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High number of hospitalisations and non-classical presentations: lessons learned from a measles outbreak in 2017,
L Cornelissen1, T Grammens1, S Leenen2
1Service of Epidemiology of Infectious Diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
Abstract:
We describe and analyse an outbreak of measles that affected Belgium early 2017. In total, 289 cases were reported, mostly (53%) in people 15 years or older. For 133 (46%) vaccination status was unknown and a further 117 (41%) were not vaccinated. According to national guidelines, 83 of the unvaccinated cases (29% of total cases) should have received minimum one dose of vaccine, but did not. One in five cases (21%) did not present with the classical triad of fever, rash and any of coryza, conjunctivitis or cough. Rash was the most sensitive symptom, being absent in only six cases. A large proportion of cases (125/289, 43%) required hospitalisation. In hospitalised patients, the most commonly observed complications were hepatic disorders (present in 58/125 hospitalised patients, 46%). Thirty-six of the cases (12%) were in healthcare workers and nosocomial spread contributed importantly to the outbreak. Older age at presentation, altered clinical presentations and presence of complications like hepatitis can delay the correct diagnosis of measles. Clinicians should maintain a high index of suspicion in any individual presenting with rash. If the elimination target is to be reached, catch-up vaccination campaigns should be intensified and target young adults and health care workers.
Insights
An early 2017 measles outbreak in Belgium primarily affected unvaccinated adults, with many cases showing atypical symptoms. Intensified vaccination campaigns targeting young adults and healthcare workers are crucial for measles elimination.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Measles outbreaks pose a significant public health challenge, particularly in populations with suboptimal vaccination coverage.
- Understanding the epidemiology and clinical presentation of measles is vital for effective control strategies.
Purpose of the Study:
- To analyze the characteristics of a measles outbreak in Belgium in early 2017.
- To identify risk factors, clinical presentations, and complications associated with the outbreak.
- To inform public health interventions for measles prevention and control.
Main Methods:
- Retrospective analysis of reported measles cases in Belgium during early 2017.
- Data collection on patient demographics, vaccination status, clinical symptoms, and outcomes.
- Assessment of vaccination status against national guidelines.
Main Results:
- 289 measles cases were reported, with a majority (53%) in individuals aged 15 years and older.
- A significant proportion of cases (41%) were unvaccinated, and 29% of unvaccinated cases had not received the recommended vaccine doses.
- Atypical presentations were common (21%), with rash being the most consistent symptom. Hospitalization occurred in 43% of cases, with hepatic disorders as a frequent complication.
- Healthcare workers accounted for 12% of cases, highlighting the risk of nosocomial spread.
Conclusions:
- The outbreak underscores the need for improved measles vaccination coverage, especially among young adults and healthcare workers.
- Delayed diagnosis can result from atypical presentations and complications like hepatitis, necessitating a high index of suspicion for measles in patients with rash.
- Intensified catch-up vaccination campaigns are essential to achieve measles elimination targets.
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