Epidemiological and clinical characteristics of children with morbilli in Serbian enclaves in Central Kosovo

Abstract

Introduction Morbilli is a highly contagious disease manifested by catarrhal changes of the conjunctiva, mucous membrane of the upper respiratory tract, and maculopapular rash that spreads from the face and neck towards the trunk and extremities. Even nowadays, morbilli poses a significant social and health problem in the regions that have not reached adequate levels of vaccination. The aim of the study was to investigate epidemiological and clinical characteristics, as well as vaccination status of persons affected by morbilli in Serbian enclaves in Kosovo. Methods This is a retrospective 3-month study (October–January 2017). Sixty-nine affected children were treated at the Pediatric Department of the Clinical Hospital Center Pristina. The diagnosis was established according to epidemiological and clinical characteristics, blood count, and findings of specific IgM antibodies in serum. The method of descriptive epidemiology was used in the study. Student's t-test was used to compare the numerical means and the Chi2 test and Fisher's exact test were used for comparing distribution of descriptive characteristics. Results Mean age of children was 8.25 ± 3.83 years (MIN 7 months, MAX 18 years and a half), male gender: 7.16 ± 6.29, female gender: 9.43 ± 5.87 years. Age-related distribution was: 22.7% between 10–14 years, 18.7% between 2–5 years, 13.0% between 5–9 years, 9.7% between 6 months and 1 year, 6.6% less than 2-year-old, and 9.7% children between 15–19 years of age. There were 76.7% unvaccinated children and 23.3% incompletely vaccinated children. The infection was acquired: in 48.6% in school and pre-school facilities; in 23.1% in healthcare facilities; in 14.1% the infection occurred due to family epidemic, the source of the infection was of unknown etiology in 10.1%. As for ethnicity, there were 37.6% Roma children, 27.4% Albanian, and 22.4% Serbian children. Clinical signs and symptoms were: temperature (higher than 39 °C - 57.8%, up to 38.5 °C - 44.5%; 9.4% had subfebrile conditions); facies morbillosa - present in 83.5%, dry cough present in 33.7%; Koplik's spots in 6.4%; nausea and vomiting in 36.7%, diarrhea in 21.2%; initial maculopapular rash retroauriculary - 79.8%, on face - 95.2%, on the trunk - 78.2%, on the extremities - 49.9%. Tipe of rashes was: dense rashes (60.7% > Roma children, 19.6% > Albanian children, 8.9% > Serbian children) and sparse rashes: 39.3% Serbian children. Complication of the disease was: laryngitis - 34.6%, otitis media - 11.4%; pneumonias - 53.6% and death - 1.8%. Conclusions The majority of affected children were Roma and Albanian unvaccinated children. Due to the course and complications of the disease, morbilli should be eradicated by mandatory vaccination of unvaccinated and incompletely vaccinated individuals. Epidemiological and healthcare control of affected persons in Serbian enclaves in Kosovo should be performed regarding the disease reports, laboratory and serological testing, as well as isolation and treatment of infected individuals.