Abstract
Measles is an extremely contagious, vaccine-preventable infection that was officially declared eradicated in the US in 2000. However, measles outbreaks are increasingly occurring in the US. Measles cases have considerable morbidity requiring hospitalization, yet little is known about hospitalization and complications from measles in recent years. To analyze the frequency, predictors, costs and other outcomes of hospitalization for measles in the US. The 2002-2016 Nationwide Inpatient Sample, containing a 20% sample of US hospitalizations (n = 96,568,625), was analyzed. Measles and comorbidities were defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) or ICD-10-CM codes. Multivariable survey logistic regression and linear regression models controlling for sociodemographic demographic factors were constructed to understand associations with organ-specific complications, and cost of care and length of stay, respectively. Overall, 1,018 measles hospitalizations occurred in 2002-2016, and hospitalizations increased over time. In multivariable logistic regression models, measles was associated with higher odds of gastrointestinal, hematologic, infectious, neurologic, ophthalmologic, pulmonary, and renal complications, with the strongest association observed with encephalitis (39.84 [16.51-96.12], P<0.0001). Increased length of stay (LOS) and similar cost of care (mean [95% CI]; 4.8 [4.4-5.4]; $7,438 [$6,446-$8,582]) were observed versus (vs.) all other admissions (4.5 [4.4-4.5]; P<0.01; $7,854 [$7,774-$7,935], P>0.05). There were 34 deaths in hospitalized measles patients; inpatient mortality was numerically higher in those with vs. without measles (proportion ± SEM: 3.3±1.2% vs. 2.3±0.01%, P = 0.333). Lack of outpatient or prescription data. Measles continues to pose a substantial and preventable health care burden, with serious complications, hospitalization and inpatient mortality. Further studies are needed to improve the prevention and management of measles.
Highlights
Measles is a highly contagious and potentially life-threatening, airborne disease characterized by high fever, cough, coryza, conjunctivitis, and morbilliform rash
Multivariable survey logistic regression and linear regression models controlling for sociodemographic demographic factors were constructed to understand associations with organ-specific complications, and cost of care and length of stay, respectively
In multivariable logistic regression models, measles was associated with higher odds of gastrointestinal, hematologic, infectious, neurologic, ophthalmologic, pulmonary, and renal complications, with the strongest association observed with encephalitis (39.84 [16.51–96.12], P
Summary
Measles is a highly contagious and potentially life-threatening, airborne disease characterized by high fever, cough, coryza, conjunctivitis, and morbilliform rash. Despite major strides in vaccine coverage, measles is still a leading cause of vaccine-preventable death, especially in children, with more than 20 million new cases and 100,000 deaths worldwide annually [21,22]. The US has faced a resurgence of measles outbreaks in recent years, driven largely by travel-related exposures and communities with low rates of vaccination [25]. According to the Centers of the Disease Control and Prevention (CDC), there were 1,282 confirmed cases of measles in 31 states with 128 hospitalizations from January to December 2019, the highest yearly total since the year 1992; this trend that has been mirrored worldwide. Measles is an extremely contagious, vaccine-preventable infection that was officially declared eradicated in the US in 2000. Measles cases have considerable morbidity requiring hospitalization, yet little is known about hospitalization and complications from measles in recent years
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