Measles-related hospitalizations and associated complications in Jerusalem, 2018–2019

Abstract

Objectives: The 2018 measles outbreak in Israel affected >2000 people in Jerusalem. The aim of the study was to describe clinical features and complications of hospitalized measles patients in Jerusalem, as related to age group and risk factors. Methods: All individuals hospitalized with measles in the three main hospitals in Jerusalem during March 2018 to February 2019 were included. Demographic, clinical and laboratory data were analysed. Results: Of 161 hospitalized individuals, 86 (53.4%) were <5 years old, 16 (10%) were 5 years but <20 years old, and 59 (36.6%) were 20 years old. Most, 114/135 (85%), were unvaccinated. Immunocompromised state was identified in 12/161 (7.5%) patients, 20/161 (12.4%) had other underlying comorbidities, and four were pregnant. Hypoxaemia on admission was a common finding in all age groups. Hepatitis was more common among adults 20 years old (33/59, 59%). Measles-related complications were noted in 95/161 (59%) patients, and included pneumonia/pneumonitis (67/161, 41.6%), which was more common in young (<5 years) children, diarrhoea (18/161, 11.2%), otitis (18/161, 11.2%), and neurological complications (6/161, 3.7%)dthe latter occurring more frequently in the 5-to 20-year age group. Two of the 12 immunocompromised patients died of measles-related complications. A high readmission rate (19/161, 11.8%) within 3 months was documented among hospitalized measles patients. Conclusion:The burden of hospitalization, as well as the high rate of short-and long-term complications observed in hospitalized patients, underscore the importance of maintaining a high measles vaccine coverage, with enhanced targeting of unvaccinated population pockets.

Clinical characteristics and outcomes of measles outbreak in adults: A multicenter retrospective observational study of 93 hospitalized adults in Greece

“…Pneumonitis is probably the most serious complication of measles. The prevalence of pneumonitis in our study (46.2 %) was slightly higher than the one recently reported in Israel (30.5 %), in Serbia (26.8 %) and China (33 %), although the latter two studies included pediatric and adolescent cases that could have affected the pooled results [ 13 , 15 , 16 ]. Here, we show that male sex, older age, higher CRP and low lymphocyte counts are significantly associated with the presence of pneumonitis.…”

“…Hepatic involvement and pneumonitis frequencies were as high as 80.6 % and 46.2 % respectively. When compared to other recent studies including adults, our cohort was quite similar in terms of mean age, sex distribution, presenting symptoms and baseline laboratory findings [ 13 ]. Despite the high prevalence of pneumonitis in this study, case fatality rate remained low (1.1 %), possibly explained by the cohort’s characteristics (young previously healthy patients).…”

Measles Encephalitis: Towards New Therapeutics

“…During the acute phase of MeV infection, the patients develop several symptoms, including fever, cough, nasal congestion, characteristic erythematous maculopapular rash, conjunctivitis, and pathognomonic Koplik spots on oral mucosa. Diarrhea and vomiting are often observed in infected children during the disease [50,51] or appear as a complication following the disease [5,52]. Additionally, MeV infection leads to a strong immunosuppression that can last for several months and lead to severe secondary infections [53,54].…”

Notes from the Field: Large Measles Outbreak in Orthodox Jewish Communities — Jerusalem District, Israel, 2018–2019

“…During March 2018-May 2019, an outbreak of 4,115 measles cases occurred in Israel, following international importations, mainly from Ukraine. Approximately one half of the cases (2,202) occurred in residents of Jerusalem District, primarily in unvaccinated children in orthodox Jewish communities. The district's population (1.25 million, approximately 14% of the national population) is 70% Jewish, approximately one third of whom are orthodox Jews.…”

“…Cases were confirmed by reverse transcription-polymerase chain reaction testing or detection of measles-specific immunoglobulin M in 708 (32%) patients and by epidemiologic linkage in 1,494 (68%). Approximately 8% of patients (176) were hospitalized (2). Two deaths occurred, one in an unvaccinated child aged 18 months, and the second in an immunocompromised adult, aged 82 years.…”