Risk factors for mortality among admitted children with complications of measles in Pakistan – an observational

Aurangzeb, Brekhna; Fatmee, Areesh; Waris, Rehmana; Haider, Nighat; Berjees, Asma; Raza, Syed Hashim

doi:10.47391/jpma.977

Cited by 5 publications

(5 citation statements)

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“…[24][25][26][27][28] A study from Pakistan reported that 63% measles patients had pneumonia. 29 We found relatively higher rates of complications development among current set of children with measles. This could have been due to the fact that during COVID pandemic, people were hesitant to head to hospitals and that could have caused a delay in management of measles, allowing more patients to develop complications before heading to a healthcare facility.…”

Section: Discussionmentioning

confidence: 57%

The spectrum of measles in COVID-19 pandemic; An observational study in children.

Payal Bai,

Muhammad Salik,

Heena Rais

et al. 2023

TPMJ

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Objective: To assess the spectrum of measles during COVID-19 era among children. Study Design: Cohort study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari Karachi. Period: February 2019 to February 2021. Material & Methods: Clinically diagnosed measles children of either gender aged between 3 months to 5 years admitted to our tertiary care center in the 2 years marked period of the study were analyzed. Measles was labeled as the presence of high grade fever (>104 0F) and maculopapular rash. Medical history was noted and clinical examination was performed in all children. Necessary laboratory investigations like complete blood count and chest X-rays (CXR) were evaluated. All patients were treated as per standard institutional protocols. Outcomes were noted in terms of successful discharge or expiry. Results: In a total of 88 children, 55 (62.5%) were male. The mean age was 1.61±1.12 years while 49 (55.7%) children were aged ≤ 1 year. Twenty four (27.3%) children were fully vaccinated appropriate to their age. Fever and rash were found among all children (100%) while respiratory distress and coryza were reported by 82 (93.2%) and 51 (58.0%) children respectively. Overall duration of hospitalization was 7.02±2.32 days. Mortality was reported in 11 (12.5%) children while 76 (86.4%) children were successfully discharged. Development of acute respiratory distress (p=0.0011) and shock (p<0.0001) proved to have significant association with mortality. Conclusion: Mortality was relatively high among children with measles during the COVID-19 pandemic era. During hospitalization, most frequent complications were pneumonia, and eye and/or mouth related complications. Development of acute respiratory distress and shock proved to have significant association with mortality.

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Section: Discussionmentioning

confidence: 57%

The spectrum of measles in COVID-19 pandemic; An observational study in children.

Payal Bai,

Muhammad Salik,

Heena Rais

et al. 2023

TPMJ

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“…Joshi and colleagues [ 18 ] showed that in Nepal in 2004, persons with measles who were stunted had an increased relative risk (RR: 5.34 [2.31–12.36]) of death compared with persons who were not stunted. Among persons hospitalized with measles in Pakistan from 2013 to 2017, Aurangzeb and colleagues [ 28 ] estimated that there was an increased odds (OR: 6.8 [3.24–14.26]) of death among those who were stunted compared to those who were not stunted.…”

Section: Resultsmentioning

confidence: 99%

“…In South Africa from 2009 to 2010, le Roux and colleagues [ 33 ] showed that there was an association between overall weight-for-age and measles case fatality. Also, among persons hospitalized with measles in Pakistan from 2013 to 2017, Aurangzeb and colleagues [ 28 ] noted that there was an increased odds (OR: 2.93 [1.44–5.93]) of death among measles cases who were underweight compared to those who were not underweight. Coetzee and colleagues [ 34 ] showed that among pediatric hospitalized measles patients in an intensive care unit in South Africa in 2014, underweight persons had an increased relative risk (RR: 2.77 [1.38–5.55]) of death compared to persons who were not underweight.…”

Section: Resultsmentioning

confidence: 99%

“…During an outbreak in the Democratic Republic of the Congo in 2013, Gignoux and colleagues [ 21 ] noted a decreased relative risk (RR: 0.2 [0.1–0.3]) of death among children with measles who were previously vaccinated with at least two doses of MCV (compared to those that were previously unvaccinated or had only received one dose). Aurangzeb and colleagues [ 28 ] showed that in Pakistan from 2013 to 2017, children with measles that were previously unvaccinated had an increased relative risk (RR: 7.0 [2.03–24.01]) of death compared to those who had received at least two doses of any MCV; additionally, children with measles that had previously only had one dose had an increased relative risk (RR: 5.73 [1.49–22.07]) of death compared to those who had received at least two doses of any MCV.…”

Section: Resultsmentioning

confidence: 99%

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Population-Level Risk Factors Related to Measles Case Fatality: A Conceptual Framework Based on Expert Consultation and Literature Review

Sbarra,

Jit,

Mosser

et al. 2023

Vaccines

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A better understanding of population-level factors related to measles case fatality is needed to estimate measles mortality burden and impact of interventions such as vaccination. This study aimed to develop a conceptual framework of mechanisms associated with measles case fatality ratios (CFRs) and assess the scope of evidence available for related indicators. Using expert consultation, we developed a conceptual framework of mechanisms associated with measles CFR and identified population-level indicators potentially associated with each mechanism. We conducted a literature review by searching PubMed on 31 October 2021 to determine the scope of evidence for the expert-identified indicators. Studies were included if they contained evidence of an association between an indicator and CFR and were excluded if they were from non-human studies or reported non-original data. Included studies were assessed for study quality. Expert consultation identified five mechanisms in a conceptual framework of factors related to measles CFR. We identified 3772 studies for review and found 49 studies showing at least one significant association with CFR for 15 indicators (average household size, educational attainment, first- and second-dose coverage of measles-containing vaccine, human immunodeficiency virus prevalence, level of health care available, stunting prevalence, surrounding conflict, travel time to major city or settlement, travel time to nearest health care facility, under-five mortality rate, underweight prevalence, vitamin A deficiency prevalence, vitamin A treatment, and general malnutrition) and only non-significant associations for five indicators (antibiotic use for measles-related pneumonia, malaria prevalence, percent living in urban settings, pneumococcal conjugate vaccination coverage, vitamin A supplementation). Our study used expert consultation and a literature review to provide additional insights and a summary of the available evidence of these underlying mechanisms and indicators that could inform future measles CFR estimations.

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“…Almost every organ in the body is destructed by measles due to damage to mucosal membranes and transitory and profound immunosuppression. This may persist for months following measles, causing complications and may prove fatal 4 . Nonimmunization, overcrowding, malnutrition, immunological deficiency, vitamin A deficiency, infection at a young age, lack of healthcare facilities, severe consequences of measles viz pneumonia and encephalitis, are among the prominent risk factors.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Measles Related Complications in Hospitalized Children

Ullah¹,

Muhammad²,

Ullah³

et al. 2023

PJMHS

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Background: Measles is a highly contagious viral infection, highly prevalent in children, clinically associated with complications of nervous, respiratory and digestive systems, with significant morbidity and mortality rate in the developing countries. Objectives: The study was aimed to determine the frequency of measles-related complications in hospitalized children. Methods: The study was conducted in tertiary care hospital of District Dera Ismail Khan, from February 2022 to November 2022, including 212 children affected with measles. Results: Most of the affected children (p<0.05) were infants of age group less than 2 years (45.28%), and males (63.67%) were at higher risk (p<0.05) as compared to the females (36.32%). Significantly higher proportion (p<0.05) of rural kids were affected with measles (58.96%) than urban. Most of the affected children (p<0.05) were not immunized (93.86%; 199/212), and the disease was significantly associated (p<0.05) with the nutritional, socioeconomic, immunization status of the patients. Different complications like pneumonia (31.13%), gastroenteritis (19.33%), conjunctivitis (17.45%), otitis media (7.07%) and encephalitis (2.35%), while 22.64% (42/212) were also observed and six of the 212 patients died of the infection. Conclusion: A huge proportion of patients contracted the disease due to the absence of vaccination measures and the disease was associated fatal secondary complications. Therefore, the government must encourage immunization against this extremely contagious but preventable infection in the children. Keywords: Complications; Encephalitis; Immunization; Measles; Pneumonia.

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Risk factors for mortality among admitted children with complications of measles in Pakistan – an observational

Cited by 5 publications

References 0 publications

The spectrum of measles in COVID-19 pandemic; An observational study in children.

The spectrum of measles in COVID-19 pandemic; An observational study in children.

Population-Level Risk Factors Related to Measles Case Fatality: A Conceptual Framework Based on Expert Consultation and Literature Review

Frequency of Measles Related Complications in Hospitalized Children

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