Risk Factors and Complications in Measles Mortalities

EXCLI Journal

Malawi Medical Journal, 1998

In the twelve month period from March 1992 to February 1993. 266 consecutive children with measles were admitted to the children's unit at Queen Elizabeth Central Hospital (QECH). Blantyre. During the 12 month period the overall mortality was 10.9%; mortality was highest (22.5%) in children 12-23 months age. One-third of the children admitted were under 9 months of age. not eligible for measles vaccination. Pneumonia complicated illness of 30% of cases and was the greatest clinical predictor of mortality. Among inf.mts under 9 months of age, who were receiving inappropriate food supplementation before 4 months of age the risk of death was 6.4 rimes the risk of death in children who were not receiving food supplementation. Other aspects of measles epidemiology are discussed.

Disasters, 2006

Letter to the editors Adverse events following immunisation (AEFI) attributable to measles vaccine are rare (Duclos and Ward, 1998). These include mild, self-limiting illness to potentially serious but uncommon events like thrombocytopenia (Beeler, Varricchio and Wise, 1996) and anaphylaxis. AEFI's may also result from errors in handling, preparing and administering vaccine. Despite frequent measles campaigns for measles mortality reduction and regional elimination (UNICEF, 2001), few campaign-related AEFI's are described in the published literature (Pless, Bentsi-Enchill and Duclos, 2003). This letter reports a cluster of vaccine-associated abscesses that occurred in Nahrin District, Afghanistan, following a national measles vaccination campaign. 1 From December 2001-December 2002, the Ministry of Health (MoH) of the Transitional Islamic State of Afghanistan conducted a nationwide measles vaccination campaign with assistance from international organisations. The campaign targeted all children aged between six months and 12 years (CDC, 2003) and reached 11 million children nationwide. In Nahrin District, 20,607 children were vaccinated between 23 September and 10 October 2002. On 28 October, Expanded Program on Immunization (EPI) workers involved in routine polio eradication activities in Nahrin District observed abscesses among children vaccinated during the measles campaign and reported these to the provincial EPI management team. From 10-22 November, the MoH, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) investigated these reports via health record reviews, active case finding and interviews with community members, parents of case patients and vaccination team workers. A questionnaire was administered to parents and guardians of affected children to obtain information on the case patient's history of vaccination and other injections, the name of the vaccinator during the campaign, the date of onset of swelling, the treatment history and the final outcome of the illness. All case patients with persisting abscesses were referred to a MoH physician for treatment. Because no specimen processing laboratories were available in the region, cultures were not taken from abscesses. Furthermore, information on vaccine lot numbers by village could not be traced. On 9 February 2003, a follow-up visit was conducted; this included an interview with the local vaccination team leader who had previously fled the area fearing community reprisals. One hundred and fifty-two patients with campaign-related abscesses were reported in the four affected villages; no associated deaths were reported. Despite a search of surrounding villages, no additional cases of campaign-related abscesses were identified. Questionnaires were administered to parents or guardians of 67 case patients (44 per cent of total cases) from three villages; the remaining case patients could not be located due to difficult access and population mobility. Four (six per cent) of the 67 case patients investigated were less than one year of age, nine (13 per cent) were between

Journal of Tropical Pediatrics, 1998

It has been observed that the occurrence of respiratory complications and diarrhoea among measles cases has changed over time but this change has not been quantified. A study was carried out in the city of Gweru, Zimbabwe, to quantify these changes. Rates of respiratory complications and diarrhoea among measles cases were determined in each year for the period 1968-89. It was found that mean rates of respiratory complications and diarrhoea during 1968-78 were 17.2 per cent (95 per cent CI = 11.6-22.8) and 52 per cent (95 per cent CI = 0-11) respectively while during 1979-89, mean rates of respiratory complications and diarrhoea were 6.5 per cent (95 per cent CI = 1-12.1) and 16.4 per cent (95 per cent CI = 10.1-22.0) respectively. Analysis of variance (ANOVA) to determine the main effects and the interaction showed that the main effects were not statistically significant (F = 0.01, d.f. u = 1,40, p = 0.935; and F = 0.13, d.f. u = 1,40, p = 0.725 respectively) Meanwhile the interaction term of complications and period was statistically significant (F = 15.7, dX, 2 = 1,40, p < 0.001). It was concluded that a change in rates of respiratory complications and diarrhoea had occurred among measles cases. It is suggested that the increase in vaccination coverage in 1979-89 and the shift in age at infection to older age groups in the same period may have brought about this change through selective suppression of respiratory complications among measles cases. Results Spectrum of measles complications and rates of complications among cases In the period under review the spectrum of measles complications included pneumonia, diarrhoea, croup,

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

Thousands of measles cases are reported annually in Thailand even though measles vaccine has been introduced in the expanded program of immunization for every 9-month-old infant for nearly 20 years. Severe cases are admitted to the hospital, usually with complications, some cases lead to death. To study the clinical presentations of severe cases of measles and its complications and find the correlations of severity of pneumonia with age, nutritional status and history of vaccination. The hospital charts of measles patients admitted to the Queen Sirikit National Institute of Child Health (QSNICH) during 1998-2002 were retrospectively reviewed. Demographic data, history including history of measles vaccination, physical examinations, laboratory investigations, treatment and hospital course which were relevant were recorded. Paired t-test and Pearson&#39;s correlation were used for data analysis. There were 156 cases of measles admitted to the QSNICH. There were 95 boys and 61 girls an...

Journal of Evidence Based Medicine and Healthcare, 2017

The aim of the study is to search out the incidence of complications of measles immunisation in malnourished children.

Vaccine, 2002

Background: It has been assumed that measles infection may be associated with persistent immune suppression and long-term excess mortality. However, few community studies of mortality after measles infection have been carried out. We examined long-term mortality for measles cases, sub-clinical measles cases, and uninfected contacts after an epidemic in rural Senegal.

International Journal of Medicine and Public Health

Background: Measles has been a major public health concern leading to death among children despite availability of safe and cost-effective vaccines. Global push to improve vaccine coverage resulted in an 84% reduction in deaths. However, data from the year 2016 still reveals that there were 89, 780 measles deaths globally. 1 Aim: To study the epidemiological determinants influencing measles in children previously immunized with measles vaccine. Objectives: To determine the proportion of measles infected cases with history of prior measles immunization. To compare clinical profile of patients with and without history of prior measles immunization. Setting and design: Record based, Retrospective Cross sectional Study. Materials and Methods: A retrospective study was conducted using hospital records from an infectious disease hospital situated in Greater Mumbai. The study was carried out over duration of 1 year. Records of all cases admitted for measles from January 2013 to December 2013 were studied in detail. Sampling technique used was universal sampling. Total sample size was 471. Majority of the cases were admitted based on the WHO clinical definition while for a few suspicious cases Measles specific IgM was carried out. Statistical analysis used: Chi square test. Results: Out of 471 case records reviewed for measles, 47% children were vaccinated for measles. Percentage of undernourished children who received the immunization was 48%. A statistically significant association was observed for age, gender and duration of disease amongst those who were immunized for measles (p<0.01). Conclusion: A significant percentage of children despite immunization suffered from measles. Age, gender and nutrition were found to play a vital role in acquisition of measles both in the vaccinated and unvaccinated children.

The professional medical journal, 2015

…Background:Despite efforts to promote widespread vaccination,measles still remains an important cause of morbidity and mortality in children especially in developing countries. The aim of this study was to review the pattern and outcome of measles patients admitted at Benazir Bhutto Hospital (BBH) Rawalpindi during measles epidemic 2013.Study Design: Cross sectional descriptive study. Period:Three months during measles epidemic 2013 (March-May). Setting:Pediatric department BBH Rawalpindi. Materials and Methods:Data regarding demographic profile, clinical presentation, complications and outcome of measles patients was collected and analyzed using SPSS 15.Results:A total of 192 patients of both sexes were included with mean age of 35.48+32.71 months. Majority of patients(71.4%) were unvaccinated and 88% had history of contact with measles patients. The common complications observed were pneumonia and pneumonia with gastroenteritis and both were found statistically significant in patients with malnutrition and low socioeconomic status.Conclusion:The current study concluded that improving measles immunization and nutritional status in children is essential for reducing morbidity and mortality of measles.

Clinical Microbiology and Infection, 2019

Objectives: The 2018 measles outbreak in Israel affected >2000 people in Jerusalem. The aim of the study was to describe clinical features and complications of hospitalized measles patients in Jerusalem, as related to age group and risk factors. Methods: All individuals hospitalized with measles in the three main hospitals in Jerusalem during March 2018 to February 2019 were included. Demographic, clinical and laboratory data were analysed. Results: Of 161 hospitalized individuals, 86 (53.4%) were <5 years old, 16 (10%) were 5 years but <20 years old, and 59 (36.6%) were 20 years old. Most, 114/135 (85%), were unvaccinated. Immunocompromised state was identified in 12/161 (7.5%) patients, 20/161 (12.4%) had other underlying comorbidities, and four were pregnant. Hypoxaemia on admission was a common finding in all age groups. Hepatitis was more common among adults 20 years old (33/59, 59%). Measles-related complications were noted in 95/161 (59%) patients, and included pneumonia/pneumonitis (67/161, 41.6%), which was more common in young (<5 years) children, diarrhoea (18/161, 11.2%), otitis (18/161, 11.2%), and neurological complications (6/161, 3.7%)dthe latter occurring more frequently in the 5-to 20-year age group. Two of the 12 immunocompromised patients died of measles-related complications. A high readmission rate (19/161, 11.8%) within 3 months was documented among hospitalized measles patients. Conclusion: The burden of hospitalization, as well as the high rate of short-and long-term complications observed in hospitalized patients, underscore the importance of maintaining a high measles vaccine coverage, with enhanced targeting of unvaccinated population pockets.

2016

Aim: To determine the risk factors associated with complicated measles in children. Study design: It was a descriptive cross sectional study. Duration: Six months from 1 st January 2013 to 30 th June 2013. Settings: Department of Pediatrics, Teaching Hospital D.G Khan Medical College. Methods: A total of 100 cases fulfilling the inclusion/exclusion criteria were enrolled in the study. Results: In this study out of 100 patients54 (54%) were male cases and 46 (46%) female cases. Risk factors in complicated measles were recorded as: malnutrition (56%), nonvaccinated (78%), young age (age less then 5 years) (80%), immune deficiency (cases with history of recurrent infections) (12%) and vitamin A deficiency (cases with bitot spots on bulbar conjuctiva (3%). Conclusion: Younger age, poor socio economic status leading to over crowding and malnutrition, nonvaccination and immune deficiency were commonest risk factors of complicated measles.

Acta Medica Bulgarica

Journal of the College of Physicians and Surgeons Pakistan Jcpsp, 2014

Objective: To determine the risk factors regarding guardian's practices associated with development of Measles and also find out effectiveness of Measles vaccine among children less than 12 years of age presenting to the hospitals of Karachi. Study Design: Matched case control study. Place and Duration of Study: Multicenter surveillance was conducted in 11 public and private sector hospitals of Karachi from January 2011 to September 2012 in consultation with World Health Organization Measles Surveillance Cell. Methodology: Cases were children aged less than 12 years with Measles presenting to the hospitals. Controls for cases were enrolled from the same hospitals without Measles, matched for age and gender. Studied variables were analyzed by multivariate conditional logistic regression analysis adjusted for age and gender. Results: Measles cases were more likely to have mothers with 'lower education' [adjusted matched Odds Ratio or mOR: 3.2 (95% CI: 1.2-7.6), for < 5 years of schooling adjusted mOR: 2.2 (95% CI: 1.0-5.7) for 6-10 years of schooling]. Children with Measles were also more likely to be not given breast milk in initial 2 years of life [adjusted mOR: 2.6, 95% CI 1.0-7.0]. Cases were also more likely to have never received vaccination [adjusted mOR: 10.1, 95% CI 4.5-22.5] and having no other children vaccinated at home [adjusted mOR: 3, 95% CI 1.5-5.3]. Vaccine effectiveness for single dose was found to be 87.4 (95% CI: 76.1-93.4), while for two doses it was approximately 93% (95% CI: 86.2-96.6). Conclusion: For Measles elimination, mother's education on breast feeding and appropriate weaning practices is required.

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&#39;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...