The tragic measles deaths in Samoa have highlighted some work I have been doing looking at measles that is caught in our hospital settings, what is known as nosocomial infection.
We know that when measles outbreaks start to include nosocomial infections that the outbreak is much more severe. Importantly, understanding nosocomial infection a bit better might also generate a useful dialogue around how we can help protect our hospital settings during outbreaks.
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I was particularly interested in understanding whether hospital staff are vaccinated and protected from getting measles which means they could then not pass it on to vulnerable patients.
I started by asking the Minister how many people generally have caught measles from DHB hospitals this year. The answer was Canterbury - 7, Mid central - 4, Northland - 7, Waikato - 3.
One can imagine patients catching measles in hospitals from several scenarios, catching it from patients and members of the public, for example sitting in A&E beside someone who may or may not have had measles or maybe a hospital visitor, or possibly catching it from staff who didn't know they were infectious with measles.
I was interested in hospital staff involvement and so I focused on the Canterbury outbreak in February this year that involved 40 cases. I asked the Minister how many Canterbury DHB staff had contracted measles and the answer was six. We don't know if these people were or were not at work during the infectious period, remembering people can be infectious with measles but not know they have it for several days before the rash appears.
If the six hospital staff who contracted measles were back-office staff with no patient contact, then that would be a safer scenario than if they had patient contact and so the job descriptions of the six staff who contracted measles was my next question.
The answer was cleaner, radiographer, phlebotomist [takes blood for the laboratory], laboratory technician, administration support worker and a booking clerk. All of these people could have patient contact to varying degrees although the Minister did affirm that no patients would seem to have caught measles from the six which is reassuring.
The final question was what was the vaccination status of the six Canterbury staff who caught measles. The answer was three were vaccinated, two unvaccinated, one unknown. This raises many questions. Why did the vaccinated staff contact measles?
The most common explanation I find is that either their recollection of vaccination is from a less than clear childhood memory, or they are one of the 30 to 50-year-olds who did indeed have the measles vaccine but who now need the booster for full immunity.
This leaves the three other people who could not confirm measles vaccination and gets to the dialogue I think we should have around whether health professionals should be vaccinated for infectious diseases.
I believe they should. I have worked in medical centres across the world where I was not allowed to start work until I had produced lab tests showing immunity to various diseases.
Various groups applying for visas to come to New Zealand are required to produce laboratory evidence for immunity to various diseases and I think health professionals should also respect the privileged position they have and be vaccinated.
I welcome the dialogue.
• Dr Shane Reti is MP for Whangārei.