This week it’s pertussis, last week it was measles. Nowadays it seems there is always at least one preventable disease outbreak juggling its way through the news cycle. What’s happening to bring these almost-eliminated diseases back into the spotlight? The answer lies somewhere between waning vaccines, foreign travel and vaccine-hesitant parents. What more can a hospital do to minimize the risk of exposure and avoid the high cost of an outbreak? Most will agree the best way is to strengthen the barrier of immunity on all fronts.

No matter the mission – medical staff, administrator, visitor, vendor and volunteer – everyone walking through the door of a hospital contributes to the mix of bacteria and virus accrued within its walls. According to Becker’s Hospital Benchmarks, the average number of full time employees in a hospital is 908. With over 5k hospitals in the U.S. that puts the total calculation of healthcare staff over 5 million.  To that number we must add the thousands of professional visitors and vendors who cross the hospital’s threshold daily going into the OR, meeting with administrators, providing post-acute care and even delivering flowers. These commercial visitors can come into direct contact with patients through activities as simple as sharing an elevator.
Strengthening the immune barrier means holding the entire population accountable to prevent outbreaks. In order to achieve herd immunity, meaning large numbers of those with immunity protect those not immune, most successful calculations require at least 90 to 95 percent of the population to be able to resist infection. Since patients themselves would account for the 5 to 10 percent most vulnerable, that means almost everyone else who enters a hospital must be immune to achieve the level of protection needed. One of the best ways to manage that immunity is via comprehensive credentialing. Validating correct vaccine dosages, properly evaluating titer test results and staying up with the latest changes in immunizations are critical to making sure everyhospital’s ecosystem is prepared to fight off the next outbreak.

Pertussis – The CDC announced this week a 24% increase in the number of pertussis cases reported so far this year. This number already exceeds the number of cases reported last year. The State of California declared a pertussis epidemic this week with 3,458 cases reported as of April this year. This number is more than the total number reported for all of 2013. The increase in the number of cases is being attributed to the waning acellular DTaP vaccine currently administered in infancy. The CDC recommends a Tdap (an adult version that includes pertussis) for all healthcare personnel as soon as feasible without regard to the interval since the previous dose of Td (the adult version that does not include pertussis).
Measles – The CDC is reporting at least 477 confirmed cases of measles in 16 outbreaks in 20 states so far in 2014. This is the highest number of cases in 18 years. Often the disease was introduced after a recent international trip and spread locally to those who were not vaccinated.  The CDC recommends all healthcare personnel receive two doses of MMR vaccine at least 28 days apart which, for measles, provides a 95 percent immunity rate.
Mumps – Recent outbreaks at Ohio State University and Fordham University in New York have resulted in 464 cases reported as of May, 2014. In comparison, a lesser number of 438 cases were reported for all of 2013. The CDC recommended two doses of MMR provides only an 88 percent immunity rate for mumps which perpetuates in the crowded environments of university living and healthcare institutions.
Drug-Resistant Tuberculosis – While the overall rate of TB is declining in the U.S., a drug-resistant (XDR) TB is now being reported in 84 countries around the world. While still treatable, the treatment period for the drug-resistant strain increases from 6 months to 28 months. According to the WHO, half a million people contracted the superbug strain of tuberculosis in 2012 and they estimate up to 2 million people worldwide may be infected by 2015. The CDC recommends all healthcare personnel be tested annually for TB unless they work in a low-risk environment.
Shingles – Herpes zoster rates are increasing among adults in the United States according to the CDC. While some blame the varicella vaccine now required in the U.S. for the increase, studies show that not only did the increase begin before the introduction of the varicella vaccine but other countries that do not require the childhood dose are also experiencing an increase. The CDC recommends all healthcare personnel receive 2 doses of varicella vaccine at least 28 days apart which provides about 98% effectiveness.

The healthcare community needs to lead the charge in fighting disease outbreaks and show, through example, the importance of vaccinations. The stronger the barrier, the stronger the protection.


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