An Update and Review of Measles for Emergency Physicians

Graber, Elise M. Alves; Andrade, Francisco J.; Bost, William; Gibbs, Michael

doi:10.1016/j.jemermed.2020.02.007

Cited by 16 publications

(59 citation statements)

References 5 publications

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“…More specifically, 98 (28.7%) children were treated with a single antibiotic, 17 (5%) with two antibiotics and 4 (1.2%) with three antibiotics. The most frequently used antibiotics were ampicillin/b lactamase inhibitor (37) and 3rd generation cephalosporin (35). Six (1.75%) children with gastrointestinal involvement (hematemesis, severe vomiting) were treated with PPIs, whereas 47 (13.7%) children with respiratory system involvement received nebulized bronchodilators.…”

Section: Resultsmentioning

confidence: 99%

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Measles epidemic in pediatric population in Greece during 2017–2018: Epidemiological, clinical characteristics and outcomes

et al. 2021

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Background and aim A measles outbreak occurred in Greece during 2017–2018 affecting mainly pediatric population. The aim of the study was to describe the epidemiological and clinical characteristics of the cases diagnosed in the major pediatric tertiary hospital of Athens, where 26.5% of national pediatric measles cases were diagnosed and treated. Methods This is a retrospective study of children 0–16 years old, who presented at the emergency department and/or were hospitalized with clinical presentation compatible with measles and diagnosis was confirmed with molecular detection of the measles RNA in pharyngeal swabs. Epidemiological, clinical and laboratory characteristics were retrieved from medical records and analyzed. Results A total of 578 children with measles were identified during the study period. 322 (55.7%) were male with median age 36 months (range:1–193), while the largest number of documented cases (251; 43.4%) were children aged 1–5 years. Most children (429/578; 74.2%) belonged to the Roma minority and only 64 (11.1%) had Greek origin. 497 (91.5%) children were unvaccinated and 37 (6.8%) were partially vaccinated with measles vaccine. Hospitalization was required for 342 (59.2%) children, whereas one or more complications were reported in 230 (67.2%) of them. Most frequent complications were elevated transaminases (139; 40.6%), acute otitis media (72; 21%), dehydration (67; 19.6%) and pneumonia (58; 16.9%). 11 children (3.2%) required intensive care admission for altered mental status/status epilepticus (3), sepsis (2) and ARDS (6). 119/342 (34.8%) children were treated with antibiotics because of possible or confirmed bacterial coinfection. One death was reported, concerning an 11-month-old unvaccinated infant, with underlying dystrophy, who died of sepsis. Conclusion Measles is not an innocent viral infection, as it is still characterized by high morbidity and complications rates. Unvaccinated or partially vaccinated populations could trigger new outbreaks, resulting in significant cost in public health. To avoid future measles outbreaks, high vaccination coverage should be achieved, as well as closing immunity gaps in the population and ensuring high-quality measles surveillance.

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Section: Resultsmentioning

confidence: 99%

“…All children who admitted in the Intensive Care Unit (ICU) were given IVIG and most of them also received vitamin A and ribavirin. Variable use of vitamin A in measles cases has been reported in different studies despite official recommendations [2,29,34,35].…”

Section: Plos Onementioning

confidence: 99%

Measles epidemic in pediatric population in Greece during 2017–2018: Epidemiological, clinical characteristics and outcomes

et al. 2021

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“…Humans are the only hosts for measles virus and there are no known animal reservoirs that maintain its circulation ( 7 ). Additionally, measles can be readily diagnosed through the typical clinical syndrome that includes fever and rash, and identified with the support of potential traveling history to endemic areas ( 16 ). These virological and epidemiological features contribute to the possibility of measles eradication.…”

Section: Discussionmentioning

confidence: 99%

Trends of the Global, Regional, and National Incidence of Measles, Vaccine Coverage, and Risk Factors in 204 Countries From 1990 to 2019

Wang

Jing

et al. 2022

Front. Med.

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BackgroundMeasles is a highly contagious disease that has caused global morbidity and mortality. Though great progress has been made in measles elimination, the resurgence of measles has been observed in recent years. As extant literature were mainly confined to data of local area, we conducted a systematic analysis to explore the trends of the incidence of measles, coverage rate, and the risk factors from 1990 to 2019 on global, regional, and national levels.MethodsData on cases of incidence, age standardized rate (ASR), vaccine coverage, and risk factors of measles were retrieved from the Global Burden of Disease (GBD) Study 2019 database. Estimated averaged percentage change (EAPC) of ASR was calculated to quantify the trends of measles incidence. Pearson correlation was applied to assess the association of EAPC and measles-containing vaccine coverage rate with socio-demographic index (SDI) in 2019, and the correlation between ASR and measles-containing vaccine coverage rate.ResultsGlobally, there was a significant decrease in the number (84.18%) and ASR (6.13%, 95% CI: 5.41–6.84%) of measles incidence from 1990 to 2019. More than 80% of incidence cases were attributed to children under 5 and the proportion was highest in low SDI region. Countries and territories with low ASRs are mostly clustered in North America, Southern Latin America, and Western Europe, whereas those with high ASRs are mainly clustered in Africa, East Asia, and South Asia. Lower SDI was associated with higher ASR and lower vaccine coverage rate. The more the SDI value was further away from 0.6, the smaller the absolute value did EAPC have. Child wasting accounted for the most measles-related death cases, followed by child underweight, child stunting, and vitamin A deficiency.ConclusionsMeasles eradication is feasible, but urgently demands political commitment, financial support, and public engagement. In the context of COVID-19 pandemic and the global resurgence of measles, surveillance systems and routine immunization programs should be improved, while vaccine hesitancy needs to be addressed.

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“…The COVID-19 pandemic has likely increased measles mortality – more than 20 countries have suspended measles vaccination and vitamin A supplementation campaigns as healthcare workers focus attention on COVID-19 leading to a surge in measles infections and mortality particularly in low income settings such as the DR Congo where measles has killed more than 6500 children and is still spreading 185 . Vitamin A is recommended mainly to reduce mortality 186 and risk of complications from pneumonia, croup and ocular problems 187 by correcting the low or depleted retinol levels resulting from measles infection. The treatment regimen consists of the administration of high dose vitamin A on two consecutive days.…”

Section: Vitamin Amentioning

confidence: 99%

Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review

James

Ali

Armitage

et al. 2020

Preprint

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Background: Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to COVID-19 infection, progression to symptoms, likelihood of severe disease and survival. The pandemic has fostered many nutrition-related theories, sometimes backed by a biased interpretation of evidence. Objectives: To provide a systematic review of the latest evidence on how malnutrition across all its forms (under- and over-nutrition and micronutrient status) may influence both susceptibility to, and progression and severity of, COVID-19. Methods: We synthesised information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity and diabetes; protein-energy malnutrition; anaemia; vitamins A, C, D, and E; poly-unsaturated fatty acids; iron; selenium; zinc; anti-oxidants, and nutritional support. For each section we provide: a) a landscape review of pertinent material; b) a systematic search of the literature in PubMed and EMBASE databases, including a systematic search of a wide range of pre-print servers; and c) a screen of six clinical trial registries. Two reviewers were assigned per section for data extraction. All original research was considered, without restriction to study design, and included if it covered: 1) SARS-CoV-2, MERS-CoV or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16th May and 11th August, 2020. PROSPERO registration CRD42020186194. Results: Across the 13 searches, a total of 2732 articles from PubMed and EMBASE, 4164 articles from the pre-print servers, and 433 trials were returned. A total of 288 published articles and 278 pre-print articles were taken to full text screening. In the final narrative synthesis, we cover 22 published articles, 39 pre-print articles and 79 trials. The review highlights a range of mechanistic and observational evidence to highlight the role nutrition can play in susceptibility and progression of COVID-19. However, to date, there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery, although results of clinical trials are eagerly awaited. Conclusions: To date there is no conclusive evidence supporting adoption of novel nutritional therapies. However, given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. There is strong evidence that prevention of obesity, and its consequent type-2 diabetes, will reduce the risk of serious COVID-19 outcomes.

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An Update and Review of Measles for Emergency Physicians

Cited by 16 publications

References 5 publications

Measles epidemic in pediatric population in Greece during 2017–2018: Epidemiological, clinical characteristics and outcomes

Measles epidemic in pediatric population in Greece during 2017–2018: Epidemiological, clinical characteristics and outcomes

Trends of the Global, Regional, and National Incidence of Measles, Vaccine Coverage, and Risk Factors in 204 Countries From 1990 to 2019

Could nutrition modulate COVID-19 susceptibility and severity of disease? A systematic review

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