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Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018

BACKGROUND: Case fatality ratio (CFR) among all age groups during the 2016–2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles. METHODS: Nati...

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Autores principales: Donadel, Morgane, Stanescu, Aurora, Pistol, Adriana, Stewart, Brock, Butu, Cassandra, Jankovic, Dragan, Paunescu, Bogdan, Zimmerman, Laura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976682/
https://www.ncbi.nlm.nih.gov/pubmed/33740895
http://dx.doi.org/10.1186/s12879-021-05966-3
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author Donadel, Morgane
Stanescu, Aurora
Pistol, Adriana
Stewart, Brock
Butu, Cassandra
Jankovic, Dragan
Paunescu, Bogdan
Zimmerman, Laura
author_facet Donadel, Morgane
Stanescu, Aurora
Pistol, Adriana
Stewart, Brock
Butu, Cassandra
Jankovic, Dragan
Paunescu, Bogdan
Zimmerman, Laura
author_sort Donadel, Morgane
collection PubMed
description BACKGROUND: Case fatality ratio (CFR) among all age groups during the 2016–2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles. METHODS: National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged < 59 months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases (“cases”) and 250 non-fatal cases (“controls”) matched by age, sex, district of residence, and urban/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors. RESULTS: Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21 day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0–24.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4–35.3]). CONCLUSIONS: Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-05966-3.
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spelling pubmed-79766822021-03-19 Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018 Donadel, Morgane Stanescu, Aurora Pistol, Adriana Stewart, Brock Butu, Cassandra Jankovic, Dragan Paunescu, Bogdan Zimmerman, Laura BMC Infect Dis Research Article BACKGROUND: Case fatality ratio (CFR) among all age groups during the 2016–2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles. METHODS: National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged < 59 months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases (“cases”) and 250 non-fatal cases (“controls”) matched by age, sex, district of residence, and urban/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors. RESULTS: Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21 day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0–24.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4–35.3]). CONCLUSIONS: Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-05966-3. BioMed Central 2021-03-19 /pmc/articles/PMC7976682/ /pubmed/33740895 http://dx.doi.org/10.1186/s12879-021-05966-3 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Donadel, Morgane
Stanescu, Aurora
Pistol, Adriana
Stewart, Brock
Butu, Cassandra
Jankovic, Dragan
Paunescu, Bogdan
Zimmerman, Laura
Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
title Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
title_full Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
title_fullStr Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
title_full_unstemmed Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
title_short Risk factors for measles deaths among children during a Nationwide measles outbreak – Romania, 2016–2018
title_sort risk factors for measles deaths among children during a nationwide measles outbreak – romania, 2016–2018
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976682/
https://www.ncbi.nlm.nih.gov/pubmed/33740895
http://dx.doi.org/10.1186/s12879-021-05966-3
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