Clinical characteristics and outcome of children evaluated and treated at Tygerberg Children's Hospital during a measles epidemic

[摘要] ENGLISH ABSTRACT: Objective: To describe the clinical characteristics and outcome of children presenting to Tygerberg Children's Hospital with measles infectionMethods: This was a retrospective, descriptive study of children presenting to TygerbergChildren's Hospital, from 1 February to 31 March 2010 with a diagnosis of measles, during the measles epidemic of 2009/2010. Folders of every second admission were reviewed. Datawasanalysedusing Statisticaversion10of2012.Thestudy wasapprovedby Stellenbosch University Ethics Committee.Results: Five hundred and eighty five children were seen and evaluated for complicated measles, 239 patients were included. Seventy nine percent (n=189/239) were admitted of which 54.3% were male. The median age at admission was 9 (Interquartile range 6 to 19) months. Children less than 9 months accounted for 50.2% (n=120) and 25.9% (n=62) were less than 6 months of age. The median WHO weight-for-age Z-score (WAZ) was 0.69 (IQR -1.82 to 0.29), malnutrition was found in 39.9% (n=81) of children less than 5 years.Children residing in the Khayelitsha sub-district accounted for 43.1% (n=103) of the study population. Uptake of the first dose of measles vaccine was 31.1% and of the second dose of measlesvaccine was 23.8%. The median length of stay (LOS) was 3 days (IQR 2 – 5 days). Gastroenteritis (67.4%; n=161) and pneumonia (54.4%; n=130) were the most common complications. The majority assessment. A single dose ofchildren had more than one complication at the time of of vitamin A was received by 71.1% (n=170/239) of children during evaluation and 47.6% (n=114/239) received 2 doses.Seven (2.9%; n=7/239) patients required ICU care. Four (57.1%; n= 4/7) were less than 9 months of age. Pneumonia (85.7%; n=6) was the most common reason for admission.Four (1.7%; n=4/239) children died. The median age at death was 9 months (IQR 7 – 14 months). Pneumonia (75%; n=3/4) was the most common cause of death.HIV testing was done in 40.6% (n=97/239) of children.HIV exposure was found in 28.9% (n=69/239) on history. HIV infection was present in 8.4% (n=20/239) of children, of these,60% (n=12/20) were on HAART.HIV-infected children were older than HIV-uninfected children (median 40 and 9 months respectively, p=0.003). Thirty percent (n=6/20) of HIV- infected children had received any measles vaccination prior to admission.Five percent (n=1/20) of HIV-infected children died vs 4.2% (n=3/72) of children who were confirmed HIV negative.Conclusion:Our study showed that measles causes a significant burden of morbidity and mortality in children. HIV infection however did not increase the morbidity and mortality due to measles co-infection.Interventions to improve vaccination rates and practices at community level are required in order to prevent further epidemics in the future.Further research is needed to determine whether the first measles vaccine dose should be given earlier rather than 9 months of age in order to prevent early infection.

[发布机构] Stellenbosch University