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Measles Outbreak in a High-Income Country: Are Pediatricians Ready?
Andrea Lo Vecchio1, Carlotta Montagnani2, Andrzej Krzysztofiak3
1Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Florence.
Background:
Measles is a highly communicable infection with potentially severe complications. It is rarely reported in high-income countries and the limited awareness and experience of pediatricians may result in misdiagnosis. The present study aimed at investigating physician's ability and timing to reach diagnosis during a recent outbreak in Italy.
Methods:
The Italian Society for Pediatric Infectious Diseases conducted a retrospective, multicenter study in children hospitalized for measles between 1 January 2016 and 30 August 2017 in secondary and tertiary care hospitals. The appropriateness of diagnosis at admission, the time to reach clinical diagnosis, and serological confirmation of measles were recorded.
Results:
At hospital admission, measles was misdiagnosed in 101 (40.5%) of the 249 children (median age, 14.5 months) enrolled. The appropriate diagnosis increased from 30% to 72.5% during the period of observation (P < .001). A greater chance of receiving an appropriate diagnosis was demonstrated in children who reported a contact with measles (odds ratio [OR], 5.2; 95% confidence interval [CI], 3.0-9.2) or in those seen in institutions that managed more cases (OR, 7.39; 95% CI, 3.22-16.9; P = .0001). In contrast, children with underlying chronic conditions had a higher risk of misdiagnosis (appropriate diagnosis OR, 0.19; 95% CI, 0.10-0.33). The mean time from the onset of symptoms to clinical diagnosis was 4.55 ± 2.2 days and to serological confirmation was 7.0 ± 3.4 days.
Conclusions:
Measles is frequently misdiagnosed in low-prevalence settings. Specific measures to increase pediatricians' awareness about vaccine-preventable infections need to be implemented.
Insights
Measles is often misdiagnosed in high-income countries. Increased pediatrician awareness of vaccine-preventable diseases like measles is crucial for timely and accurate diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Measles is a highly contagious viral illness with severe potential complications.
- Low prevalence in high-income nations leads to reduced pediatrician experience and potential for misdiagnosis.
- A recent measles outbreak in Italy prompted an investigation into diagnostic accuracy.
Purpose of the Study:
- To investigate the diagnostic accuracy and timeliness of measles diagnosis by physicians during a recent outbreak in Italy.
- To identify factors influencing the correct and timely diagnosis of measles in pediatric patients.
Main Methods:
- A retrospective, multicenter study was conducted by the Italian Society for Pediatric Infectious Diseases.
- Data were collected on children hospitalized with measles between January 2016 and August 2017.
- Key metrics included diagnosis appropriateness at admission, time to clinical diagnosis, and serological confirmation.
Main Results:
- Measles was misdiagnosed in 40.5% of 249 hospitalized children at admission.
- Appropriate diagnosis rates improved significantly over the study period (30% to 72.5%).
- Factors associated with correct diagnosis included known measles contact and higher case volume in the institution; chronic conditions increased misdiagnosis risk.
Conclusions:
- Measles diagnosis is frequently incorrect in low-prevalence settings, highlighting a need for improved physician awareness.
- Implementing targeted educational strategies for pediatricians on vaccine-preventable infections is recommended.
- Timely diagnosis is critical, with mean times of 4.55 days to clinical diagnosis and 7.0 days to serological confirmation.
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