Occupational Exposure Classification for Pregnant Healthcare Workers
Yes, a pregnant healthcare worker's contact with a measles (morbilli) patient in the ward is categorized as an occupational exposure requiring immediate evaluation and management, as healthcare workers are at increased risk for measles transmission in medical facilities and all healthcare facilities must ensure workers are immune to measles. 1
Why This Constitutes a Work-Related Exposure
Healthcare workers face elevated measles transmission risk compared to the general population. During 1985-1991, at least 795 measles cases (1.1% of all reported cases) occurred among adult healthcare workers, with 29% among nurses and 15% among physicians. 1 Between 1993-1996,15 of 75 measles outbreaks involved transmission in medical facilities. 1
Any healthcare worker—medical or nonmedical, paid or volunteer, with or without direct patient-care responsibilities—who is susceptible can contract and transmit measles if exposed. 1 This broad definition clearly encompasses the scenario described, making it an occupational exposure by definition.
Immediate Actions Required
The pregnant healthcare worker must be evaluated urgently for measles immunity status. 1 Acceptable evidence of immunity includes:
- Documentation of two doses of live measles vaccine administered on or after the first birthday, separated by ≥28 days 1
- Laboratory evidence of measles immunity 1
- Documentation of physician-diagnosed measles disease 1
- Birth before 1957 (though healthcare facilities should still consider vaccination for unvaccinated workers born before 1957 without documented immunity) 1
If the worker lacks documented immunity, this is a medical emergency requiring immediate intervention. 2, 3
Special Considerations for Pregnancy
Measles vaccination (MMR) is contraindicated during pregnancy. 1 The vaccine should not be administered to women known to be pregnant, and women should be counseled to avoid pregnancy for 30 days after monovalent measles vaccine or 3 months after MMR administration. 1
However, if a pregnant woman is inadvertently vaccinated or becomes pregnant within 3 months after vaccination, this should not ordinarily be a reason to consider termination of pregnancy. 1 She should be counseled about the theoretical basis of concern for the fetus. 1
For a pregnant healthcare worker who is susceptible and has been exposed, vaccination cannot be used for immediate protection. 1 The facility must implement alternative protective measures, which may include work restriction or redeployment away from measles exposure risk. 4, 2
Employer and Institutional Responsibilities
All medical institutions must ensure that healthcare workers are immune to measles. 1 This is not optional—healthcare workers have a responsibility to avoid causing harm to patients by preventing transmission of these diseases. 1
The infection control program should isolate the disease, not routinely transfer the employee based on pregnancy alone. 4 However, when a pregnant worker lacks immunity and exposure has occurred, temporary work modification is appropriate. 2, 3
During measles outbreaks, rapid vaccination of susceptible workers is necessary to halt disease transmission, but serologic screening before vaccination is not recommended due to the need for speed. 1 For pregnant workers, this creates a unique challenge requiring immediate occupational health consultation. 2
Documentation and Follow-Up
This exposure should be formally documented as an occupational incident. The healthcare facility should maintain records of the exposure, immunity assessment, and any interventions provided. 1
If the pregnant worker is found to be susceptible, she should be counseled about measles symptoms and monitored for disease development during the incubation period (typically 9-10 days). 5, 6 Urgent specialist advice is required if exposure occurs or if the worker develops symptoms. 2
Rubella-susceptible pregnant women should be vaccinated immediately postpartum before hospital discharge. 1 This prevents future occupational exposure risks in subsequent employment.