Measles outbreaks among unvaccinated communities are becoming increasingly common. Two outbreaks have been reported in Colorado within the last year, including an ongoing outbreak in Broomfield County. In response, Denver Health has implemented a clinical decision support tool, an Epic OurPractice Advisory (OPA), to identify gaps in measles immunity among adult patients.
Methods:
Between May and October 2025, approximately 62,444 adults visited Denver Health outpatient clinics. The OPA flags patients with no record of either a measles antibody results or prior measles vaccination. Patients are excluded from further testing if a provider accepts a verbal report of prior vaccination or infection. Providers then order a measles antibody titer and administer vaccination if the titer is low or undetectable. A descriptive analysis was performed to evaluate the effectiveness of the OPA in identifying patients in need of follow-up.
Results:
The OPA flagged 28,383 unique patients lacking documented measles immunity. Of these, 24,145 (85%) were eligible for serologic testing after clinical assessment, but only 5,447 (22.6%) of those eligible had titers ordered. Of those with orders, 3,540 patients (65%) completed testing. Among those with orders, there were 1,097 (31%) without evidence of immunity. Of those with no evidence of immunity, a total of 348 (32%) patients returned for follow-up after testing, and 160 (46%) received the MMR vaccination.
Implications:
The OPA effectively identified patients lacking protective measles antibodies, with approximately 45% of the patient population lacking documentation. This clinical decision support tool proves valuable in prompting conversations about measles immunity and strengthening surveillance within a safety-net hospital setting. While the tool demonstrated strong identification capabilities, subsequent follow-up and vaccination rates were low. These findings show that a screening tool is an important first step, but future studies are needed to find best practices to bridge the gap between screening and care.
