Measles Cases Rise in U.S. as Health Systems Face Preparedness Challenge

As measles cases rise across the United States, clinical leaders must ensure their organizations have the clinical protocols, workforce training, and infection-control infrastructure needed to rapidly identify, isolate, and contain highly contagious diseases. The disease was declared eliminated in the United States in 2000, and most physicians have never treated a case.

That reality is now changing, creating a new preparedness challenge for health system leadership. As measles cases reappear across the country, CMOs must ensure their organizations can recognize the disease quickly, isolate infected patients, and prevent outbreaks from spreading within hospitals and clinics.

The strategic concern for CMOs is not simply the rise in measles cases. It is whether their clinical teams, infection-prevention protocols, and vaccination programs are ready to respond to a disease that is both unfamiliar to many clinicians and one of the most contagious pathogens in medicine. Effective preparedness requires coordinated leadership across infectious disease teams, emergency departments, laboratories, and public health partners to ensure that a single case does not escalate into a systemwide outbreak.

There are three primary concerns about the resurgence measles cases, beginning with the health of children, according to the CMO for the Division of Hospital Medicine at Medical University of South Carolina Health. Measles is not a benign disease. Some individuals with measles will develop severe neurological involvement, such as seizures, subacute sclerosing panencephalitis, or brain damage. This can result in clinical devastation to a child, which can result in long-term care needs.

Second, health system and hospital CMOs must be concerned about the ability of their facilities to address a measles outbreak. Measles is a highly contagious disease, and statistics show that one in five unvaccinated patients who get measles will be hospitalized. Health systems need to identify space to separate these patients from other patients as soon as possible.

Third, the resurgence of measles raises concern for what lies ahead. As childhood vaccination rates decline, questions arise about whether diphtheria and polio outbreaks could occur in the future. It all speaks to the importance of measles vaccination. Two doses of the measles vaccine lower an exposed person's risk of contracting measles from 90% to 3%.

There are several steps that health systems, hospitals, and physician practices can take to be prepared for measles outbreaks, according to the director of the Division of Infectious Diseases at MUSC Health, which operates 18 hospitals in The Palmetto State. The first step is for CMOs and other clinical leaders to make sure clinical staff understand the epidemiology of the measles outbreaks in the United States. Hospitals and physician practices should be aware of the hot spots, the affected populations, how patients are presenting with the disease, and whether there are cases in their state or region.

High-risk populations for measles infection include people who have not been vaccinated, people who have not been fully vaccinated, and people with compromised immune systems such as cancer patients. These populations are not only at higher risk for acquiring measles but also for having more serious cases of the disease that require a high level of care.

Essential elements of measles preparedness at health systems, hospitals, and physician practices include educating patient populations about the disease including measures to prevent exposure to the virus. Hospitals and physician practices should have the capability to notify people if they may have been exposed to measles. It is important to engage teams that can collaborate when there is a measle outbreak such as public health teams, infectious disease teams, pharmacy teams, and the senior leadership of hospitals and physician practices. There should be development and implementation of policies, including requirements for vaccination of clinical staff and infection prevention measures such as isolating patients who present for measles.

Measles, a potentially deadly disease, was on the verge of being wiped out until a scientifically dreadful paper linking the mumps, measles and rubella vaccine to autism was published. According to the World Health Organization, tens of millions of deaths have been prevented by vaccines in the 20th century.