Risk factors for severe complications and mortality among hospitalized children with measles during a major outbreak in Northern Vietnam, 2017 - 2019

Abstract

Introduction: Measles outbreaks increased worldwide during the period of 2017-19. Similarly, Vietnam experienced one of the largest measles outbreaks in recent decades, with various paediatric patients presenting severe complications. In this study, we aim to identify factors associated with death and severity among children with measles admitted to Vietnam National Children's Hospital between 2017 and 2019. Method: This single-center retrospective cohort study included 2072 patients with measles admitted from 1/1/2017 to 31/12/2019. Data on epidemiological, clinical characteristics, vaccine status, and outcomes were collected and summarised. We conducted both univariable and multivariable logistic regression analyses to examine the correlations between various characteristics of hospitalized children and mortality. Findings: In total, there were 2072 patients, including 1297 (62.6%) males and 775 (37.4%) females. The median age was 9 months (interquartile range 7 - 17). 87.3% of cases were reported not to have received any MCV. 30 (1.4%) patients died, with 40% aged less than 9 months. Only 3 among 30 (10%) children had received at least 1 dose of MCV deceased. Pneumonia bronchitis was the most common complication, occurring in 1413 (68.2%) patients. The following characteristics were significantly associated with mortality in the multivariable analysis: age under 9 months and age from 9 months to 5 years, residing 20 to 200 kilometres from VNCH, and having adenovirus or other healthcare-related infections. Age group was also significantly associated with severity in the multivariable analysis. Interpretation: Vietnam continues to face the threat of future measles epidemics, given the burden of hospitalization and the high rate of complications observed in hospitalized patients. This highlights the critical need to maintain high measles vaccine coverage, particularly by targeting the unvaccinated population. To prevent future outbreaks and lower measles incidence, routine immunization needs to be strengthened, and earlier scheduling of MCV1 needs to be further evaluated. The comprehensive analysis of the 2017-19 measles outbreak presented in this study will contribute to informed decision-making regarding appropriate measures to counteract future resurgences of measles in Vietnam. Funding: No specific grant from funding agencies in the public, commercial or not-for-profit sectors supported the submission and publication of this manuscript.