Abstract
Recognition of measles is crucial to prevent transmissions in the hospital settings. Little is known about the level of recognition of measles and possible causes of not recognising the disease by physicians in the post-vaccine era. We report on a measles outbreak in a paediatric hospital in Austria in January to February 2017 with strikingly high numbers of not recognised cases. The extent and course of the outbreak were assessed via retrospective case finding. Thirteen confirmed measles cases were identified, two with atypical clinical picture. Of eight cases with no known epidemiological link, only one was diagnosed immediately; four were recognised with delay and three only retrospectively. Eleven typical measles cases had four ‘unrecognised visits’ to the outpatient clinic and 28 on the ward. Two atypical cases had two ‘unrecognised visits’ to the outpatient clinic and 19 on the ward.Thirteen clinicians did not recognise typical measles (atypical cases not included). Twelve of 23 physicians involved had never encountered a patient with measles before. The direct and indirect costs related to the outbreak were calculated to be over EUR 80,000. Our findings suggest the need to establish regular training programmes about measles, including diagnostic pitfalls in paediatric hospitals.
Highlights
A considerable increase of measles cases in the European Union/European Economic Area (EU/EEA) countries was observed between January 2016 and March 2019 compared with previous years, with 44,074 measles cases being reported
Genotyping was performed according to the measles and rubella World Health Organization (WHO) reference laboratory recommendations [15] using the Measles Nucleotide Surveillance (MeaNs) database tool for sequence analysis of a 450 nt amplicon coding for the nucleoprotein (N-450)
Six cases became infected after visiting the outpatient clinic and two while hospitalised
Summary
A considerable increase of measles cases in the European Union/European Economic Area (EU/EEA) countries was observed between January 2016 and March 2019 compared with previous years, with 44,074 measles cases being reported. Major reasons for measles transmission in hospitals are the high contagiousness of the measles virus, the capacity of the virus to persist in aerosol suspensions, unvaccinated healthcare personal, the nonspecific initial presentation of the patients, crowding of patients in outpatient clinics, inability to isolate febrile children from afebrile children in waiting rooms and the lack of awareness of physicians [2,6,7,8,9]. After 2–4 days, a maculopapular rash starting from the face spreading down the body appears. Some patients might present with atypical symptoms, e.g. the rash might not start on the face or not be maculopapular (e.g. be purpuric instead). Patients with atypical measles symptoms or not presenting with full symptoms of the disease contribute to misdiagnoses during outbreaks [10,11]
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