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1.
Adv Respir Med ; 88(3): 197-203, 2020.
Article in English | MEDLINE | ID: mdl-32706103

ABSTRACT

INTRODUCTION: Measles is a contagious disease that re-emerged among young adults as a consequence of suboptimal vaccination coverage. Since in the pre-vaccination era measles affected mainly children, little is known about measles-associated respiratory complications in adults. The aim of this study was to describe clinical and radiological findings in adults affected by measles who developed respiratory complications during a recent measles outbreak. MATERIAL AND METHODS: In this retrospective chart review-based study we analyzed data from patients admitted for measles from January to June 2018 to a large tertiary care hospital, in one of the main cities in the south of Italy. This city has been the country's heart of the epidemic with a high morbidity and mortality rate. RESULTS: Among 177 patients (mean age 26 ± 9 years), only 2 were vaccinated. Thirty patients (16.9%) had signs of pneumonia on chest radiography. Computed tomography scan showed the following abnormalities: centrilobular nodules (63%), ground-glass attenuation (63%), air-space consolidation (36%), pleural effusion (16%) and pneumothorax (10%). Five patients developed severe lung injury and hypoxemia requiring admission to Intensive Care Unit. Two young unvaccinated women with no past medical history died from acute respiratory failure. The death was sudden and unpredictable. CONCLUSIONS: Measles-associated pneumonia in unvaccinated young adults can cause severe respiratory impairment and death. Our findings support the need for a mandatory vaccination policy.

4.
Clin Infect Dis ; 2020 Jul 03.
Article in English | MEDLINE | ID: mdl-32619227

ABSTRACT

During a national measles outbreak in 2018-2019, the Tel Aviv District suffered a major upsurge of cases, with 413 patients reported. Among them, 100 (24%) were under the age of one, 92 (22%) patients were aged 12 months to 4 years, 47 (11%) were 5-18 years, 169 (41%) were aged 19-60 years, 5 (1%) patients were older than 61 years (born before 1957). Among all cases, 230 (56%) were part of the Ultra-Orthodox Jewish community, 55 (13%) were among undocumented African immigrants. Despite high vaccination coverage, sustained measles transmission occurred, owing in part to importations and numerous exposures in medical settings by a susceptible birth cohort. The Ultra-Orthodox Jewish community was particularly afflicted owing to its condense population, high birth rates and multiple exposures in crowded religious settings. This outbreak demonstrates the necessity of addressing immunity gaps as well optimal healthcare planning in order to prevent future outbreaks.

5.
Article in English | MEDLINE | ID: mdl-32605070

ABSTRACT

On 22 March 2019 the Thai Department of Disease Control (DDC) was notified that 16 workers, including Thai and Myanmar migrant workers, from two factories located in Nakhon Phathom Province, had presented with a fever with rash during the previous 2 weeks. Active case finding was conducted among workers in both factories using face-to-face interviews. Suspected cases were defined as a worker who developed fever with rash with one of the following symptoms: cough, coryza or conjunctivitis. Testing for measles IgM antibodies and viral identification through throat swabs by polymerase chain reaction (PCR) were performed to confirm diagnosis. Vaccination history among cases was reviewed. Nationality and age-specific attack rates (AR) were calculated. An environmental study and a social network analysis were conducted to better understand the transmission process. A total 56 cases (AR = 0.97%) were identified. Of 21 serum measles IgM collected, 8 (38.0%) were positive. Of 8 throat swabs collected, 5 (62.5%) were positive for measles genotype D8. The disease attack rate in migrant employees was twice as large as the rate in Thai counterparts (AR = 0.7 and 1.4%). The first case was identified as a Myanmar worker who arrived in Thailand two weeks prior to his illness. The Myanmar workers' accommodation was more crowded than that for Thai workers. The hot spots of transmission were found at a drinking water tank which had shared glasses. Among the cases, 62.5% could not recall their vaccination history, and 25% had never had an injection containing a measles vaccination. The majority of migrant cases had never completed a two-dose measles vaccination. To halt the outbreak, measles vaccines were administered to the employees, particularly those working in the same sections with the cases and shared glasses were removed. For future policy action, a vaccination program should be incorporated into the work permit issuance process.

6.
BMC Infect Dis ; 20(1): 496, 2020 Jul 11.
Article in English | MEDLINE | ID: mdl-32652942

ABSTRACT

BACKGROUND: Despite high overall population vaccine coverage, identified clusters of persons refraining from vaccination interfere with pursued measles elimination. Clinical diagnosis of measles is often obvious due to its typical rash. Yet, febrile rashes may occur during many viral infections. Misdiagnosis of a specific primary viral infection may have severe consequences, particularly in immunocompromised subjects or pregnant women. To our knowledge, this case presentation is the first description of a measles and parvovirus B19 coinfection outbreak. Analysis of this outbreak underlines rash diagnosis difficulties and potential serology interpretation pitfalls. This case report is helpful for the clinicians in the context of measles re-emergence and proposes several methods to improve the diagnosis approach. CASE PRESENTATION: We investigated an outbreak of rash in 6 out of 8 Traveler family members presenting to Rennes University Hospital (West of France). Anti-B19V and measles IgM/IgG antibodies were measured and detection of Parvovirus B19 and measles virus genomes were done on blood and/or respiratory samples. Virological investigations finally documented 6 cases of parvovirus B19 infections, including 4 associated with measles. Interestingly, in the four coinfection cases, the rash was typical of B19V primary infection for the two children but typical of measles for the two adults. Clinical diagnosis of rash may be misleading and thorough virological investigations may be required to avoid misdiagnosis. CONCLUSIONS: This investigation first reports an intra-familial outbreak of MeV/B19V coinfections highlighting the high transmissibility of both viruses and the diagnostic challenges of dual rash-associated infections. This report also underlines the potential deleterious consequences of failure to identify measles cases, especially in a community with low vaccination coverage.

7.
Pediatr Infect Dis J ; 39(8): e209-e211, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32675758

ABSTRACT

During local small measles outbreak in Japan, 3 adolescents with febrile skin rash suspected as having measles were diagnosed with primary human herpesvirus (HHV)-7 infection. Primary HHV-7 infection can cause exanthem subitum in not only young children but also adolescents. HHV-7 should be considered as a possible causative agent for adolescent febrile skin rash during the measles outbreak.

8.
BMJ ; 369: m2219, 2020 Jun 04.
Article in English | MEDLINE | ID: mdl-32499215
11.
Sci Adv ; 6(22): eaaz4037, 2020 May.
Article in English | MEDLINE | ID: mdl-32548250

ABSTRACT

In 2018-2019, New York City experienced the largest measles outbreak in the United States in nearly three decades. To identify key contributing factors, we modeled the transmission dynamics of this outbreak. Results indicate that delayed vaccination of 1- to 4-year-olds enabled the initial spread and that increased infectious contact, likely via "measles parties," facilitated later transmission. We found that around half of infants were susceptible by age 1 and thus had many infections. Without the implemented vaccination campaigns, numbers of infections and hospitalizations could have been >10 times higher and would predominantly affect those under 4. These results suggest that a first vaccine dose before age 1 and the second dose before age 4 could allow parents to vaccinate and protect children more effectively should a high level of vaccine hesitancy persist. Enhanced public health education is needed to reduce activities that unnecessarily expose children to measles and other infections.

13.
Pan Afr Med J ; 35: 84, 2020.
Article in English | MEDLINE | ID: mdl-32537087

ABSTRACT

Introduction: In October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes the epidemiology of the outbreak and determines public health implications for measles elimination in Madagascar. Methods: Data have been collected using line list developed for the outbreak. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M (IgM) antibody. Results: A total of 2,930 samples were analysed in the laboratory among which 1,086 (37%) were laboratory confirmed. Measles cases age ranged from a minimum of 1 month to a maximum of 88 years. The median and the mean were 7 years and 9 years respectively. Children between 1 to 9 years accounted for 50.6% of measles cases. Attack rate (39,014 per 1,000,000 inhabitants) and case fatality rate (1.2%) were highest among children aged 9-11 months. A total of 67.2% cases were unvaccinated. As of March 14th, 2019, all the 22 regions and 105 (92%) health districts out of 114 were affected by the measles outbreak in Madagascar. Conclusion: Measles outbreak in Madagascar showed that the country is not on the track to achieve the goal of measles elimination by 2020.

14.
J Hosp Infect ; 2020 Jun 13.
Article in English | MEDLINE | ID: mdl-32544506

ABSTRACT

A measles outbreak in London is described, involving 34 cases across two hospitals and a local community across two countries. After a single introduction to hospital, spread propagated via unvaccinated retail shop workers to healthcare staff, highlighting the importance of expanding occupational health policies to non-clinical hospital staff. Further spread into an under-vaccinated Traveller community is a reminder that measles can spread in the absence of herd immunity. Subsequently endemic measles transmission has been re-established in the UK.

15.
Virulence ; 11(1): 686-694, 2020 12.
Article in English | MEDLINE | ID: mdl-32507005

ABSTRACT

A large measles epidemic has been ongoing in Romania and many European countries, since 2016. We report case-based surveillance data for all patients (n = 1371) with laboratory-confirmed and epidemiologically-confirmed measles hospitalized in a major infectious diseases hospital in Bucharest Romania during the first three years of the current measles epidemic (July 2016-July 2019). More than half of the patients (57.6%) had ages below 5 years; 6% (n = 82) had preexisting comorbidities. Only 1.5% of the patients had been fully vaccinated, 5.9% had received only one vaccine dose, while 92.8% had not been vaccinated at all against measles. The rate of measles-related complications was 93.4%; complications occurred more frequently among patients who were not eligible for vaccination due to young age or underlying diseases, and among children, who developed pneumonia and enterocolitis more frequently than adults. The median hospital length-of-stay was 6 days. Eight cases (0.6%) required intensive care and mechanical ventilation, and three deaths (0.2%) were recorded. Measles disproportionately affects patient groups who are not eligible for vaccination. During the current epidemic in Romania, 98.5% of the patients hospitalized for measles had not been vaccinated and among these, 75.7% would have been eligible for vaccination. For the remaining pool of unvaccinated children, supplementary immunization activities are urgently needed.

16.
BMC Infect Dis ; 20(1): 398, 2020 Jun 05.
Article in English | MEDLINE | ID: mdl-32503450

ABSTRACT

BACKGROUND: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. METHODS: We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. RESULTS: We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient's onset (ORadj = 34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an "isolation" ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. CONCLUSIONS: This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.


Subject(s)
Measles/diagnosis , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , Cross Infection/diagnosis , Disease Outbreaks , Female , Hospitals, Pediatric , Humans , Immunoglobulin M/blood , Infant , Male , Measles/epidemiology , Morbillivirus/immunology , Uganda/epidemiology , Vaccination Coverage
17.
Econ Hum Biol ; 38: 100871, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32521477

ABSTRACT

This paper explores the effects of a measles outbreak on vaccination uptake in Austria, using administrative data with individual-level information on childhood vaccinations. I define a treatment group of children affected by the outbreak, and compare them with a control group of earlier-born children who are unaffected. Twelve months after the outbreak, the vaccination rate of the treatment group is 2.5 (first dose of the measles, mumps and rubella vaccine) and 4 (second dose) percentage points higher than the corresponding rates of the control group. The results do not indicate that families at increased risk respond more strongly, suggesting that the outbreak changed the perceived value of vaccinations across the whole population. Findings also reveal heterogeneity in the response of families based on the parents' level of education, indicating that parents with higher education levels absorb new information more rapidly.

18.
Vaccine ; 38(32): 4996-5001, 2020 Jul 06.
Article in English | MEDLINE | ID: mdl-32535017

ABSTRACT

OBJECTIVES: In August 2016, a measles outbreak at Kansai International Airport was the first workplace measles outbreak since Japan was verified as having achieved measles-elimination status in March 2015. We investigated this outbreak with a focus on evaluating the ability of vaccinated individuals to transmit measles virus (MV). METHODS: We considered a case of laboratory-confirmed measles with onset between August 9 and September 29, 2016, among workers of Kansai International Airport. History of vaccination status with measles-containing vaccine (MCV) was confirmed by reviewing records. The potential sources of each MV infection were assessed by interviewing each infected worker about the clinical course of their infection and their behavioral history. RESULTS: Of 30 affected ground crews identified, 16 (53%) were vaccinated with ≥ 1 dose of MCV, 2 (7%) were unvaccinated, and 12 (40%) had an unknown vaccination status. The index case, a patient with classical measles with unknown vaccination status, presumably transmitted MV to all the subsequent 29 cases. The majority of patients (23, 77%; 15 vaccinated, 8 in unknown vaccination status) were diagnosed with modified measles due to mild illness. Modified measles were characterized clinically by signs of catarrh (4/23, 17%) in a few cases, with a median incubation period of 16 (range, 11-21) days. No onward transmission from vaccinated cases was suggested. An overseas traveler who visited the airport with measles symptoms was identified as the possible primary source of this outbreak. CONCLUSIONS: The low MV transmission ability of vaccinated individuals was reaffirmed. Contact tracing of vaccinated modified measles cases can be limited to a person at high risk of infection (e.g., households, person with immunosuppression). To maintain measles-elimination status, completing two doses of MCV should be ensured, especially for international travelers and for those who are frequently exposed to these travelers, such as airport workers.

19.
Epidemiol Serv Saude ; 29(3): e2018208, 2020.
Article in English, Portuguese | MEDLINE | ID: mdl-32428068

ABSTRACT

OBJECTIVE: to report on Family Health Strategy action at a Primary Health Care Unit in addressing the measles epidemic in Fortaleza, CE, Brazil. METHODS: the actions were carried out between September 2013 and December 2015; nineteen suspected measles cases were registered, three of which were confirmed: two children under 1 year old and one 27-year-old man. RESULTS: 16,726 people between 5 and 29 years old were vaccinated, vaccination coverage in the target population was 82.6%; 101% coverage was achieved among children aged 5 to 11 and 76.8% coverage of people aged 12 to 29. CONCLUSION: the strategies used contributed to achieving the vaccination coverage target in the target population, resulting in the population registered in the Health Unit catchment area falling into the category of low risk of measles transmission.

20.
Pan Afr Med J ; 35(Suppl 1): 2, 2020.
Article in English | MEDLINE | ID: mdl-32373253

ABSTRACT

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

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