Measles, caused by the measles virus (MeV), is a highly infectious pediatric viral disease and its recovery usually occurs within one week of the onset of the rash[1]. However, some patients may develop complications, the most common of which is pneumonia, often detected at autopsy[2,3]. In our case, a four-year-old girl presented with fever and cough for three weeks. Despite receiving antibiotic therapy, she developed left-sided empyema and was referred to our tertiary-care center on the 24th day of her illness. She received the BCG vaccine and two doses each of Oral Polio and Hepatitis B vaccine before the onset of the disease. Chest auscultation revealed reduced air entry on the left side. Investigations revealed anemia, neutrophilia and positive blood culture yielding Klebsiella species. Computed tomography of the chest showed left lung empyema, loculated pneumothorax and left lower lobe collapse. On the 12th day of hospital admission, she developed a confluent maculo-papular rash over the trunk, which suggested a viral exanthema. Two days after the rash, she underwent thoracotomy. Intraoperatively, gangrenous parts of the left lower lobe and adherent thickened pleura were excised. On histopathology, large areas of pulmonary infarction were noted with some viable parenchyma. The alveolar spaces in the viable areas were filled with fibrino-purulent exudates with mononuclear cell infiltration in the septa. A characteristic finding revealed the presence of many multinucleated giant cells within the alveolar spaces, and lining the alveolar septa and the bronchioles. Well-defined intra-nuclear eosinophilic inclusions surrounded by a halo (Figure 1A and 1B), typical of measles infection were also noted; however, cytoplasmic inclusions were not seen. The fever and the rash subsided about a week after the decortication.Figure 1: H&E staining of pleural decortication specimen in a four-year-old girl diagnosed with measles giant cell pneumonia. (A) Syncytial giant cells with intranuclear eosinophilic inclusion bodies surrounded by halo (arrow) seen lining thealveolar septa (× 600). (B) Bronchiole showing similar syncytial giant cells with intranuclear inclusions (H&E × 600).A giant cell pneumonia (GCP) with typical inclusions of MeV was rarely reported in pleural decortications performed in children. GCP can occur in malnourished children, elderly patients and those who are immunocompromised. The giant cells are formed by the fusion of the epithelial cells due to the expression of the H and F viral proteins on the surface of the infected cells and lining the alveolar septa and the bronchioles[4]. Of the four stages of measles, giant cell formation is a feature of prodromal phase and thus occurs before the development of rash[5]. Our patient had been symptomatic for a period of nearly a month, which is beyond the usual duration of the incubation period of measles. It is likely that our patient probably started with a bacterial pneumonia and empyema, and then infected by MeV. The aggravating factors would have been profound immunosuppression induced by MeV, malnutrition and non-immunized status for measles. GCP is also caused by other viruses like respiratory syncytial virus, parainfluenza virus and human metapneumovirus[6]. Serological and microbiological tests were not performed in our case but the typical well defined eosinophilic intranuclear inclusions clinched the diagnosis. There is also often bacterial super-infection, as seen in our case along with more alarming lung gangrene. Most descriptions of measles GCP are in autopsied cases. To the best of our knowledge, this is the first case of measles GCP to be described in a pleural decortication tissue. Conflict of interest statement The authors declare that they have no conflict of interest. Ethical approval and patient’s consent to participate The patient's parents gave consent for the publication, as the patient is only 4 years old. Funding The authors received no extramural funding for the study. Authors’ contributions Concepts, design, definition of intellectual content and literature search: SPA and PV; data acquisition and manuscript preparation by SPA; manuscript editing by PV; manuscript review by SPA and PV; guarantor by SPA. Publisher’s note The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Edited by Pan Y, Lei Y, Zhang Q

Цель исследования: изучение особенностей течения и частоты развития осложнений кори у взрослых в сезоне 2018-2019 годов. Материалы и методы. Исследования проводились в клинике инфекционных болезней Национальной медицинской академии последипломного образования имени П. Л. Шупика в период с сентября 2018 г. по март 2019 г. Обследовано и пролечено 368 больных с диагнозом корь, в возрасте от 18 до 65 лет. Результаты. В статье приведены современные научные данные и результаты наших исследований относительно особенностей течения и частоты возникновения различных осложнений кори у взрослых. Выводы. Осложнения кори у взрослых могут развиться в любом периоде болезни. Установлено, что чаще регистрировались острый гнойный трахеобронхит – у 41,04 % больных, негоспитальная пневмония – у 24,86 %. В сезоне 2018-2019 годов отмечено увеличение больных реактивными гепатитами, которые наблюдались у 28,29 % больных корью.

Актуальність. Незважаючи на наявність безпечної й ефективної вакцини, кір залишається однією з головних причин смерті серед дітей у всьому світі. У 2017–2018 роках у різних країнах світу та в нашій країні зокрема спостерігається зростання кількості хворих на кір. В Україні на 41-й тиждень від початку 2018 року на кір захворіли 33 165 осіб, серед яких 13 184 дорослі та 19 981 дитина. Метою роботи було вивчення клінічних особливостей кору в дітей під час спалаху 2017–2018 рр. Матеріали та методи. Були досліджені діти, які проходили стаціонарне лікування в інфекційній лікарні з приводу кору. Результати. Було проаналізовано 140 історій хвороби дітей, які проходили стаціонарне лікування у Київській міській дитячій клінічній інфекційній лікарні з діагнозом «кір». Більшість (62,9 %) становили діти шкільного віку. Діти перших 2 років життя становили лише 16,5 % від загальної кількості досліджуваних пацієнтів. У переважної більшості пацієнтів із кором (79,1 %) у клінічній картині були наявні симптоми класичної тріади: кон’юнктивіт, кашель та нежить. Тривалість періоду лихоманки була вірогідно довшою в пацієнтів, які не отримували вакцинацію від кору, порівняно зі щепленими (7,50 ± 1,92 дня та 6,60 ± 1,74 дня відповідно). У нещеплених осіб також була суттєво довшою тривалість продромального періоду, 3,20 ± 1,48 дня проти 2,50 ± 1,31 дня в щеплених пацієнтів. Тривалість висипань залежала від віку дитини і була найкоротшою в дітей першого року життя (4,96 ± 1,29 дня) та найдовшою в пацієнтів віком від 1 до 2 років (6,09 ± 2,11 дня). Ускладнений перебіг захворювання спостерігався в 14,3 % хворих. Більшість ускладнень (82,9 %) була пов’язана з органами респіраторного тракту. Суттєво більша частота ускладнень спостерігалась у пацієнтів із супутньою патологією. Висновки. Клінічні характеристики кору в дітей мають залежність від віку та вакцинального статусу пацієнтів.

Background: Pathomicrobial and molecular investigations of respiratory system diseases was undertaken on twelve adult buffalo carcasses received for necropsy examination at post mortem facility of Department of Veterinary Pathology, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar, Haryana during the period from August, 2018 to February, 2019. Methods: After collection of the samples, laboratory work was undertaken in the laboratories of Department of Veterinary Pathology, Department of Animal Biotechnology and Central Laboratory of the College, LUVAS, Hisar, Haryana (India) in the year 2018-2019 regarding the examination of the clinical history, pathological, microbiological and molecular investigations. Result: The gross pathological changes observed in lungs were variable degree of vascular changes, mild to severe consolidation, fibrin deposition along with adhesions to the thoracic wall. Histopathological findings revealed abnormalities of inflation such as pulmonary emphysema, atelectasis, pulmonary congestion and haemorrhages which was associated with different types of pneumonia viz. fibrinous bronchopneumonia, suppurative giant cell pneumonia, interstitial pneumonia and serous pneumonia. Lung, heart blood and tracheal swab samples collected from the buffalo carcasses revealed eighteen bacterial isolates which were identified by Vitek 2 system. These include E. coli (11 isolates), Salmonella enteric enterica (2 isolates), Acinetobacter ursingii (1 isolate), Staphylococcus haemolyticus (1 isolate), Staphylococcus sciuri (1 isolate), Staphylococcus warneri (1 isolate) and Staphylococcus hominis (1 isolate) mostly belonging to opportunistic pathogen category. E. coli serotypes confirmed from these cases were O83, O149 and O8. The results of in vitro drug sensitivity testing revealed that most of bacterial strains were found sensitive to cefoperazone/sulbactum and co-trimoxazole. Molecular studies confirmed Bovine Herpes Virus-1 (BHV-1) infection in one case with Fibrinous bronchopneumonia through real-time quantitative PCR indicating the prevalence of the infection in the state.

Fully Retargeted, Myeloma-Specific Oncolytic Measles Viruses.

Background Immunization is among the most important public health interventions against common childhood diseases. However, a missed opportunity for vaccination (MOV), may hamper the progress made in reducing childhood illness through vaccination. Knowing the magnitude and contributing factors for MOV, is essential for planning and executing preventive measures; however, these factors are not well elucidated in the Tanzania context. Broad Objective To determine the magnitude and factors for MOV among children under five-years old admitted at Mwananyamala hospital. Methodology We conducted a hospital-based, cross-sectional descriptive study among children under-five year old who were admitted at Mwananyamala hospital and their respective care givers from October to November 2018. An interview-guided questionnaire was used to collect data from the caregivers. The childhood immunization history was obtained from the immunization cards. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20). Results A total of 209 caretakers and their respective children were enrolled in the study. Thirty-eight (18.2%) had MOV, and among the missed vaccines, the second dose of measles and rubella was the most missed vaccine (45.5%). Identified factors for MOV were unavailability of the vaccine on the day of vaccination 12 (31.3%), the child being sick on the day of vaccination 10(26.3%), due date forgotten 8 (20.8%), not informed on when to return for vaccination 7(18.1%), and no money for transport to vaccination center 1 (2.7%). Conclusion and recommendation The magnitude of missed opportunity for vaccination is still high among hospital admitted children. Vaccine procurement and distribution as well as improved communication among caretakers and health personnel should be more strengthened to reduce the number of children who are missing vaccines. Keywords: Missed opportunity for vaccination, Children, Under-five, Dar es Salaam.

Introducción: La salud pública es el resultado del esfuerzo organizado de la sociedad, principalmente de las instituciones públicas y las políticas de salud y de su gestión. Parte de sus funciones esenciales es la vigilancia permanente de la salud pública. El objeto del estudio es el diagnóstico de la situación general de salud pública y la epidemia de COVID-19 en Venezuela durante el año 2020. Métodos: Se trata de un estudio de revisión, basado en información de fuentes documentales nacionales e internacionales sobre la situación de salud de la población venezolana y la epidemia de COVID-19 para el mes de septiembre de 2020. Se seleccionan los determinantes e indicadores de impacto de la salud más resaltantes y de monitoreo por los organismos responsables de la salud pública y de sectores afines. Resultados: Los indicadores de impacto se han deteriorado con pérdida de 3 años en la esperanza de vida durante el último quinquenio, aumento de la mortalidad materna en más de 70 puntos durante los últimos 5 años y la mortalidad infantil menores de 5 años pasó de 16 x 1 000 nacidos vivos en 2012 a 24 x 1 000 nacidos vivos en 2016. Los determinantes sociales y ambientales en franco deterioro con aumento de la pobreza a más del 95 % de la población, la prevalencia de la desnutrición crónica pasa el 30 %, el salario mínimo no alcanza 1 dólar americano diario, la educación ha perdido cobertura y los programas preventivos como la vacunación no llegan a evitar las enfermedades inmuno-prevenibles controladas como difteria y sarampión. La epidemia de COVID-19 ha empobrecido más la población y empeorado los programas de prevención de las enfermedades transmisibles y las no transmisibles. La violencia dentro de las principales causas de muerte general en Venezuela y la primera causa de muerte en adolescentes y jóvenes adultos. Conclusiones: El diagnóstico general de salud de Venezuela para 2020, muestra un deterioro grave de los determinantes y los indicadores de impacto, que frente a la epidemia de COVID-19 en curso se han deteriorado a extremos no cuantificados hasta el momento con muestras de violación a los derechos humanos a la salud y la dignidad de las personas. La epidemia de COVID-19 ha afectado negativamente las coberturas de los programas preventivos y de control médico. Venezuela requiere urgente ayuda humanitaria internacional puesto que ha sido sobrepasada en sus capacidades para enfrentar la epidemia que profundiza la severa “emergencia humanitaria compleja”; reconocida y declarada por la ONU desde 2019.

Factors associated with protection from measles in nurses in Hong Kong

This thesis explores the association between the age gap between parents and health outcomes for children in Sub-Saharan Africa. An average man-older age gap between partners has been observed all over the world and is the largest in many Sub-Saharan African countries. A large age gap is common in patriarchal societies and has been associated with less female autonomy and impeded decision-making for the couple, resulting in less contraceptive use and a possible higher risk of interpersonal violence. This thesis examines another association with age gaps by focusing on the health outcomes for children in families with large and small age gaps between the mother and her partner. It is hypothesized that children will have worse health outcomes in families where the age gap between the mother’s partner and the mother herself is larger than average. Using data from the Demographic and Health Surveys (DHS), multilevel logistic regression is run to test the association between three health indicators while controlling for confounding variables such as mother’s age, education level and wealth. The health indicators are treatment of fevers, vaccination against measles and underweight. The results show some statistically significant associations, with all three variables supporting the hypothesis that children in age heterogamous families are doing worse. Children of couples with a larger than average age gap have lower likelihood of being treated for fever or cough, and a higher likelihood of being underweight, and children of couples with a smaller than average age gap have a higher likelihood of having received the first measles vaccination. The results show that the age gap between parents is a factor to take into consideration when studying child health and family structures in Sub-Saharan Africa.

According to WHO vaccine prophylaxis covering 90% of the amenable population is the most effective and economically sound way to manage the epidemic process. At the same time among patients suffered from measles, pertussis and diphtheria, the number of vaccinated exceeds 20.0%.

Resurgimiento de enfermedades infecciosas y movimiento antivacunas, ¿qué pasa en México?

100 healthy adults aged 18–30 years were examined for the presence of measles immunity. A protective level of measles antibodies was found in 32%, and in 68% of adults such antibodies were not detected. Specific cellular immunity to measles virus antigens was detected in 57.37% of the examined individuals, in 26.07% of them specific cellular immunity to measles viruses was not detected, and in 6.56% the response was regarded as equivocal. Seronegative adults were vaccinated with measles cultural live vaccine (“Vector”, Russia). After 6 weeks, protective levels of anti-measles antibodies were detected in all vaccinated patients, the average level was 2.18 (1.40‒3.68) IU/ml. Specific cellular immunity to antigens of measles viruses in 3 people was regarded as equivocal, in the rest of the vaccinated as positive.

麻疹和风疹是由麻疹病毒和风疹病毒感染引起的具有高度传染性的急性发热出疹性疾病。疫苗的免疫预防接种是消除麻疹和风疹的最有效手段。通过简要介绍麻疹和风疹的流行病学特征、临床表现、辅助检查、诊断和鉴别诊断以及清除手段和预防接种措施，对临床工作提供支持。.

Sarcoma botryoides is a rare histological variant of rhabdomyosarcoma (RMS) found in the mucosal lining of body cavities of the bladder, vagina, nasopharynx, and biliary tract. Vaginal RMS typically affects young girls below 2 years of age but has also been reported in adolescents. Most patients present late when the tumor has already caused significant regional effects and complications. The management of such children usually poses numerous challenges in a resource-poor setting. A 3-year-old girl presented with a 1-year history of a progressive mass protruding through the vaginal introitus, associated with bleeding, progressive weight loss of 6 months, and abdominal swelling of 3 months duration. After 6 weeks of hospital stay, a diagnosis of sarcoma botryoides was made, and chemotherapy was commenced 2 weeks following the diagnosis. Delays were encountered due to financial constraints, laboratory stock-outs, and hesitance in accepting treatment by the parents. She completed one cycle of chemotherapy, comprising vincristine, actinomycin, and cyclophosphamide, with demonstrable reduction in the tumor sizes. Unfortunately, her management was complicated by severe measles infection acquired during admission; and she succumbed to the illness. Treatment of childhood cancers is bedevilled by the multiple levels of delays, and a host of co-morbidities that combine to produce an undesirable outcome. There is a need for a highly coordinated multidisciplinary approach that is hinged on a strong support for infection prevention and treatment access, in addition to good nutrition, adequate supply of blood, and blood products.

A key concern in public health is whether disparities exist between urban and rural areas. One dimension of potential variation is the transmission of infectious diseases. In addition to potential differences between urban and rural local dynamics, the question of whether urban and rural areas participate equally in national dynamics remains unanswered. Specifically, urban and rural areas may diverge in local transmission as well as spatial connectivity, and thus risk for receiving imported cases. Finally, the potential confounding relationship of spatial proximity with size and urban/rural district type has not been addressed by previous research. It is rare to have sufficient data to explore these questions thoroughly. We use exhaustive weekly case reports of measles in 954 urban and 468 rural districts of the UK (1944–1965) to compare both local disease dynamics as well as regional transmission. We employ the time-series susceptible-infected-recovered model to estimate disease transmission, epidemic severity, seasonality and import dependence. Congruent with past results, we observe a clear dependence on population size for the majority of these measures. We use a matched-pair strategy to compare proximate urban and rural districts and control for possible spatial confounders. This analytical strategy reveals a modest difference between urban and rural areas. Rural areas tend to be characterized by more frequent, smaller outbreaks compared to urban counterparts. The magnitude of the difference is slight and the results primarily reinforce the importance of population size, both in terms of local and regional transmission. In sum, urban and rural areas demonstrate remarkable epidemiological similarity in this recent UK context.

Pockets of susceptibility resulting from spatial or social heterogeneity in vaccine coverage can drive measles outbreaks, as cases imported into such pockets are likely to cause further transmission and lead to large transmission clusters. Characterizing the dynamics of transmission is essential for identifying which individuals and regions might be most at risk. As data from detailed contact-tracing investigations are not available in many settings, we developed an R package called <i>o2geosocial</i> to reconstruct the transmission clusters and the importation status of the cases from their age, location, genotype and onset date. We compared our inferred cluster size distributions to 737 transmission clusters identified through detailed contact-tracing in the USA between 2001 and 2016. We were able to reconstruct the importation status of the cases and found good agreement between the inferred and reference clusters. The results were improved when the contact-tracing investigations were used to set the importation status before running the model. Spatial heterogeneity in vaccine coverage is difficult to measure directly. Our approach was able to highlight areas with potential for local transmission using a minimal number of variables and could be applied to assess the intensity of ongoing transmission in a region.

Клинико-эпидемиологические и диагностические особенности кори во время вспышки в вакцинированной популяции

From December 2019 to March 2020, Novel COVID-19 has spread in almost all countries throughout the world creating a havoc among the people. Lockdown as a solutions to it has been implemented worldwide to bring the situation under control. Lockdown can help to reduce the spread of Corona virus which in turn will reduce number of Novel COVID-19 cases and the toxic contamination of environment. As a result the reduction of all type of pollution will lead to decrease number of patient related to air borne diseases like measles, chickenpox tuberculosis, etc. The purpose of this review article is to explain the impact of one month lockdown on global environment.

Objetivo: O presente artigo objetivou identificar o estado vacinal dos adolescentes da área adscrita de uma Unidade Básica de Saúde da Família de uma cidade no Estado do Piauí. Métodos: Trata-se de um estudo seccional com abordagem quantitativa, desenvolvido por meio de inquérito domiciliar, no período de abril a julho de 2017. A amostra foi constituída por 361 adolescentes e a análise foi realizada por meio de estatística descritiva. Resultados: Verificou-se que, a cobertura vacinal contra rubéola, sarampo e caxumba atingiu 42,7% dos adolescentes, difteria e tétano (31,9%), hepatite-B observou-se 42,1% de cobertura, enquanto que, 43,2% dos adolescentes foram vacinados contra febre amarela e 21,1% contra HPV. Destaca-se que, aproximadamente 50% dos entrevistados desconhecem a existência de um cartão de vacina do adolescente e que 58,8% dos adolescentes não sabiam informar contra quais doenças estavam imunizados. Conclusão: Conclui-se que o conhecimento dos adolescentes é incipiente em relação à imunização, destacando-se assim, a necessidade da realização de ações educativas pelos profissionais da saúde em parceria com as escolas.

In 2018, an unvaccinated child returned home from Israel to New York City with measles. Other cases followed. The NYC Department of Health and Mental