High number of hospitalisations and non-classical presentations: lessons learned from a measles outbreak in 2017, Belgium

Abstract

We describe and analyse an outbreak of measles that affected Belgium early 2017. In total, 289 cases were reported, mostly (53%) in people 15 years or older. For 133 (46%) vaccination status was unknown and a further 117 (41%) were not vaccinated. According to national guidelines, 83 of the unvaccinated cases (29% of total cases) should have received minimum one dose of vaccine, but did not. One in five cases (21%) did not present with the classical triad of fever, rash and any of coryza, conjunctivitis or cough. Rash was the most sensitive symptom, being absent in only six cases. A large proportion of cases (125/289, 43%) required hospitalisation. In hospitalised patients, the most commonly observed complications were hepatic disorders (present in 58/125 hospitalised patients, 46%). Thirty-six of the cases (12%) were in healthcare workers and nosocomial spread contributed importantly to the outbreak. Older age at presentation, altered clinical presentations and presence of complications like hepatitis can delay the correct diagnosis of measles. Clinicians should maintain a high index of suspicion in any individual presenting with rash. If the elimination target is to be reached, catch-up vaccination campaigns should be intensified and target young adults and health care workers.

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

“…Similar challenges had occurred in recent measles outbreaks in other countries [ 10 , 11 ]. In addition, delays could be explained by the fact that several children did not present with the classic triad of symptoms and were at the beginning managed to a different direction [ 4 , 12 , 13 ].…”

Measles in Romania – clinical and epidemiological characteristics of hospitalized measles cases during the first three years of the 2016-ongoing epidemic

“…When comparing our data with a study that looked at a limited number of participants in the USA (n = 33), we found lower rates of bacterial pneumonia (12.2% in our study compared to 30% reported by Hester et al) and otitis media (4.4% compared to 42%), but a longer duration of hospital stay (a median of 6 days compared to a median of 3.7 days reported by Hester et al) [ 22 ]. When comparing our data with the concurrent 2017 measles outbreak in Belgium (n = 125), the patients from our study had lower rates of cytolysis (19.0% compared to 46%), bacterial pneumonia (12.2% vs. 16%) and acute encephalitis (0.4% vs. 3%), a similar rate of otitis media (4.4% vs. 4%), and a higher rate of enterocolitis (44.4% vs. 30%), while the duration of hospital stay was comparable (6 days vs. 5 days) [ 23 ].…”

Evolving measles status and immunization policy development in six European countries

“… 74 Thereafter from 2012 to 2016 case numbers declined, and then a substantial outbreak involving 289 cases developed in Wallonia from late-December 2016 through May 2017. 75 , 76 Imported cases (from Romania) were linked to 51 cases. 75 , 76 The majority of cases were either unvaccinated (40%) or with unknown vaccination status (46%).…”