Huskins, W. Charles

Background: Measles is a highly transmissible virus. A single case can result in significant exposures within a healthcare facility and prompt action is needed to prevent secondary cases. In October 2025, Infection Prevention and Control (IPAC) was notified of a patient being admitted to our facility with recent international travel and symptoms consistent with measles. The patient was unvaccinated and had five healthcare facility visits prior to measles being suspected and subsequently confirmed. Objective: To describe our facility’s effective identification, prioritization, and prophylaxis of individuals exposed to measles. Methods: IPAC leveraged the electronic medical record to identify potentially exposed patients. Patients were quickly assessed for age and immune status, then prioritized and assigned to primary care teams. These teams promptly contacted patients and coordinated PEP administration. Results: Across five encounters, the index patient exposed 539 other patients. Due to delayed notification, our teams had less than four days to administer PEP for those exposed and still within PEP window. PEP administration began within hours of the index case’s positive test and patients received PEP within three days (Table 1). No secondary measles cases occurred within our facility. Conclusion: Timely and coordinated multidisciplinary effort enabled us to rapidly respond to our first measles case and control secondary transmission. Although the index case resulted in a large exposure, patients that were exposed and eligible for PEP were quickly prioritized to prevent secondary transmission.

Background: Advanced planning and adaptable response strategies are essential for preventing measles transmission in healthcare facilities. Objective: To describe a measles management plan and subsequent modifications in response to a cluster of measles cases. Methods: Drawing on previously published work (doi:10.1017/ice.2025.49), the Infection Prevention and Control (IPAC) team initiated a multi-disciplinary team and developed a measles preparedness plan with the following domains: Guidance and education; early detection and testing; isolation and patient movement; contact tracing and exposure management (Table 1). In October 2025, a patient was admitted during their fifth healthcare encounter and was diagnosed with measles. Two family members were later hospitalized with measles. Delayed recognition of the first case prompted enhancements to our preparedness framework (Table 1). Results: The first case resulted in 539 exposed patients. The second resulted in 87 exposures, and the third resulted in no exposure. Despite the extensive exposure, zero secondary measles were reported. Conclusion: Proactive planning enabled rapid response to our first case and controlled secondary transmission. Despite extensive planning, delayed identification of the first case caused significant exposures. As the cluster unfolded, we refined our plan, resulting in zero exposures from the last patient and zero secondary cases, despite over 850 exposures. These efforts may guide other healthcare facilities in improving their measles preparedness and response.

Background: A measles case requires immediate action to identify and administer prophylaxis to exposed individuals in healthcare settings. Infection preventionists (IPs) often balance proactive contact tracing with waiting for a positive test result. Objective: To develop a tool that enables IPs to stratify suspect measles cases by risk level, thereby supporting the decision to prioritize or defer active intervention while awaiting test results. Methods: In spring 2025, we developed a preliminary matrix and used 19 additional suspect patients to further refine the scoring of the tool. In August 2025, we deployed a finalized tool. The two-dimensional risk matrix incorporated both epidemiological risk factors and clinical risk factors, each scored numerically based on yes or no questions. The sum of both categories was used to assign a final risk level that determined the recommendations for IPs (Figure 1). The study population included patients tested for measles during the implementation period. Descriptive statistics were used to summarize the distribution of risk categories and outcomes. Among the whole cohort, Firth’s logistic regression was used to evaluate the association between clinical or epidemiological risk score and measles diagnosis. Among the production cohort, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the diagnostic performance. Results: Since implementation, the matrix was applied to 56 patients tested for measles. Of these, 10.7% (n=6) were categorized as high risk, 32.1% (n=18) as medium, and 57.1% (n=32) as low. Four of the 56 patients were positive for measles, 3 were categorized as high-risk and 1 as medium risk. Each one-unit increase in epidemiological risk was associated with a 2 folds increase in the odds of a positive measles diagnosis (odds ratio = 2.0; 95% CI, 1.3–3.6). The low-risk category had an NPV of 1, indicating that all low?risk patients tested negative, thus supporting safe workload reduction by deprioritizing these cases. Conclusion: The Measles Exposure Response Risk Matrix effectively stratified cases and supported IP prioritization efforts. Low-risk groups required no action, expedited testing was reasonable for medium-risk cases, and proactive actions were reserved for high-risk cases. Clinical and epidemiologic risk scores progressed from arbitrary assignment to validated metrics, confirmed by statistical analysis. The flexible design permits adaptation to other infectious diseases, including avian influenza and mpox. With rising measles incidence, tools like this matrix will be essential to support rapid, evidence-based actions by infection prevention teams.

ABSTRACT Novel β-lactam/β-lactamase inhibitors (βL/βLIs) are important therapies for carbapenem-resistant Pseudomonas aeruginosa (CRPA). However, the global extent of resistance to these agents and the impact of resistance on patient outcomes are unclear. We therefore evaluated patients with CRPA isolates at 35 hospitals (nine countries) from December 2018 to November 2019. Antimicrobial susceptibility testing was performed at a central laboratory by agar dilution for ceftolozane-tazobactam (C/T) and ceftazidime-avibactam (CZA) and by broth microdilution for imipenem-relebactam (I/R). Characteristics and outcomes, including desirability of outcome rankings (DOOR), were compared between patients infected with isolates not susceptible vs susceptible to each agent. Of 800 CRPA isolates, susceptibility to C/T, CZA, and I/R was 69%, 67%, and 33%, respectively. USA isolates ( n = 526) were more frequently susceptible to these agents than isolates from other countries ( n = 274; C/T: 83% vs 42%; CZA: 77% vs 47%; I/R: 37% vs 23%; P < 0.001 for each comparison) and isolates with carbapenemases ( n = 157) were less frequently susceptible than isolates without carbapenemases ( n = 643; C/T: 7% vs 84%; CZA: 24% vs 77%; I/R: 6% vs 39%; P < 0.001 for each comparison). Thirty-day mortality and DOOR were similar overall in patients infected with isolates not susceptible vs susceptible to each βL/βLI. However, the adjusted probability of a better DOOR outcome for a randomly selected patient with bacteremia due to a C/T-not susceptible vs -susceptible isolate was 38.2% (95% confidence interval, 25.6%–52.7%). Resistance to novel βL/βLIs, especially I/R, is common in CRPA, particularly outside the USA and in carbapenemase-producing isolates. Additional treatment options are needed for CRPA infections.