1638. Measles Outbreak Risk Assessment for Transplant Candidates and Recipients

BACKGROUND: A measles outbreak began in 2018 with ongoing transmission in the New York City (NYC) area, affecting children and vulnerable adults. We developed a systematic 3-part approach to address measles risk in our solid-organ transplant program’s adult population by 1) identification of non-immune adults living in at-risk ZIP codes 2) education focused on risk reduction for all at-risk patients and families and 3) vaccination of non-immune waitlisted patients and consideration of prophylactic immunoglobulin G (IgG) for post-transplant non-immune patients at high risk for measles exposure. METHODS: All waitlisted and transplanted patients residing in any of 11 ZIP codes with recent measles cases in the NYC area as of April 4, 2019, were included. We also focused on the 4 ZIP codes in the NYC Health Commissioner’s vaccination order from April 9, 2019. We reviewed electronic medical records (EMR) of patients born after 1956 for measles immunity by serology or vaccine documentation. A 1-page measles patient education handout was created, reviewed for health literacy appropriateness and utilized in English and non-English language versions. RESULTS: 118 waitlisted or previously transplanted patients resided in at-risk ZIP codes. Among the 118 patients, 56 (47.5%) were presumed immune based on birth year before 1957. Among 62 patients born in 1957 or later, 5 (8.1%) had preexisting positive measles IgG in the EMR and 1 patient had documentation of measles vaccination without measles IgG testing. Fifty-seven patients without EMR evidence of measles immunity were called to undergo measles IgG testing. 29 patients agreed to testing and an additional 19 patients had the test added to routine laboratories. Of these 48 patients, 1 was non-immune and 1 had equivocal immunity. Among transplanted patients identified as non-immune or with equivocal immune status, a recommendation for prophylactic IgG was made. All 118 patients received a measles informational handout by mail. Furthermore, we identified 21 patients born after 1956 living in the 4 zip codes targeted by the NYC health Commissioner’s order, and among those tested all were found to be immune. CONCLUSION: A systematic risk assessment during a large measles outbreak identified at-risk transplant patients and provided timely education and screening for measles immunity. DISCLOSURES: All authors: No reported disclosures.