#1: The Clinico-Epidemiologic Profile and the Correlation of Nutrition and Immunization Status With Outcome of Measles Patients During an Outbreak

Abstract

Abstract Background Measles is a highly contagious disease that leads to substantial morbidity among pediatric patients. Vaccination has already been implemented in the Philippines, but still measles outbreak is resurgent. This study will be of importance because it can be utilized to establish the factors that lead to the recent measles outbreak. Objectives To describe the demographic and clinical profile of pediatric patients diagnosed with measles during the recent measles outbreak in a tertiary hospital in Central Luzon, Philippines; and to investigate the relationship of nutrition and measles immunization status with the outcomes of measles. Methods Cross-sectional analytic study, conducted in Tertiary training government hospital. Included in the study were less than 19 years old, admitted between January and April 2019, and manifested the following criteria for suspected measles:fever, generalized maculopapular rash, cough, coryza, conjunctivitis. Descriptive statistics was used to present data for the clinico-demographic profile of patients. A correlation study was done by determining the statistical significance of the relationship of nutrition and vaccination status with measles complications and outcomes; and the relationship of complications with outcomes of patients. Results In total, 373 patients were included in this study, 60% (224) were males; 40% (149) were females. The majority was under 0–6 months, 40% (149). Most cases came from Pampanga, 333 (89.2%). A total of 355 (95%) patients were classified as clinically compatible measles, seven (2%) were laboratory confirmed, and all seven had measles IgM antibodies, four (1%) were epidemiologically linked cases. Most of the cases manifested the classic symptoms of measles: fever 100%, rashes 99%, cough 96%, colds 84%, conjunctivitis 55%, and Koplik’s spots was seen in only 13%. As to exposure, those with exposure (49%) and without exposure (51%) are almost the same. The majority of the patients (285, 76%) had no measles vaccine and the top reason for non-immunization is the issue of the patients being too young for vaccination. The majority had normal nutritional status (72.4%). Three hundred and twelve patients reported the occurrence of clinical complications in patients with measles. Pneumonia was seen in 75% of cases and 9.3% had diarrhea. The occurrence of diarrhea is not directly correlated (P = 0.823) with the outcome of measles while Pneumonia shows a significant correlation (P < 0.001) with the outcome of measles. Death among patients was seen in cases with pneumonia. The occurrence of pneumonia is not significantly correlated with nutritional status (P = 0.083) while diarrhea is significantly correlated with nutritional status(P = 0.027). Two hundred and forty-eight patients with normal nutritional status did not develop diarrhea. Vaccination status shows a significant correlation with the occurrence of pneumonia(P =0.001). Out of the 285 non-vaccinated cases, 223 developed pneumonia. Vaccination status did not show a significant correlation with the occurrence of diarrhea (P = 0.946). Nutritional status and vaccination status was not significantly correlated with measles outcome(P = 0.605 and 0.120).In terms of outcome, 90% of the patients were discharged while 10% died. Conclusion Most were males, aged 0 to 6 months. There was a clustering of cases in Pampanga. The majority was classified as clinically compatible measles. The most common complication was pneumonia. Half had exposure to measles. The majority had no vaccine. The presence of diarrhea is significantly related to nutritional status. Pneumonia is significantly correlated with vaccination status and the outcome of measles. Most of the patients were discharged.