Audit of Measles Infection in Children From a Tertiary Hospital

Department of Pediatrics,
Kanchi Kamakoti CHILDS Trust Hospital,
12 A, Nageswara Road, Nungambakkam,
Chennai 600 034, India.
E-mail: [email protected]
 

Measles is an acute viral infectious disease caused by measles virus. The World Health Organisation (WHO) estimates that almost 1 million deaths occur each year due to measles, the majority (85%) in Asia and Africa(1). We conducted a retrospective study of clinical profile and outcome of measles infection at private urban tertiary care childrens hospital, during the period January 2006 till December 2007. Case records of children who were admitted during the above period with clinical measles [defined as any person in whom the clinician suspects measles infection or any person with fever and maculopapular rash with cough or coryza or conjunctivitis(2)] or laboratory confirmed measles [defined as clinical measles infection with presence of measles specific IgM antibodies in serum(2)] were analyzed for age, sex, clinical features, measles immunization status, measles specific serum IgM antibodies, vitamin A supplementation status and measles related complications. During this period, 70 (0.3%) children were admitted out of 23172 hospital admissions. Of these 36 (51%) were boys and 34 (49%) were girls and the male: female ratio was 1.05:1. Fifteen (22%) children were less than one year old, 24 (34%) between one and 5 years, 23 (33%) between 5 and 10 years and 8 (11%) more than 10 years. Amongst the clinical features, fever was seen in 100%, rash in 86%, coryza in 71% and conjunctivitis in 67%. Koplik spots, pathognomic of measles were seen only in 29%. Leucopenia (total WBC count<4000 cells/mm3) was seen in 46% and leucocytosis (total WBC count>10,000) in 13%. Measles specific IgM antibodies by ELISA was done only in 42(60%) and positive in 16(23%) and there was clustering of cases between the months of January-June. It is unfortunate that 77% children had received measles immunization earlier thus stressing the need for revaccination and only 56 (80%) children received oral vitamin A supplementation. The proportion of children attacked by measles even after immunisation went on increasing with the increasing age, suggesting the waning of immunity with increasing age, which is similar to earlier study reported by Sharma, et al(3). With regards to measles related complications, one child had mild upper GI bleed and one had photophobia. All cases were brought under measles surveillance system and managed conservatively. There was no mortality. To conclude, measles is re-emerging with lot of children affected despite their previous immunization status though our findings represent only the tip of the iceberg. Larger studies in future are needed to stress the importance of including second dose of measles in Universal Immunisation Program.

3. Sharma MK, Bhatia V, Swami HM. Outbreak of measles amongst vaccinated children in a slum of Chandigarh. Indian J Med Sci 2004; 58: 47-53.