Measles Outbreak in a High-Income Country: Are Pediatricians Ready? (original) (raw)
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BMC Pediatrics
Background Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. Methods In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1–6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The sam...
Negative impact of clinical misdiagnosis of measles on health workers confidence in measles vaccine
Epidemiology and Infection, 2004
We conducted a survey to determine the accuracy of the clinical diagnosis of measles in Zimbabwe. Between December 1996 and February 1997, we collected blood samples and clinical and demographic information from a sample of 105 children with a clinical diagnosis of measles. A clinical case of measles was defined as a person with a history of fever, rash for three or more days, and either cough, coryza, or conjunctivitis. A laboratory-confirmed case of measles or rubella had IgM antibodies against measles virus or rubella virus respectively. A total of 91% of children met the clinical case definition. Among those who met the clinical case definition for measles, 72% were IgM-positive for measles virus only, 23% were IgM-positive for rubella virus only, 3% were IgM-positive for both measles and rubella viruses, and 2% were IgM-negative for both viruses. This study demonstrates the importance of considering selective laboratory confirmation of measles in periods of high disease inciden...
Measles incidence estimations based on the notification by general practioners were suboptimal
Journal of Clinical Epidemiology, 2004
The aim of this study was to determine the notification by general practitioners (GPs) to the Municipal Health Service (MHS) and the presentation of measles complaints by patients to the GP during a measles epidemic in a 78% vaccinated population. Study Design and Setting: Measles cases in children under 13 years were identified via questionnaires, GPs' records, and MHS's records. Consultation rate, notification rate, and completeness of notification were determined. Determinants of consultation were identified by multivariable logistic regression analysis. Results: Among 1654 responders, 164 measles cases were identified. Consultation rate: 30%; notification rate: 30% (range among GPs: 0-62%); completeness of notification: 9%. Determinants of GP consultation: perceived seriousness of illness (adjusted OR 45; 95% CI: 6-347), self-reported complications (adjusted OR 9; 95% CI: 1-70), and need to consult for respiratory tract infections (adjusted OR 8; 95% CI: 1-51). Conclusion: Incidence estimations based on the notification by GPs to the MHS are suboptimal for measles in The Netherlands.
Evaluation of Pediatric Measles Cases in 2019: Single Center Experience
Japanese Journal of Infectious Diseases, 2023
Measles, though able to be prevented and eliminated by vaccination, is a highly contagious viral disease that can lead to serious complications, disability, and death. The aim of this study was to evaluate the characteristics of measles cases in single center. This retrospective study consecutively enrolled children who were considered to be suspicious measles cases based on their clinical features and attended the Pediatric Clinic at Esenler Gynecology and Pediatrics Hospital between January 1 and June 30, 2019. There were no fully vaccinated patients in measles cases. Conjunctivitis was significantly more common in the unvaccinated group than in the partially vaccinated group (p=0.027). Moreover, the duration of conjunctivitis was significantly longer in the unvaccinated group (p=0.019). Unvaccinated patients had a significantly lower median leukocyte count and significantly higher median CRP level (p=0.019, p=0.021). Vitamin A (VA) level and leukocyte count had a moderate positive correlation (r=0.698; p=0.008). In order to prevent measles, it is necessary to implement controlled migrant movement, to vaccinate and follow-up this population for measles as well as vaccine preventable diseases.
Journal of Clinical Virology, 2020
Measles outbreaks are increasingly reported among countries that were close-to-eliminate measles infection. There are few reports of clinical characteristics of measles in adults in the contemporary literature. In this study we aim to describe the clinical characteristics and complications of measles infection in hospitalized adults during the recent epidemic in Greece. Methods: A multicentre observational retrospective study was conducted in three tertiary hospitals in Greece. All adult hospitalized patients (≥18 years old) with serologically confirmed and/or clinical features compatible with measles were included. Pediatric patients and patients with missing data were excluded. Results: In total, 93 patients, 40 males (43 %) and 53 females (57 %), mostly young patients were included. Most of them (87 %) had no past medical history. Among women, 4 were pregnant. 56 (60.2 %) and 25 (26.9 %) patients reported either unknown or incomplete vaccination for measles. Ribavirin was administered in 8 (8.6 %) patients. Pneumonitis and hepatic involvement were the most common complications, occurring in 43 (46.2 %) and 75 (80.6 %) patients respectively. Pneumonitis was significantly associated with male sex, older age, lower lymphocyte counts and higher C-reactive protein (CRP) on admission. One pregnant woman suffered spontaneous fetal miscarriage and one patient died due to acute respiratory distress syndrome (ARDS) and high-risk pulmonary embolism. Conclusion: Considerable proportions of incompletely vaccinated or unvaccinated adults have led to the reemergence of measles in countries with reported close-to-elimination rates. Pneumonitis is a major complication among adults with measles. More studies are imperative in order to explore the role of immune paresis in measles.
Epidemiology and Infection, 2020
We describe and analyse an outbreak of measles that affected Belgium early 2017. In total, 289 cases were reported, mostly (53%) in people 15 years or older. For 133 (46%) vaccination status was unknown and a further 117 (41%) were not vaccinated. According to national guidelines, 83 of the unvaccinated cases (29% of total cases) should have received minimum one dose of vaccine, but did not. One in five cases (21%) did not present with the classical triad of fever, rash and any of coryza, conjunctivitis or cough. Rash was the most sensitive symptom, being absent in only six cases. A large proportion of cases (125/289, 43%) required hospitalisation. In hospitalised patients, the most commonly observed complications were hepatic disorders (present in 58/125 hospitalised patients, 46%). Thirty-six of the cases (12%) were in healthcare workers and nosocomial spread contributed importantly to the outbreak. Older age at presentation, altered clinical presentations and presence of complica...
Pakistan Armed Forces Medical Journal, 2016
Objective: To determine the different demographic parameters, associated morbidity and mortality of measles cases admitted in a paediatric unit of a teaching hospital.Study Design: Descriptive cross sectional study.Place and Duration of Study: Pediatrics department Combined Military Hospital Kharian from October 2012- September 2013.Material and Methods: All patients admitted with diagnosis of measles according to World Health Organization (WHO) definition of clinical measles up to 12 years of age were included. Detailed history and clinical examination was done. Required information regarding study parameter was collected on a pre designed proforma. Different complications in relation to age, vaccination and nutritional status were assessed. Statistical data was analyzed by SPSS version 17.Results: Among total 68 patients, 48(70.58%) were male and 20 (29.41%) female. Mean age was 21.26 (± 26.95) months. Thirty four (50%) patients were between 6-8 (completed) months of age, 3 (4.41 ...
Clinical outcome in children hospitalized with complicated measles
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
To determine the association of clinical outcome of measles in children with demographic profile and complications. A cross-sectional analytical study. Isolation ward, The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), from January 2003 to August 2004. Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay (p=0.010). Pneumonia (40.0%) and diarrhoea (38.5%) were the commonest com...