Prevalence and management of measles susceptibility in healthcare workers in Italy: a systematic review and meta-analysis

ABSTRACT

Introduction

The national and international guidelines recommend evaluating all healthcare workers (HCWs) for their measles immune status and possibly vaccinating those who are seronegative.

Areas covered

We conducted a systematic review and meta-analysis in order to estimate the rate of measles susceptibility among HCWs in Italy and to explore possible options for the management of those found to be susceptible. Twenty-three studies were included in the meta-analysis. The prevalence of HCWs susceptible to measles was 11.5% (95%CI = 8.1–15.4%) and was higher in studies in which prevalence was evaluated by survey (16.7%; 95%CI = 8.9–26.3) than by the direct evaluation of blood specimens (9.1%; 95%CI = 6.2–12.5%). Occupational medicine examinations for measles screening with possible subsequent vaccination of seronegatives and the exclusion of susceptible HCWs from high-risk settings were common management strategies.

Expert opinion

HCWs susceptible to measles are an important epidemiological concern in Italy, and efforts to identify and actively offer the vaccine to this population should be increased.

KEYWORDS:

• Healthcare workers
• management of susceptible
• measles
• MMR vaccine
• nosocomial infection

Article highlights

Evidence before this study

• Despite international recommendations, there is good evidence of a significant measles susceptibility among HCWs.

• The existence of a pattern of susceptible HCWs in hospital settings is a determinant of nosocomial clusters.

• A national figure of the prevalence of HCWs susceptible to measles in Italy is not available. Added value of this study

• The prevalence of HCWs susceptible to measles in Italy was 11.5% (95%CI: 8.1–15.4%).

• The Italian proportion of HCWs susceptible to measles is higher compared to European HCWs (12% vs. 6%).

• The scenario of management strategies for these individuals is very different among Italian Regions.Implications of all the available evidence

• healthcare professionals susceptible to measles are a genuine public health concern in Italy.

• mandatory vaccination for susceptible HCWs especially if working in infectious high-risk Units seems the best options.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer discloses that a number of their own works have been referenced throughout the review. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Contribution statement

FPB and ST conceived the study. FPB, SM, PS, and SDN did the literature research. FPB did the meta-analysis. CAG and PL participated in the design of the meta-analysis. FPB and ST co-drafted the first version of the article.

Abbreviations

HCW: healthcare worker; MMR: measles, mumps, rubella.

Ethical approval

This research was approved by Apulian Epidemiological Observatory.

Additional information

Funding

This paper was not funded.