[Measles outbreak in the adult age group: evaluation of 28 cases]

Nowadays, the age group affected from measles has widened and the disease has become more common among adolescents and young adults. The number of measles case reports have increased in our country, particularly from 2010-2011, and measles outbreaks occurred in various regions in 2012 and 2013. The aim of this study was to analyze the demographical and epidemiological characteristics, clinical and laboratory findings, and complications of adult patients with measles who were affected during the outbreak. A total of 28 patients (25 male, 3 female; age range: 19-39 years, median age: 24) who were hospitalized and followed-up in our clinic between January 2013 and June 2013, were evaluated. In the serum sample of the index case, measles-specific IgM antibodies were detected by ELISA, and measles virus RNA by real-time polymerase chain reaction (RT-PCR), then genotyping was performed to detect the epidemiological relationship. In all of the other cases, measles IgM and IgG antibodies were screened by ELISA. The most common symptoms on admission included high fever (n= 28, 100%), malaise (n= 25, 89%), sore throat (n= 25, 89%), headache (n= 20, 71%) and cough (n= 18, 64%). At physical examination, rash (n= 28, 100%), lymphadenopathy (n= 11, 39%) and conjunctivitis (n= 10, 36%) were in the foreground, and Koplik spots were detected in five (18%) cases. The most common laboratory findings were; increased level of C-reactive protein (n= 15, 54%), leukopenia (n= 12, 43%) and increased serum levels of aminotransferases (n= 12, 43%), and thrombocytopenia was detected in five (18%) patients. One or more complications (secondary bacterial pneumonia in 5, diarrhea in 4, hepatitis in 3 and otitis in 2 cases) developed in the eight (29%) patients. Measles RT-PCR and IgM tests yielded positive results for the index case, and the isolate was identified as D8 strain by genotyping. Measles lgM antibodies were also positive in all of the other cases. The hospitalization period was estimated as 3-7 days (median: 5 days), while all the patients were discharged with recovery. It appeared that, our index case had come from a troop in Amasya province three days ago and he had a history of contact with suspected measles patients. In addition, the D8 strain determined in the index case was found to be related with the strain that caused the outbreak in Amasya province. Of the cases, 20 (71.4%) were military personnel, and eight (28.6%) were civilian who had histories of contact with military personnel. Regardless of immunity status in the outbreak period, all of the healthcare staff in our hospital, especially in risky departments, was recommended to be vaccinated. Personnel vaccination was provided at a high rate, however nosocomial transmission occurred in two unvaccinated cases. In conclusion, measles is an important health problem, especially in the adult age group, because of the complications and labour loss. For outbreak management; the awareness of health personnel should be increased following the identification of index case, proper isolation measures should be taken for the hospitalized patients, and routine reporting should be carried out timely and accurately.