Evaluation of Pediatric Patients Diagnosed with Measles: A Retrospective Study in Istanbul

Abstract

Objective Measles, predominantly impacting the pediatric population, manifests symptoms encompassing fever, rash, rhinorrhea, cough, conjunctivitis, accompanied by infrequent yet plausible life-threatening complications.

Methods This retrospective study conducted between January 2022 and July 2023 at a 1,105-bed tertiary hospital in Istanbul, Turkey, was focused on children diagnosed with measles and aged <18 years. Cases with measles-specific immunoglobulin M antibodies or with measles virus RNA detected by polymerase chain reaction were defined as definite measles cases.

Results A total of 78 pediatric patients were diagnosed with measles, of whom 40 were evaluated as definite (51.3%) cases. Among the definite cases, 29 (72.5%) and 11 (27.5%) were girls and boys, respectively. Their median age was 78 (42–158) months. It was observed that 28 (70%) patients were unvaccinated against measles, whereas data on the vaccination status of 6 (15%) patients could not be obtained. As for the symptoms, rash was observed in all diagnosed patients (100%), fever in 37 (92.5%), cough in 27 (67.5%). In addition, pneumonia was observed in 20 patients (50%). Vitamin A was administered to 5 (12.5%) patients below 2 years old. Of the patients, 29 (72.5%) were hospitalized. Three patients required intensive care unit follow-up. No mortality was recorded. When outpatients and inpatients were compared, the incidence rate of pneumonia was statistically higher in inpatients (p = 0.013).

Conclusions Recent World Health Organization data reveal a surge in childhood measles instances, underscoring the imperative of bolstering vaccination rates to fortify societal immunity and safeguard individuals against potential complications.

Keywords

child - measles - complication - vaccination

Authors' Contribution

Z.Y. and M.A. analyzed the data and drafted the manuscript. Z.Y., N.H.Z., and M.A. critically reviewed the analyses. Z.Y., N.H.Z., M.A., U.Y., C.Ç., A.K., and Y.A. reviewed and commented on initial and final drafts of the manuscript.

Publication History

Received: 29 March 2024

Accepted: 18 September 2024

Article published online:
24 October 2024

• References

• 1 Paules CI, Marston HD, Fauci AS. Measles in 2019—going backward. N Engl J Med 2019; 380 (23) 2185-2187
• 2 Centers for Disease Control and Prevention (CDC). Global measles mortality, 2000–2008. MMWR Morb Mortal Wkly Rep 2009; 58 (47) 1321-1326
• 3 Dabbagh A, Laws RL, Steulet C. et al. Progress toward regional measles elimination—worldwide, 2000–2017. MMWR Morb Mortal Wkly Rep 2018; 67 (47) 1323-1329
• 4 Global measles mortality reduction and regional elimination, 2000–2001. Can Commun Dis Rep 2002; 28 (10) 81-88
• 5 Patel MK, Goodson JL, Alexander Jr JP. et al. Progress toward regional measles elimination—worldwide, 2000–2019. MMWR Morb Mortal Wkly Rep 2020; 69 (45) 1700-1705
• 6 Dabbagh A, Patel MK, Dumolard L. et al. Progress toward regional measles elimination—worldwide, 2000–2016. MMWR Morb Mortal Wkly Rep 2017; 66 (42) 1148-1153
• 7 World Health Organization. Accessed August 20, 2023 at: https://www.who.int/health-topics/measles#tab=tab_1
• 8 World Health Organization. Accessed August 20, 2023 at: https://www.who.int/news/item/12-11-2020-worldwide-measles-deaths-climb-50-from-2016-to-2019-claiming-over-207-500-lives-in-2019
• 9 Kahraman S, Kaplan F. . Türkiye'de Kızamık Hastalığının Son Yıllarda Artma Nedenleri [R easons for increase in recent years of measles disease in Turkey]. Health Sci Rep 2020; 2 (03) 175-183
• 10 Ministry of Health, Measles Elimination Program. [in Turkish]. Accessed August 20, 2023 at: https://hsgm.saglik.gov.tr/depo/Mevzuat/Genel_Nitelikli_Yazi_ve_Gorusler/Kizamik_Eliminasyon_Programi.pdf
• 11 Republic of Turkey Ministry of Health Vaccine Portal. [in Turkish]. Accessed August 20, 2023 at: https://asi.saglik.gov.tr/asi-takvimi2
• 12 Global Vaccine Action Plan. Decade of vaccine collaboration. Vaccine 2013; Apr 18; (31) Suppl 2: B5-31
• 13 Yıldırım DG, Caymaz C, Siraneci R. Evaluation of demographic characteristics of our pediatric patients with measles. Comprehensive Medicine 2020; 12 (03) 241-246
• 14 Türkkan Ö, Önal Z, Sağ Ç. et al. Özellikleri KOD. Hastalığın Morbidite ve Mortalitesinin Değerlendirilmesi. Haydarpaşa Numune Eğitim Araştırma Hastanesi Tıp Derg 2017; 57 (02) 83-88
• 15 Ciofi Degli Atti M, Filia A, Bella A. et al. Measles cases in children requiring hospital access in an academic pediatric hospital in Italy, 2008–2013. Pediatr Infect Dis J 2017; 36 (09) 844-848
• 16 Hester G, Nickel A, LeBlanc J. et al. Measles hospitalizations at a United States children's hospital 2011–2017. Pediatr Infect Dis J 2019; 38 (06) 547-552
• 17 Metin O, Tanir G, Oz FN. et al. Evaluation of 44 pediatric measles cases detected in Ankara, Turkey during 2012–2013 epidemic and molecular characterization of the viruses obtained from two cases. Mikrobiyol Bul 2014; 48 (02) 259-270
• 18 Hao L, Ma C, Wannemuehler KA. et al. Risk factors for measles in children aged 8 months–14 years in China after nationwide measles campaign: a multi-site case-control study, 2012–2013. Vaccine 2016; 34 (51) 6545-6552
• 19 Donadel M, Stanescu A, Pistol A. et al. Risk factors for measles deaths among children during a Nationwide measles outbreak—Romania, 2016–2018. BMC Infect Dis 2021; 21 (01) 279
• 20 Lee CT, Hagan JE, Jantsansengee B. et al. Increase in infant measles deaths during a nationwide measles outbreak—Mongolia, 2015–2016. J Infect Dis 2019; 220 (11) 1771-1779
• 21 Tepebaşılı İ, Çaksen H, Odabaş D. et al. Kızamık, Doğu Anadolu Bölgesinde Hala Ciddi Bir Sorun!. Van Tip Derg 2003; 10 (03) 69-71
• 22 Gastañaduy PA, Banerjee E, DeBolt C. et al. Public health responses during measles outbreaks in elimination settings: strategies and challenges. Hum Vaccin Immunother 2018; 14 (09) 2222-2238
• 23 Kızamık, Kızamıkçık ve Konjenital Kızamıkçık (KKS) Sürveyansı Genelgesi. 2010 . [in Turkish]. Accessed September 24, 2024 at: https://saglik.gov.tr/TR,11146/kizamik-kizamikcik-ve-konjenital-kizamikcik-kks-surveyansi-genelgesi-2010.html
• 24 Atkinson W, Wolfe C, Hamborsky J. eds. Epidemiology and Prevention of Vaccine—Preventable Diseases (the Pink Book). 12th ed. Washington, DC:: Public Health Foundation;; 2011
• 25 Ilyas M, Afzal S, Ahmad J, Alghamdi S, Khurram M. The resurgence of measles infection and its associated complications in early childhood at a tertiary care hospital in Peshawar, Pakistan. Pol J Microbiol 2020; 69 (02) 1-8
• 26 Arenz S, Fischer R, Wildner M. Measles outbreak in Germany: clinical presentation and outcome of children hospitalized for measles in 2006. Pediatr Infect Dis J 2009; 28 (11) 1030-1032
• 27 Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med 1990; 323 (03) 160-164
• 28 Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. Cochrane Database Syst Rev 2005; 2005 (04) CD001479