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Turaiche M, Grigoras ML, Bratosin F, Bogdan I, Bota AV, Cerbu B, Gurban CV, Wulandari PH, Gurumurthy S, Hemaswini K, Citu C, Marincu I. Disease Progression, Clinical Features, and Risk Factors for Pneumonia in Unvaccinated Children and Adolescents with Measles: A Re-Emerging Disease in Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13165. [PMID: 36293745 PMCID: PMC9603068 DOI: 10.3390/ijerph192013165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Measles causes in vaccinated children, with some exceptions, a mild disease, while the unvaccinated can suffer complications that result in serious consequences and even death. Although the introduction of the measles vaccine has reduced the number of cases and the viral spread, the current downward vaccination trend has resulted in the resurgence of the disease. Currently, Romania has a measles vaccination coverage below the 95% safety threshold. Thus, an outbreak started in 2016 and still ongoing in Romania, many cases being identified in the Western region in the pediatric population. Our objective was to conduct a thorough examination of clinical characteristics, evolution, and risk factors in vaccinated and unvaccinated children in this region. To reach our objectives we used a retrospective cohort analysis. The authors reviewed clinical and laboratory data from patients hospitalized at "Victor Babes" Hospital for Infectious Diseases and Pulmonology in Timisoara. We found a total of 136 qualifying cases of measles among the children admitted to this facility. The two comparison groups consisted of 104 children under 10 years and 32 patients between 10 and 18 years. An important characteristic of both study groups was the high prevalence of patients from the Roma ethnicity, which, although represents a minority in Romania, the prevalence was over 40% in the current study. The infection source was in 40.4% of children under 10 years inside the family, while 71.9% of infections in the group of adolescents were isolated (p-value = 0.047). The multivariate risk factor analysis identified as independent risk factors for the development of pneumonia the older age of patients (OR = 1.62), poor nutritional status (OR = 1.25), Roma ethnicity (OR = 2.44), presence of anemia (OR = 1.58), and procalcitonin (OR = 3.09). It is essential to handle these risk factors in a patient with measles, especially in conjunction with an unknown vaccination status. To achieve a vaccination rate greater than 95 percent for Romanian children, measles vaccination awareness must be promoted, moreover in the Roma population. More comprehensive preventative methods must be developed promptly with the objective of eradicating measles in Romania via a vigorous vaccination campaign.
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Affiliation(s)
- Mirela Turaiche
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mirela Loredana Grigoras
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Iulia Bogdan
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Vasile Bota
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bianca Cerbu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Camelia Vidita Gurban
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Biochemistry, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | | | | | - Kakarla Hemaswini
- Malla Reddy Institute of Medical Sciences, Suraram Main Road 138, Hyderabad 500055, India
| | - Cosmin Citu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Iosif Marincu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Turaiche M, Feciche B, Gluhovschi A, Bratosin F, Bogdan I, Bota AV, Grigoras ML, Gurban CV, Cerbu B, Toma AO, Gurumurthy S, Wulandari PH, Marincu I. Biological Profile and Clinical Features as Determinants for Prolonged Hospitalization in Adult Patients with Measles: A Monocentric Study in Western Romania. Pathogens 2022; 11:pathogens11091018. [PMID: 36145449 PMCID: PMC9505879 DOI: 10.3390/pathogens11091018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Measles is a highly infectious and sometimes deadly illness that is preventable with vaccination. The present research aims to analyze the most recent measles epidemic from Romania that occurred in a population with a falling desire to receive immunizations, by detailing the clinical picture and biological profile of hospitalized patients. A secondary goal of the present research is to identify characteristics that increase the likelihood of a longer hospitalization and the development of measles-related pneumonia. A retrospective cohort study was conducted to follow the course and effects of measles virus infection in adult hospitalized patients who were divided into two groups based on whether they had been in the hospital for more than 6 days or fewer than 6 days. A total of 114 adult patients with measles were eligible to participate in the trial if they had a positive measles-specific IgM antibody test resulting from the study. The average age in the short hospital stay group was 28.1 years, while the average age in the long hospital stay group was 31.9 years. There was a statistically significant difference in the number of Roma persons in the research groups, with 17.4 percent of them having a lengthy hospital stay compared to 5.9 percent in the group with a short hospital stay, according to the findings. It was observed that many patients had a long hospitalization associated with chronic lung disease (OR = 1.07), liver damage (OR = 1.66), Roma ethnicity (OR = 1.79), a long duration elapsed from the last MMR dose (OR = 2.02), elevated c-reactive protein (OR = 2.17), the presence of bilateral pulmonary condensations on X-ray (OR = 3.13), and elevated procalcitonin (OR = 3.49). The same significant independent risk factors were also associated with the development of pneumonia. It is of imperative need to address these risk factors in a patient with measles, moreover in association with an unknown status of vaccination. Vaccination awareness against measles must be pushed in Romania to determine a higher than 95% coverage. Significant efforts are still needed to ensure improved protection against measles epidemics within a specific region or population and, more importantly, in patients with significant risk factors for complications, as described in this study.
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Affiliation(s)
- Mirela Turaiche
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Feciche
- Department of Urology, Satu-Mare County Emergency Hospital, Strada Ravensburg 2, 440192 Satu-Mare, Romania
| | - Adrian Gluhovschi
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Correspondence:
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Iulia Bogdan
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Vasile Bota
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mirela Loredana Grigoras
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Vidita Gurban
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Biochemistry, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Bianca Cerbu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ana-Olivia Toma
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Srivathsava Gurumurthy
- Mysore Medical College and Research Institute, Rajiv Gandhi University of Health Sciences, Irwin Road, Mysuru 570001, India
| | | | - Iosif Marincu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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