High number of hospitalisations and non-classical presentations: lessons learned from a measles outbreak in 2017, Belgium (original) (raw)
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Open Forum Infectious Diseases, 2020
Background Measles remains endemic worldwide, despite current vaccination recommendations, and is associated with high morbidity and mortality rates. We describe all cases hospitalized in Bordeaux University Hospital (BUH), the starting point of a national significant measles outbreak in 2017–2018. Methods In this retrospective study, we included all patients hospitalized in BUH from September 1, 2017, to May 31, 2018. Inclusion criteria were age >1 year, clinical symptoms, and biological confirmation by measles immunoglobulin M or measles reverse transcription polymerase chain reaction positivity. Results We included 171 patients. Most patients were immunocompetent; only 19% had preexisting medical histories. Most patients had rash and fever (97%), but some cases were atypical and difficult to diagnose. Köplik’s spots were reported in 66 cases (38%). The most frequent biological markers were blood inflammation markers (96%) and lymphopenia (81%). Unexpectedly, we found hyponatre...
Archives of Public Health, 2013
Background: From Mid-February to April 2011 one of the largest measles-outbreak in Flanders, since the start of the 2-dose vaccination scheme in 1995, took place in Ghent, Belgium. The outbreak started in a day care center, infecting children too young to be vaccinated, after which it spread to anthroposophic schools with a low measles, mumps and rubella vaccination coverage. This report describes the outbreak and evaluates the control measures and interventions. Methods: Data collection was done through the system of mandatory notification of the public health authority. Vaccination coverage in the schools was assessed by a questionnaire and the electronic immunization database 'Vaccinnet'. A case was defined as anyone with laboratory confirmed measles or with clinical symptoms and an epidemiological link to a laboratory confirmed case. Towards the end of the outbreak we only sought laboratory confirmation for persons with an atypical clinical presentation or without an epidemiological link. In search for an index patient we determined the measles IgG level of infants from the day care center. Results: A total of 65 cases were reported of which 31 were laboratory confirmed. Twenty-five were confirmed by PCR and/or IgM. In 6 infants, too young to be vaccinated, only elevated measles IgG levels were found. Most cases (72%) were young children (0-9 years old). All but two cases were completely unimmunized. In the day care center all the infants who were too young to be vaccinated (N=14) were included as cases. Thirteen of them were laboratory confirmed. Eight of these infants were hospitalized with symptoms suspicious for measles. Vaccination coverage in the affected anthroposophic schools was low, 45-49% of the pupils were unvaccinated. We organized vaccination campaigns in the schools and vaccinated 79 persons (25% of those unvaccinated or incompletely vaccinated). Conclusions: Clustering of unvaccinated persons, in a day care center and in anthroposophic schools, allows for measles outbreaks and is an important obstacle for the elimination of measles. Isolation measures, a vacation period and an immunization campaign limited the spread of measles within the schools but could not prevent further spread among unvaccinated family members. It was necessary to raise clinicians' awareness of measles since it had become a rare, less known disease and went undiagnosed.
Romanian Journal of Infectious Diseases, 2018
Introduction. Starting with 2016 Romania had to face an alarming measles outbreak due to the continuous poor vaccination coverage. The outbreak associated an increased number of complications and deaths. Materials and methods. We performed a retrospective study, on a group of patients with measles, admitted to "Dr. Victor Babes" Hospital. Epidemiological data, clinical characteristics and the results of the biological samples were obtained from the patient's medical records between January 2016 and December 2017. Results. Out of the 632 patients, 341 (53.9%) were males. Most of them (39.2%) were children, between 1 and 4 year-old, while 19.6% were infants. A quarter of the patients (31.3%) had familial contact with a measles case. The vaccination history was unknown in 44.3% cases; almost half of the patients (47.1%) were unvaccinated. Almost all of them developed viral complications, 84.1% being diagnosed with interstitial pneumonia. Bacterial pneumonia was diagnosed in 15.0% cases, out of which 45.2% were also associated with respiratory failure. Six patients required transfer to the pediatric intensive care unit for respiratory support and 2 died. Other complications were: laryngitis 8.2%, otitis 12.0% of the cases. Also 61.77% of the patients were diagnosed with enterocolitis. There was no case complicated with encephalitis. 101 (15.9%) patients developed liver cytolysis, while dyselectrolytemia was present in 94 (14.8%) cases. Conclusions. The number of patients diagnosed with measles during the last years registered an alarming increase, especially in children under 4 year old, with a high number of complications. We consider it mandatory to apply the vaccination program to ensure an optimal vaccine coverage, useful both in stopping the current outbreak and in preventing future outbreaks.
Eurosurveillance, 2011
Several cases were imported from neighbouring cantons and countries, as confirmed by the diversity of the genotypes identified (D8, D6, D5, D4 and G3). Infections were mainly transmitted via family (54%) and school (22%) in 2003, hospital (71%) and family (29%) in 2005, and family (55%) and school (26%) in 2007-2010. In 2003, 6% of infected patients were vaccinated, 27% in 2005 and 2% in 2007-2010, none of them with two doses of measles-containing vaccine. Between 2003 and 2008, measles vaccine coverage, particularly for the second dose, increased by 23 percentage points to 91.7% in the 28 month-olds, by 27 points to 92.3% in the 5-6 year-olds, and by 19 points to 86% in the 13-14 year-olds. In a cosmopolitan setting where immunisation coverage is high but not sufficient to eradicate measles, outbreaks can be limited by efficient surveillance and early control measures. Catch-up vaccination needs to be reinforced among teenagers and young adults.
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.