Onset Of Measles Research Articles

#34: Measles Outbreak in Pediatric Oncology Patients in Hue Central Hospital, Vietnam

Abstract Background Measles outbreaks in immunocompromised populations present a significant challenge, and to interrupt endemic transmission can be difficult. This study aimed to investigate measles in pediatric oncology patients at Hue Central Hospital, Vietnam to describe demographic, epidemiological, and clinical features. Methods Potential measles infections among children with cancer were prospectively identified between April 20 to July 10, 2019 at Hue Central Hospital. Measles diagnoses were based on both clinical features and IgM laboratory evaluation. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From April 20 to July 10 in 2019, a total of 11 patients with malignancies were identified as having measles, with a median age of 4.0 years (range: 1 years to 9 years). Of these 11 patients, 2 (18.2%) had not received any dose of measles vaccine, 4 (36.4%) had received 1 dose of measles vaccine, and 5 (45.5%) had received the recommended 2 doses. All patients had fever with the median temperature of 39 degrees Celsius (range: 38.5–39.5), and median fever duration of 7 days. All patients had cough and rash, while 3 (27.3%) were complicated by pneumonia, and 2 (18.2%) had elevated liver transaminases. All patients had hospital visits or were hospitalized before measles onset, with the median length of stay of 10 days (range: 7–24 days). All patients were likely to exposed each other. 100% of these patients recovered. Conclusions Children with cancer are at extra risk of measles infection due to their immunocompromised status. Getting vaccinated is the best way to prevent measles, and improved infection control is critical for the prevention of measles in patients with malignancies. Following this measles outbreak, a designated outpatient area was established to separate the inpatient unit and limit hospital transmission.

Measles Outbreak in Pediatric Oncology Patients at Hue Central Hospital

AIM: Measles outbreak in the immunocompromised population is a big challenge to interrupt endemic transmission. This study aimed to investigate of measles in pediatric oncology patients and find the reason behind the outbreak.
 METHODS: A descriptive study was conducted on 11 pediatric oncology patients with measles. We collected demographic, epidemiological, and clinical data. Most of suspected measles cases were done measles immunoglobulin M test and clinical data were followed up and analyzed by SPSS.
 RESULTS: From April 20, 2018, to July 10, 2019, a total of 11 patients with malignancies were notified to develop measles in Hue. Of these 11 patients with the median age of 4.0 years (range: 1–9 years), two patients had not received any dose of measles vaccine, five patients received two doses, and four patients had received 1 dose of measles vaccine; all patients had fever with the median fever of 39°C (range: 38.5–39.5), the median fever duration was 7 days. All patients had cough and rash, three patients had pneumonia complication and two patients had elevated liver transaminase levels. All patients had hospital visits or were hospitalized before measles onset, with the median time: 10 days (range: 7–24 days); all patients were likely to expose each other. All 11 patients recovered.
 CONCLUSIONS: The measles outbreak was occurred among children with cancer, especially for children without prior measles vaccine or without two prior doses. Moreover, even children received two prior dose vaccine, their immunocompromised status caused them to be infected. There was not a different area for outpatient and inpatient in the hospital, so measles transmission occurred.

Ten-Year Surveillance of Measles Virus from 2007-2016 in Osaka City, Japan.

Measles is a highly contagious infection caused by the measles virus (MV). This study performed long-term surveillance in order to survey the prevalence of MV. A total of 417 patients diagnosed with or suspected of having measles were tested for MV between January 2007 and December 2016 in Osaka City, Japan. Reverse transcription-polymerase chain reaction-based testing of clinical specimens showed that 54 patients (12.9%) were MV-positive. An MV epidemic occurred in 2007, in which all detected MV strains were genotype D5, an epidemic strain in Japan at that time. The detected wild-type MV strains in sporadic or outbreak-associated cases since 2011 included genotypes D4, D8, B3, and H1. Three vaccine strains (all genotype A) were also detected. Children ＜10 years of age accounted for 90.0% of the MV-positive patients in 2007. In contrast, adults (≥ 20 years of age) accounted for the majority of MV-positive cases since 2011, as follows: 100%, 50%, 71.4%, 100%, and 87.5% of cases in 2011, 2013, 2014, 2015, and 2016, respectively. The recent high rate of two-dose MV vaccination coverage among children in Japan may have contributed to the reduced risk of MV infection and onset of measles in young persons.

Measles Outbreak in Pediatric Hematology and Oncology Patients in Shanghai, 2015.

Background:Despite substantial progress toward measles control are making in China, measles outbreaks in immunocompromised population still pose a challenge to interrupt endemic transmission. This study aimed to investigate the features of measles in pediatric hematology and oncology patients and explore the reasons behind the outbreak.Methods:We collected demographic, epidemiological, and clinical data of immunocompromised measles children. All suspected measles cases were laboratory-confirmed based on the presence of measles IgM and/or identification of measles RNA. The clinical data were statistically analyzed by t-test for continuous variables and Fisher's exact test for categorical variables.Results:From March 9 to July 25 in 2015, a total of 23 children with malignancies and post hematopoietic stem cell transplantation (post-HSCT) were notified to develop measles in Shanghai. Of these 23 patients with the median age of 5.5 years (range: 11 months–14 years), 20 (87.0%) had received 1–3 doses of measles vaccine previously; all patients had fever with the median fever duration of 8 days; 21 (91.3%) had cough; 18 (78.3%) had rash; 13 (56.5%) had Koplik's spot; 13 (56.5%) had complications including pneumonia and acute liver failure; and five (21.7%) vaccinated patients died from severe pneumonia or acute liver failure. Except the first patient, all patients had hospital visits within 7–21 days before measles onset and 20 patients were likely to be exposed to each other.Conclusions:The outcome of measles outbreak in previously vaccinated oncology and post-HSCT pediatric patients during chemotherapy and immunosuppressant medication was severe. Complete loss of protective immunity induced by measles vaccine during chemotherapy was the potential reason. Improved infection control practice was critical for the prevention of measles in malignancy patients and transplant recipients.

The 2014 measles outbreak in Osaka An epidemiological study for the elimination of measles.

To examine and analyze the spread of measles in Osaka in 2014 and determine effective measures to prevent such occurrences. We analyzed 47 cases of measles reported in Osaka, including one measles patient living in another prefecture where there was an outbreak. We focused on age distribution, the number of patients reported each week, estimated infection routes, history of measles vaccination, detection of viruses, and number of days it took to report the case after the onset of measles. Patients aged 20-39 years accounted for 24 cases (51.1%). The number of patients reported started from 2nd week with relatively broad peak to 27(th) week, and the measles epidemic was brought under control in the 47(th) week. Among the 47 cases, no source could be identified in 16 cases (34.0%). Household exposure was the main cause of the infection (25.5%), followed by imported cases (21.3%). Eighty-three percent of the overall patients had not received a measles vaccination at all or it was unclear whether they previously had been vaccinated. Genotype B3, H1, and D8 were detected in our patients and these genotypes originated overseas. It took significantly more days, from the onset of measles, for the case to be reported in patients aged 15 years and over compared with those aged under 15 years (P=0.001). For eradicating measles in Osaka, it is important to raise awareness about this issue among medical institutions, especially institutions for adults, in order for them to report cases as soon as possible, upon discovery in their patients. In addition, "catch-up" supplementary immunizations are effective for all people, including adults who are susceptible to measles.

Transverse Myelitis in Measles

An 8-year-old unvaccinated boy presented to the emergency department 1 week after the onset of measles with a one day history of abdominal pain, subfebrile temperature, and weakness of his legs. There were no complaints of visual impairment. Physical examination revealed urinary retention, muscle weakness of both legs (he was able to move his joints against gravity, but not against examiner's resistance) without sensory impairment, an absent right and diminished left knee jerk reflex, and a diminished right Achilles tendon reflex and normal plantar reflex (left not obtainable because of a lower limb plaster cast).

Measles Transmission and Vaccine Effectiveness during a Large Outbreak on a Densely Populated Island: Implications for Vaccination Policy

The Republic of the Marshall Islands (RMI) is a South Pacific nation freely associated with the United States. In 2003, the RMI experienced the largest measles outbreak within the United States or its associated areas for more than a decade, although the reported coverage of 1-dose measles-mumps-rubella (MMR) vaccine was 80%-93%. The outbreak ended only after vaccination of >35,000 persons among a population of 51,000. Of outbreak cases, 41% were reported to have been previously vaccinated. We studied measles attack rates in RMI households to assess vaccine effectiveness and patterns of disease transmission. For the household secondary attack rate study, households were selected by convenience sampling of outbreak measles cases. The primary case was defined as the first person with measles in a household. Secondary cases were household members with measles onset 7-18 days after the primary case's rash onset. Vaccine effectiveness analysis was limited to children aged 6 months to 14 years, with vaccination status verified against written records. Seventy-two households were included in the study. The median household size was 11 persons, and the median number of persons per room was 5.5. Secondary cases were more likely than primary cases to be infants (46% vs. 13%; P=.03). MMR vaccine effectiveness was 92% (95% confidence interval [CI], 67%-98%) for 1 dose and 95% (95% CI, 82%-98%) for 2 doses. Measles vaccine effectiveness was high; thus, diminished effectiveness was not the main cause of the outbreak. In communities with high population density and household crowding, very high population immunity is needed to prevent measles outbreaks and to protect infants below the age of vaccination. This may require excellent implementation of a routine 2-dose measles vaccination strategy.

Changing epidemiological features of subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a chronic central nervous (CNS) system infection caused by measles virus. Because changing immunization practices affect the epidemiology of measles and consequently SSPE, we examined the epidemiological data of our SSPE registry. Age of onset, age at onset of measles, duration of Latent period and immunization status were examined in cases recorded at the SSPE Registry Center in Turkey between 1975 and 1999. Age of onset diminished from 13 years before 1994 to 7.6 years after 1995; age at onset of measles declined from 29 months to 20 months and the Latent interval from 9.9 years to 5.9 years. Age at onset of measles and immunization status did not directly affect the duration of the Latent period. Although its incidence has decreased in Turkey, SSPE has been seen at younger ages in recent years. This change cannot be attributed solely to younger age at onset of measles. Factors affecting the duration of the Latent period should be investigated further.

Preschool children at high risk for measles: opportunities to vaccinate.

In 1989 and 1990 the United States experienced a measles epidemic with more than 18,000 and 27,000 reported cases, respectively. Nearly half of all persons with measles were unvaccinated preschool children under 5 years of age. We sought to identify potential sites for vaccine delivery. Preschool children with measles were surveyed in five inner cities with measles outbreaks in 1989 to 1990 to assess the children's use of health care services and federal assistance programs before contracting measles. Of 972 case children surveyed, 618 (64%) were eligible for measles vaccination at measles onset. Of those, 93% had previously visited a health care provider (private physician, public clinic, hospital emergency department, or hospital outpatient department) and 65% were enrolled in a federal assistance program (AFDC, WIC, or food stamps). Based on parent-reported reasons for health care visits, in Dallas and New York City, health care providers of 24% of 172 children may have missed at least one opportunity to administer measles vaccine. Many potential opportunities exist to raise the vaccination coverage of unvaccinated preschool children. These opportunities depend on (1) health care providers taking advantage of all opportunities to vaccinate, and (2) immunization services being linked to federal assistance programs.

Growth retardation in weight and catch-up growth following infection by measles and whooping cough among babies of rural Zaire (Lake Tumba)

This study has shown that measles and whooping cough affect growth in weight among babies of rural Zaire (Lake Tumba). The average loss in weight due to measles, is more than twice the amount due to whooping cough. However, the time needed to regain the original growth channel after infection by measles, is about half the time needed to fully catch up after whooping cough. The amount of weight loss is proportional to the child's weight at the onset of the disease. There is no difference in the susceptibility to lose weight after measles or whooping cough, between boys and girls, nor between Oto and Twa. This study has also shown that the effect of measles and whooping cough on the growth in weight, is independent of the season of the hear, although the incidence of these diseases showed a significant seasonal pattern. Finally, this study gives evidence for the fact that the incidence of weight loss one month after the onset of measles or whooping cough is age-related.

Neurological diseases in Karachi, Pakistan--elevated occurrence of subacute sclerosing panencephalitis.

Neurological diseases, especially subacute sclerosing panencephalitis (SSPE), were surveyed in Karachi, Pakistan disclosing following major results. (1) Indirectly estimated prevalence rates of selected neurological disease entities were comparable with the rates from western countries and Japan in heredodegenerative diseases, but grossly elevated in infectious diseases. (2) Estimated mortality statistics for the Karachi community revealed highly elevated rates for infectious, parasitic and perinatal causes of death. (3) SSPE represented about 10% of inflammatory afflictions of the cerebral parenchyma, its incidence rate being about 100% times more than that observed in developed countries. A case-control study preliminarily showed that infants who later contract SSPE have unhealthy mothers, are born small, and have various occurrences of ill health from birth to the onset of SSPE. (4) Age at the onset of measles was very young in the cases as well as in controls, unlike the average young age at onset of cases only in developed countries. Measles contracted at young age is a well known risk factor to SSPE. Whereas few children in developed countries acquire measles at such an early age, many Karachi children do. Elevated occurrence of SSPE is probably conditioned by such age patterns of measles infection, together with other risk factors more common in Karachi due to poorer health standards. A proper immunization programme is urgently needed to control measles and SSPE.

Subacute Sclerosing Panencephalitis: A New Serological Test in the Diagnosis of the Disease

In patients suspected of subacute sclerosing panencephalitis (SSPE) high levels of measles antibody in the serum and CSF have been taken as a supporting diagnostic criterion for the disease. In the present study 14 sera from patients with SSPE, 3 early-measles-con-valescent sera and 100 late-measles-convalescent sera were used for indirect immunofluorescent examination of tissue culture cells infected with wild measles virus and SSPE viruses. All 14 SSPE sera reacted with an antigen in the nuclei and cytoplasm of these infected cells, as did the 3 convalescent sera obtained 3 weeks after the onset of measles. However, no intranuclear fluorescence was detected when the 100 sera obtained 5 months or later after measles infection were used. Thus, SSPE sera derived from patients who had measles many months, or years, prior to the onset of their neurological disorder, behaved like early convalescent sera. Thus unusual characteristic can be applied as a diagnostic test for SSPE. (Supported by USPHS grant NS-6859; Grant MS 596-A-2 from the Nat. Multiple Sclerosis Soc.; DG grants Me270/4 and 270/6; and USPHS grant AI-1475.)

POSTINFECTIOUS ENCEPHALOMYELITIS

Recent years have seen increased interest in postinfectious and postvaccinal encephalitis and realization of the prevalence of bromide poisoning. A case is presented in which these conditions occurred simultaneously. <h3>REPORT OF A CASE</h3> W. W., a 9 year old white boy, was first seen Aug. 2, 1939. The chief complaint was "jerking and twitching" of six weeks' duration. <i>History.</i>—Fifteen weeks earlier he had contracted measles and was moderately ill. He stayed in bed one week but was out of school two weeks longer because of excruciating headaches, which started about a week after the onset of measles. The headaches were severe enough to make him stop whatever he was doing and run to lie down. They occurred every day or two and lasted from three hours to a day. There was occasional nonprojectile emesis. He received pills (nature unknown) for the pain but obtained no relief. After two weeks,