Measles Outbreak in Macedonia: Epidemiological, Clinical and Laboratory Findings and Identification of Susceptible Cohorts

Abstract

ObjectivesDespite a 92-99% national vaccination coverage since 2000, the former Yugoslav Republic of Macedonia experienced a large measles outbreak between 2010 and 2011. Here we investigate the characteristics of patients hospitalized during this outbreak at the Clinic of Infectious Diseases in Skopje.MethodsEpidemiological, clinical and laboratory data of 284 measles patients, including 251 from Skopje (43.80% of the 573 reported cases) and 33 from elsewhere in Macedonia were collected.ResultsThe most affected age groups were children up to 4 years of age and adolescents/adults of 15 years and older. Most patients were unvaccinated (n=263, 92.61%) and many had non-Macedonian nationalities (n=156, 54.93%) or belonged to the Roma ethnicity (n=73, 25.70%). Bronchopneumonia and diarrhea were the most common complications. Eighty-two out of 86 tested patients (95.35%) had measles-specific IgM antibodies. The outbreak was caused by the measles variant D4-Hamburg.ConclusionsThe epidemic identified pockets of susceptibles in Skopje and indicated that additional vaccination opportunities in particular for people with non-Macedonian nationality and traveler communities are warranted to ensure efficient measles control in Macedonia. The high attack rate among children of less than 1 year suggests that vaccination before 12 months of age should be considered in high risk settings.

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

“…In our setting, a significant number of children with measles developed complications (39.8%). These results are similar to those described in other European countries which experienced large measles outbreaks in the same time period [ 12 , 17 , 29 , 31 ]. Complications were more common in younger children especially regarding respiratory system involvement, acute otitis media, bronchiolitis or neutropenia, whereas older children usually presented with dehydration and thrombocytopenia.…”

“…Regarding laboratory parameters of hospitalized children with measles, there was a significant number of children with mild (26%) or severe (3.8%) hyponatremia at presentation, a finding that is not regularly described. Elevated transaminases were detected in 40.6% of measles cases, which was also found in other studies [29,31].…”

“…This wide range of hospitalization rates worldwide may be related to differences in management and surveillance systems, health policies and the affected age groups. The relatively high hospitalization rate in our study may possibly reflect under-reporting of mild cases or that children with a higher risk of complications and with more severe symptoms were more likely to seek medical care [ 4 , 31 ].…”

“…Complications were more common in younger children especially regarding respiratory system involvement, acute otitis media, bronchiolitis or neutropenia, whereas older children usually presented with dehydration and thrombocytopenia. Different results regarding complication rates by age group have been described depending on the country [ 16 , 17 , 31 ].…”

Resurgence of measles in Serbia 2010–2011 highlights the need for supplementary immunization activities

“…An efficient vaccine conferring long-lasting protection against measles has been available since the 1960s [3]. Measles was a typical childhood disease in the pre-vaccination era, but at present measles also affects non-immunized adolescents and adults, and international travellers [4–7].…”