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Caraffa E, Mascia C, Ciardi MR, Lichtner M, Ajassa C, Del Borgo C, Tieghi T, Vita S, Savinelli S, Iannetta M, Russo G, Mastroianni CM, Vullo V. Steroid use in measles: A retrospective cohort study during the 2017 outbreak in tertiary referral center, Rome and Latina, Italy. J Infect Chemother 2024; 30:201-207. [PMID: 37820949 DOI: 10.1016/j.jiac.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Since early January 2017, a new measles outbreak in Italy has been observed. The aim of the study was to compare features between adults and children measles cases and evaluate the effect of steroid treatment on the above parameters. METHODS A retrospective multicenter, descriptive study was performed. We analyzed all patients admitted to the Department of Public Health and Infectious Diseases, Sapienza University, Rome and Latina, from January 2017 to December 2017 and discharged with diagnosis of measles. RESULTS We identified 113 patients discharged with the diagnosis of measles infection cases of which 59 adults and 54 children (≤16 years). In adult population 32 patients (54 %) were males, with a median age of 30.5 years old and all unvaccinated (100 %). Keratoconjunctivitis 30 (50 %) was the most frequent complication. In pediatric population 27 (50 %) patients were males, with a median age of 3 years old. Information on measles vaccination status was available for only 21 (38.8 %) of cases. Keratoconjunctivitis 40 (74 %) was the most frequent complication. Analyzing the differences between adult and pediatric patients we found that children were significantly more likely to have keratoconjunctivitis and diarrhea as complications than adults in which the rate of thrombocytopenia and hepatitis was highest. Thirty-nine adult subjects (66 %) have been treated with systemic corticosteroids. CONCLUSIONS Pediatric patients differ from adults in complications and liver involvement. Regarding steroids use, although there is no clear indication of steroid use during measles, there is no evidence of a worse outcome in our cases series.
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Affiliation(s)
- Emanuela Caraffa
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy.
| | - Claudia Mascia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Maria Rosaria Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy
| | - Tiziana Tieghi
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy
| | - Serena Vita
- Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy; National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Stefano Savinelli
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Marco Iannetta
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Department of Systems Medicine and Infectious Diseases Clinic, University Hospital Tor Vergata, Rome, Italy
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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Alruqaie N, Al Qadrah B, Almansour S, Alghamdi E, Alharbi M. A Measles Outbreak in Riyadh in 2023: Clinical and Epidemiological Characteristics. Cureus 2023; 15:e48171. [PMID: 38046773 PMCID: PMC10693316 DOI: 10.7759/cureus.48171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background Measles is a highly contagious viral disease that has recently made headlines due to outbreaks in several parts of the world. The disease can cause serious health complications, especially in young children, which has led to concerns about vaccination rates and public health policies. This study aims to investigate and describe the epidemiology, clinical characteristics, and outcomes of measles infection among children in Riyadh. Methodology We conducted a descriptive cross-sectional study among all pediatric patients with confirmed measles infection at a tertiary hospital from January 15, 2023, to March 15, 2023. We collected data including demographic characteristics, clinical presentations, and clinical outcomes. Results A total of 63 confirmed measles cases were reported. Most patients were under four years of age (82.7%), and 85.7% were unvaccinated. Adenovirus was the most common viral coinfection (12.7%). The most common complication was pneumonia (58.7%). Chest X-ray findings reported a localized right parenchymal infiltrate in 19% of patients and a patchy bilateral infiltrate in 15.9% of patients. In addition, 88.9% required hospital admission secondary to dehydration (47.6%) and hypoxia (41.3%). Among admitted patients, 17.5% were admitted to the pediatric intensive care unit (PICU), 9.5% were admitted due to respiratory failure, and 6.3% due to septic shock. Children under one year of age had a higher risk for PICU admission (p < 0.05). The mortality rate was 1.6%. Conclusions Measles is a serious disease that causes significant health effects and incurs high financial costs for public health systems. Vaccination remains the most effective way to prevent measles outbreaks and reduce their impact on individuals and communities.
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Affiliation(s)
- Nourah Alruqaie
- Pediatric Infectious Diseases, King Abdulaziz Medical City, Riyadh, SAU
| | | | | | - Eman Alghamdi
- Public Health, King Abdulaziz Medical City, Riyadh, SAU
| | - Musaed Alharbi
- Pediatric Infectious Diseases, King Abdulaziz Medical City, Riyadh, SAU
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Gianniki M, Siahanidou T, Botsa E, Michos A. Measles epidemic in pediatric population in Greece during 2017-2018: Epidemiological, clinical characteristics and outcomes. PLoS One 2021; 16:e0245512. [PMID: 33471833 PMCID: PMC7817010 DOI: 10.1371/journal.pone.0245512] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background and aim A measles outbreak occurred in Greece during 2017–2018 affecting mainly pediatric population. The aim of the study was to describe the epidemiological and clinical characteristics of the cases diagnosed in the major pediatric tertiary hospital of Athens, where 26.5% of national pediatric measles cases were diagnosed and treated. Methods This is a retrospective study of children 0–16 years old, who presented at the emergency department and/or were hospitalized with clinical presentation compatible with measles and diagnosis was confirmed with molecular detection of the measles RNA in pharyngeal swabs. Epidemiological, clinical and laboratory characteristics were retrieved from medical records and analyzed. Results A total of 578 children with measles were identified during the study period. 322 (55.7%) were male with median age 36 months (range:1–193), while the largest number of documented cases (251; 43.4%) were children aged 1–5 years. Most children (429/578; 74.2%) belonged to the Roma minority and only 64 (11.1%) had Greek origin. 497 (91.5%) children were unvaccinated and 37 (6.8%) were partially vaccinated with measles vaccine. Hospitalization was required for 342 (59.2%) children, whereas one or more complications were reported in 230 (67.2%) of them. Most frequent complications were elevated transaminases (139; 40.6%), acute otitis media (72; 21%), dehydration (67; 19.6%) and pneumonia (58; 16.9%). 11 children (3.2%) required intensive care admission for altered mental status/status epilepticus (3), sepsis (2) and ARDS (6). 119/342 (34.8%) children were treated with antibiotics because of possible or confirmed bacterial coinfection. One death was reported, concerning an 11-month-old unvaccinated infant, with underlying dystrophy, who died of sepsis. Conclusion Measles is not an innocent viral infection, as it is still characterized by high morbidity and complications rates. Unvaccinated or partially vaccinated populations could trigger new outbreaks, resulting in significant cost in public health. To avoid future measles outbreaks, high vaccination coverage should be achieved, as well as closing immunity gaps in the population and ensuring high-quality measles surveillance.
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Affiliation(s)
- Maria Gianniki
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Evanthia Botsa
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
- * E-mail:
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Demographics, Complications and Resource Utilization for Patients Hospitalized for Measles Across Us Children's Hospitals. Pediatr Infect Dis J 2019; 38:977-978. [PMID: 31232895 DOI: 10.1097/inf.0000000000002400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to retrospectively describe measles hospitalizations in 52 US children's hospitals. We identified 136 patients hospitalized for measles in 2004-2018; 17% (23/136) had complex chronic conditions, 2 of whom died or were in hospice. Among noncomplex patients only 39% received vitamin A, median length of stay was 3 days and median adjusted estimated costs were $5896.
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Tramuto F, Maida CM, Pojero F, Colomba GME, Casuccio A, Restivo V, Vitale F. Case-based surveillance of measles in Sicily during 2012-2017: The changing molecular epidemiology and implications for vaccine strategies. PLoS One 2018; 13:e0195256. [PMID: 29617454 PMCID: PMC5884552 DOI: 10.1371/journal.pone.0195256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022] Open
Abstract
Following the indication of the World Health Organization, a national plan for the elimination of measles was approved in Italy and this included the improvement of the molecular surveillance of measles viruses and the interruption of indigenous transmission of the disease. Nevertheless, large outbreaks continue to occur in almost all regions of the country, including Sicily. Here we describe the epidemiology and molecular dynamics of measles viruses as a result of the measles surveillance activity carried out by the "Reference Laboratory for Measles and Rubella" in Sicily over a 5-year period. Biological samples of 259 suspected measles cases were tested for viral RNA detection and a total of 223 (86.1%) were classified as laboratory confirmed. The median age of confirmed measles cases was 21.0 years and about half of them were adults aged 19 years and older. Overall, one-third of the patients showed clinical complications and these latter were more common among adults than children (44.9% vs. 25.7%). The vast majority of measles cases were unvaccinated (94.2%, n = 210). The phylogenetic analysis of 221 measles virus nucleotide sequences revealed sporadic detections of genotypes D4 and H1, while endemic circulation of genotypes D8 and B3 was documented. Genotype D8 was associated with epidemics occurred between 2013 and 2016, whereas genotype B3 was more recently introduced into Sicily characterizing the current measles outbreak. The results of this study confirm the autochthonous co-circulation of viral variants belonging to different genotypes during the study period, and emphasizes the need of measles surveillance programmes in order to investigate the viral dynamics, the pathways of disease transmission, and to eventually adapt the development of successfull vaccine formulations.
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Affiliation(s)
- Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Carmelo Massimo Maida
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Fanny Pojero
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Giuseppina Maria Elena Colomba
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
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