1616. Confronting Measles: The View from a New York City Health System at the Center of the Outbreak

BACKGROUND: A measles outbreak was identified in NYC in October, 2018. Over 430 cases have been confirmed to date, mostly in under-vaccinated children. Due to referral patterns, our health system provided care to a large number of these patients in the ambulatory, Emergency Department and inpatient settings, placing significant pressure on Infection Prevention and Control efforts. Our response utilized the engineering, administrative, protective equipment and educational hierarchy of controls to prevent transmission to patients, visitors and staff. METHODS: Patients residing from outbreak zip codes were flagged in our electronic medical record. Screening for symptoms, measles exposure, vaccine opportunities and education were provided when patients presented for care. Enhanced controls for premature infants and immunocompromised patients were enacted. Automated emails to providers caring for patients from the outbreak area served as reminders to consider measles in differential diagnosis. As most cases of measles occurred in children, special effort was taken to prevent transmissions in pediatrics. Patient rooms on multiple inpatient floors were converted to negative pressure with respect to corridor, as admitted patients developed symptomatic (contagious) illness while hospitalized. We limited all nonimmune visitors <5 years from entering inpatient units. Patients were contacted prior to ambulatory visits, procedures, and surgery to ensure patients from outbreak zip codes were triaged appropriately. Automated alerts to Infection Control when measles testing was ordered allowed timely implementation of prevention measures and surveillance. Finally, educational materials for patients and visitors were translated into 7 languages and shared with other NYC hospitals. RESULTS: To date, 95 patients with suspect measles presented to our system, with 20 patients (16 pediatric and 4 adult) laboratory-confirmed cases requiring hospital admission due to measles pneumonia, hepatitis, and encephalitis. There was no evidence of transmission within the hospital and ambulatory setting to patients or staff. CONCLUSION: A coordinated response involving engineering and administrative controls, PPE training and education is necessary when confronting a large urban measles outbreak. DISCLOSURES: All authors: No reported disclosures.