Euro Surveill. 2018;23(20).  https://doi.org/10.2807/1560-7917.ES.2018.23.20.18-00224  PMID: 29790461 
  9. Hiller U, Mankertz A, Köneke N, Wicker S. Hospital outbreak of measles - Evaluation and costs of 10 occupational cases among healthcare worker in Germany, February to March 2017. Vaccine. 2019;37(14):1905-9.  https://doi.org/10.1016/j.vaccine.2019.02.068  PMID: 30850241 
  10. Langley JM, Hanakowski M. Variation in risk for nosocomial chickenpox after inadvertent exposure. J Hosp Infect. 2000;44(3):224-6.  https://doi.org/10.1053/jhin.1999.0664  PMID: 10706806 
  11. Maltezou HC, Ftika L, Theodoridou M. Nosocomial pertussis in neonatal units. J Hosp Infect. 2013;85(4):243-8.  https://doi.org/10.1016/j.jhin.2013.09.009  PMID: 24156850 
  12. Pérez-Alba E, García-Ortiz A, Salazar-Montalvo RG, Hernández-Guedea MA, Camacho-Ortiz A. Mumps outbreak with high complication rates among residents in a university teaching hospital. Am J Infect Control. 2019;47(3):337-9.  https://doi.org/10.1016/j.ajic.2018.09.003  PMID: 30442444 
  13. Sundell N, Dotevall L, Sansone M, Andersson M, Lindh M, Wahlberg T, et al. Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections. Euro Surveill. 2019;24(17).  https://doi.org/10.2807/1560-7917.ES.2019.24.17.1900114  PMID: 31039835 
  14. Cherry JD. Why do pertussis vaccines fail? Pediatrics. 2012;129(5):968-70.  https://doi.org/10.1542/peds.2011-2594  PMID: 22529282 
  15. Maltezou HC, Botelho-Nevers E, Brantsæter AB, Carlsson R-M, Heininger U, Hübschen JM, et al. Vaccination of healthcare personnel in Europe: Update to current policies. Vaccine. 2019;37(52):7576-84.  https://doi.org/10.1016/j.vaccine.2019.09.061  PMID: 31623916 
  16. Porteous GH, Hanson NA, Sueda LAA, Hoaglan CD, Dahl AB, Ohlson BB, et al. Resurgence of vaccine-preventable diseases in the United States: anesthetic and critical care implications. Anesth Analg. 2016;122(5):1450-73.  https://doi.org/10.1213/ANE.0000000000001196  PMID: 27088999 
  17. Guiso N, Berbers G, Fry NK, He Q, Riffelmann M, Wirsing von König CH, et al. What to do and what not to do in serological diagnosis of pertussis: recommendations from EU reference laboratories. Eur J Clin Microbiol Infect Dis. 2011;30(3):307-12.  https://doi.org/10.1007/s10096-010-1104-y  PMID: 21069406 
  18. de Ory F, Echevarría JM, Kafatos G, Anastassopoulou C, Andrews N, Backhouse J, et al. European seroepidemiology network 2: Standardisation of assays for seroepidemiology of varicella zoster virus. J Clin Virol. 2006;36(2):111-8.  https://doi.org/10.1016/j.jcv.2006.01.017  PMID: 16616612 
  19. von Linstow ML, Nordmann Winther T, Eltvedt A, Bybeck Nielsen A, Yde Nielsen A, Poulsen A. Self-reported immunity and opinions on vaccination of hospital personnel among paediatric healthcare workers in Denmark. Vaccine. 2020;38(42):6570-7.  https://doi.org/10.1016/j.vaccine.2020.08.010  PMID: 32800467 
  20. Duncan JR, Witkop CT, Webber BJ, Costello AA. Varicella seroepidemiology in United States air force recruits: A retrospective cohort study comparing immunogenicity of varicella vaccination and natural infection. Vaccine. 2017;35(18):2351-7.  https://doi.org/10.1016/j.vaccine.2017.03.054  PMID: 28359621 
  21. Veneti L, Borgen K, Borge KS, Danis K, Greve-Isdahl M, Konsmo K, et al. Large outbreak of mumps virus genotype G among vaccinated students in Norway, 2015 to 2016. Euro Surveill. 2018;23(38).  https://doi.org/10.2807/1560-7917.ES.2018.23.38.1700642  PMID: 30255834 
  22. St-Martin G, Knudsen LK, Engsig FN, Panum I, Andersen PHS, Rønn J, et al. Mumps resurgence in Denmark. J Clin Virol. 2014;61(3):435-8.  https://doi.org/10.1016/j.jcv.2014.08.013  PMID: 25218244 
  23. Kontio M, Jokinen S, Paunio M, Peltola H, Davidkin I. Waning antibody levels and avidity: implications for MMR vaccine-induced protection. J Infect Dis. 2012;206(10):1542-8.  https://doi.org/10.1093/infdis/jis568  PMID: 22966129 
  24. Wing EJ, Remington JS. Cell-mediated immunity and its role in resistance to infection. West J Med. 1977;126(1):14-31. PMID: 318786 
  25. Advisory Committee on Immunization PracticesCenters for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-7):1-45. PMID: 22108587 
  26. Hahné SJM, Nic Lochlainn LM, van Burgel ND, Kerkhof J, Sane J, Yap KB, et al. Measles outbreak among previously immunized healthcare workers, the Netherlands, 2014. J Infect Dis. 2016;214(12):1980-6.  https://doi.org/10.1093/infdis/jiw480  PMID: 27923955 
  27. European Centre for Disease Prevention and Control (ECDC). Vaccine scheduler. Pertussis: recommended vaccinations. Stockholm: ECDC. [Accessed: 23 Apr 2021]. Available from: https://vaccine-schedule.ecdc.europa.eu/Scheduler/ByDisease?SelectedDiseaseId=3&SelectedCountryIdByDisease=-1
  28. Kumakura S, Onoda K, Hirose M. Self-reported histories of disease and vaccination against measles, mumps, rubella and varicella in health care personnel in Japan. J Infect Chemother. 2014;20(3):194-8.  https://doi.org/10.1016/j.jiac.2013.10.006  PMID: 24462433 
  29. Alp E, Cevahir F, Gökahmetoglu S, Demiraslan H, Doganay M. Prevaccination screening of health-care workers for immunity to measles, rubella, mumps, and varicella in a developing country: What do we save? J Infect Public Health. 2012;5(2):127-32.  https://doi.org/10.1016/j.jiph.2011.11.003  PMID: 22541258 
  30. Coppeta L, Morucci L, Pietroiusti A, Magrini A. Cost-effectiveness of workplace vaccination against measles. Hum Vaccin Immunother. 2019;15(12):2847-50.  https://doi.org/10.1080/21645515.2019.1616505  PMID: 31339463 
  31. Dorigo-Zetsma JW, Leverstein-van Hall MA, Vreeswijk J, de Vries JJC, Vossen ACTM, Ten Hulscher HI, et al. Immune status of health care workers to measles virus: evaluation of protective titers in four measles IgG EIAs. J Clin Virol. 2015;69:214-8.  https://doi.org/10.1016/j.jcv.2015.06.095  PMID: 26209410 
Immunity to vaccine-preventable diseases among paediatric healthcare workers in Denmark, 2019
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Marie-Louise+von+Linstow&option1=author&noRedirect=true" class="nonDisambigAuthorLink">von Linstow Marie-Louise</a>, <a href="/search?value1=Alex+Yde+Nielsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Yde Nielsen Alex</a>, <a href="/search?value1=Nikolai+Kirkby&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kirkby Nikolai</a>, <a href="/search?value1=Anna+Eltvedt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eltvedt Anna</a>, <a href="/search?value1=Thilde+Nordmann+Winther&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nordmann Winther Thilde</a>, <a href="/search?value1=Allan+Bybeck+Nielsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bybeck Nielsen Allan</a>, <a href="/search?value1=Didi+Bang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bang Didi</a>, <a href="/search?value1=Anja+Poulsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Poulsen Anja</a></span>. Immunity to vaccine-preventable diseases among paediatric healthcare workers in Denmark, 2019. <a href="/content/ecdc">Euro Surveill.</a> 2021;26(17):pii=2001167. <a href="https://doi.org/10.2807/1560-7917.ES.2021.26.17.2001167" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2021.26.17.2001167</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Jun 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 22 Oct 2020 </span> </p>
/content/10.2807/1560-7917.ES.2021.26.17.2001167
/content/10.2807/1560-7917.ES.2021.26.17.2001167
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error