Subject: Public Health Link: MEASLES - PROTECTION OF HEALTH PROFESSIONALS [NONURGENT (cascade within 48 hours)]
To: NHS Trusts - Medical Directors (England)
NHST/FT/007 - NHS FOUNDATION TRUSTS (ENGLAND) - MEDICAL DIRECTOR
Primary Care Trusts - Medical Directors
Cc: NHS Trust Chief Executives
NHST/FT/001 - NHS FOUNDATION TRUSTS (ENGLAND) - CHIEF EXECUTIVE
PCT Chief Executives
Public Health Link
Regional Directors of Public Health
SHA Chief Executives
From: Professor David M Salisbury CB - Immunisation Policy -
Monitoring and Surveillance - Department of Health
Date: 19 May 2008
Category: NON URGENT (cascade within 48 hours)
Title: MEASLES - PROTECTION OF HEALTH PROFESSIONALS
To: Medical Directors
Cc(for information only): Chief Executives of PCTs, Foundation Trusts, SHA Chief Executives, RDPHs and Public Health Link
I am writing to you to let you know about my concerns about protection of health staff and the risks to patients at a time when there are increasing number of cases of measles. I have recently learned of a junior doctor who whilst working on an oncology ward developed measles. The doctor had not been vaccinated.
I cannot emphasise enough the risk that measles presents to immunosuppressed individuals, particularly children. Between 1974 and 1984, of 51 children who died when in the first remission from acute lymphatic leukaemia, 15 of the deaths were due to measles or its complications. While the incidence of measles has declined since then and the coverage of measles-containing vaccine has increased, there have been about 1000 confirmed cases reported in England and Wales in the last 12 months. There are ongoing outbreaks in other European countries.
MMR vaccine cannot be given to immunosuppressed individuals, so their protection is dependent on avoiding exposure to the virus. Protection of healthcare workers, particularly those in contact with immunosuppressed patients, is an essential part of infection control in hospital and other healthcare settings. Under the Health Act 2006, specific duties are required of NHS bodies in England to control respiratory viruses including an alert system for suspect cases, isolation criteria and infection control measures. Occupational Health Services should include relevant immunisations (see http://www.dh.gov.uk/en/Publicationsand ... /DH_081927).
In light of the above incident, I am writing to advise you of the importance of ensuring that staff working with immunosuppressed individuals are protected against measles – for the benefit of their patients and themselves. Advice is available in the chapter on measles in the book “Immunisation against Infectious Disease” (see: http://www.dh.gov.uk/en/Publichealth/He ... DH_4097254).
Unless the relevant staff can provide written evidence of having received two doses of MMR or laboratory evidence of immunity to measles, I strongly recommend you ensure all staff in contact with of immunosuppressed patients or paediatric patients are given MMR vaccine. If a staff member is unable to have the vaccine for any reason, you will need to consider the potential risk to patients.
Professor DAVID SALISBURY CB, FRCP, FRCPH, FFPH Director of Immunisation This document has been authorised by the Department of Health: Gateway reference no: 9949
P.S. ... I forgot to curse another person as well. Dr Andrew Wakefield.