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Outbreaks Open Access
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Abstract

Recognition of measles is crucial to prevent transmissions in the hospital settings. Little is known about the level of recognition of measles and possible causes of not recognising the disease by physicians in the post-vaccine era. We report on a measles outbreak in a paediatric hospital in Austria in January to February 2017 with strikingly high numbers of not recognised cases. The extent and course of the outbreak were assessed via retrospective case finding. Thirteen confirmed measles cases were identified, two with atypical clinical picture. Of eight cases with no known epidemiological link, only one was diagnosed immediately; four were recognised with delay and three only retrospectively. Eleven typical measles cases had four ‘unrecognised visits’ to the outpatient clinic and 28 on the ward. Two atypical cases had two ‘unrecognised visits’ to the outpatient clinic and 19 on the ward.

Thirteen clinicians did not recognise typical measles (atypical cases not included). Twelve of 23 physicians involved had never encountered a patient with measles before. The direct and indirect costs related to the outbreak were calculated to be over EUR 80,000. Our findings suggest the need to establish regular training programmes about measles, including diagnostic pitfalls in paediatric hospitals.

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/content/10.2807/1560-7917.ES.2020.25.3.1900260
2020-01-23
2024-10-09
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.3.1900260
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References

  1. European Centre for Disease Prevention and Control (ECDC). Who is at risk for measles in the EU/EEA? Identifying susceptible groups to close immunity gaps towards measles elimination. Stockholm: ECDC; 28 May 2019. Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/RRA-Measles-EU-EEA-May-2019.pdf
  2. Barrett P, Cotter S, Ryan F, Connell J, Cronin A, Ward M, et al. A national measles outbreak in Ireland linked to a single imported case, April to September, 2016. Euro Surveill. 2018;23(31):1700655.  https://doi.org/10.2807/1560-7917.ES.2018.23.31.1700655  PMID: 30086818 
  3. Filia A, Bella A, Cadeddu G, Milia MR, Del Manso M, Rota MC, et al. Extensive nosocomial transmission of measles originating in cruise ship passenger, Sardinia, Italy, 2014. Emerg Infect Dis. 2015;21(8):1444-6.  https://doi.org/10.3201/eid2108.141105  PMID: 26196266 
  4. Porretta A, Quattrone F, Aquino F, Pieve G, Bruni B, Gemignani G, et al. A nosocomial measles outbreak in Italy, February-April 2017. Euro Surveill. 2017;22(33):30597.  https://doi.org/10.2807/1560-7917.ES.2017.22.33.30597  PMID: 28840827 
  5. Currie J, Davies L, McCarthy J, Perry M, Moore C, Cottrell S, et al. Measles outbreak linked to European B3 outbreaks, Wales, United Kingdom, 2017. Euro Surveill. 2017;22(42).  https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00673  PMID: 29067903 
  6. Groth C, Böttiger B, Plesner A, Christiansen A, Glismann S, Hogh B. Nosocomial measles cluster in Denmark following an imported case, December 2008-January 2009. Euro Surveill. 2009;14(8):19126. PMID: 19250624 
  7. Botelho-Nevers E, Cassir N, Minodier P, Laporte R, Gautret P, Badiaga S, et al. Measles among healthcare workers: a potential for nosocomial outbreaks. Euro Surveill. 2011;16(2):19764. PMID: 21251488 
  8. Grgic-Vitek M, Frelih T, Ucakar V, Prosenc K, Tomažič J, Petrovec M, et al. Spotlight on measles 2010: a cluster of measles in a hospital setting in Slovenia, March 2010. Euro Surveill. 2010;15(20):19573. PMID: 20504390 
  9. Grammens T, Schirvel C, Leenen S, Shodu N, Hutse V, Mendes da Costa E, et al. Ongoing measles outbreak in Wallonia, Belgium, December 2016 to March 2017: characteristics and challenges. Euro Surveill. 2017;22(17):1730524.  https://doi.org/10.2807/1560-7917.ES.2017.22.17.30524  PMID: 28488998 
  10. Melenotte C, Cassir N, Tessonnier L, Brouqui P. Atypical measles syndrome in adults: still around. BMJ Case Rep. 2015;2015:211054.  https://doi.org/10.1136/bcr-2015-211054  PMID: 26400591 
  11. Mizumoto K, Kobayashi T, Chowell G. Transmission potential of modified measles during an outbreak, Japan, March‒May 2018. Euro Surveill. 2018;23(24):1800239.  https://doi.org/10.2807/1560-7917.ES.2018.23.24.1800239  PMID: 29921344 
  12. Austrian Federal Ministry of Labour. Social Affairs, Health and Consumer Protection. Kurzbericht Masern. Evaluierung der Masern-Durchimpfungsraten mit einem dynamischen, agentenbasierten Simulationsmodell. [Short report on measles. Evalulation of measles vaccination rates with a dynamic, agent-based simulation model]. Vienna: Federal Ministry of Labour, Social Affairs, Health and Consumer Protection: 2018. German. Available from: http://www.dwh.at/site/assets/files/1736/kurzbericht_masern.pdf
  13. World Health Organization Regional Office for Europe (WHO/Europe). Guidelines for measles and rubella outbreak investigation and response in the WHO European Region. Copenhagen: WHO/Europe; 2013. Available from: http://www.euro.who.int/__data/assets/pdf_file/0003/217164/OutbreakGuidelines-updated.pdf?ua=1
  14. European Commission. Commission Implementing Decision 2012/506/EU of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. Brussels: Off Journal of the European Union. 2012;55(L262):20-1. Available from: https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:FULL:EN:PDF
  15. Rota PA, Brown K, Mankertz A, Santibanez S, Shulga S, Muller CP, et al. Global distribution of measles genotypes and measles molecular epidemiology. J Infect Dis. 2011;204(Suppl 1):S514-23.  https://doi.org/10.1093/infdis/jir118  PMID: 21666208 
  16. Gastanaduy PA, Goodson JL. Chapter 3: Measles (Robeola). In: Brunette G, Nemhauser JB, Kozarsky PE, editors. CDC Health Information for International Travel 2020. New York: Oxford University Press; 2019. p 287-291.
  17. Wendelin G. Kostenvergleich intra- und extramuraler pädiatrischer Primärversorgung von Kindern und Jugendlichen im Raum Graz. [Cost comparison of different outpatient treatment settings of children and adolescents]. [thesis]. Danube University Krems, June 2019. German. Available from: http://webthesis.donau-uni.ac.at/thesen/99299.pdf
  18. Leoni T, Schwinger J. Fehlzeitenreport 2017. Krankheits- und unfallbedingte Fehlzeiten in Österreich – Die alter(n)sgerechte Arbeitswelt. [Absence from work report 2017. Disease and accident caused absenteeism in Austria – the age appropriate working world]. Vienna; Austrian Institute for Economic Research: 2017. German. Available from: http://www.ifgp.at/cdscontent/load?contentid=10008.646640&version=1510818784
  19. Orosz L, Gáspár G, Rózsa Á, Rákos N, Sziveri S, Bosnyákovits T. Epidemiological situation of measles in Romania, Italy, and Hungary: On what threats should we focus nowadays? Acta Microbiol Immunol Hung. 2018;65(2):127-34.  https://doi.org/10.1556/030.65.2018.014  PMID: 29486573 
  20. Hazir T, Saleem M, Abbas KA. Stevens-Johnson syndrome following measles vaccination. J Pak Med Assoc. 1997;47(10):264-5. PMID: 9529856 
  21. Bernardini ML, D’Angelo G, Oggiano N, Campanati A, Ficcadenti A, Coppa GV, et al. Erythema multiforme following live attenuated trivalent measles-mumps-rubella vaccine. Acta Derm Venereol. 2006;86(4):359-60.  https://doi.org/10.2340/00015555-0071  PMID: 16874427 
  22. European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases. Measles. [Accessed 19 Dec 2019]. Available from: https://www.ecdc.europa.eu/en/measles/surveillance-and-disease-data/atlas
  23. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment. Ongoing outbreak of measles in Romania, risk of spread and epidemiological situation in EU/EEA countries. Stockholm: ECDC; 3 March 2017. Available from: https://www.ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/27-02-2017-RRA-Measles-Romania,%20European%20Union%20countries.pdf
  24. Fitzgerald TL, Durrheim DN, Merritt TD, Birch C, Tran T. Measles with a possible 23 day incubation period. Commun Dis Intell Q Rep. 2012;36(3):E277-80. PMID: 23186239 
  25. Hickman CJ, Hyde TB, Sowers SB, Mercader S, McGrew M, Williams NJ, et al. Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals. J Infect Dis. 2011;204(Suppl 1):S549-58.  https://doi.org/10.1093/infdis/jir106  PMID: 21666212 
  26. Maltezou HC, Theodoridou K, Ledda C, Rapisarda V, Theodoridou M. Vaccination of healthcare workers: is mandatory vaccination needed? Expert Rev Vaccines. 2019;18(1):5-13.  https://doi.org/10.1080/14760584.2019.1552141  PMID: 30501454 
  27. van den Hof S, Meffre CMA, Conyn-van Spaendonck MAE, Woonink F, de Melker HE, van Binnendijk RS. Measles outbreak in a community with very low vaccine coverage, the Netherlands. Emerg Infect Dis. 2001;7(7) Suppl;593-7.  https://doi.org/10.3201/eid0707.017743  PMID: 11485681 
  28. Quiambao BP, Gatchalian SR, Halonen P, Lucero M, Sombrero L, Paladin FJ, et al. Coinfection is common in measles-associated pneumonia. Pediatr Infect Dis J. 1998;17(2):89-93.  https://doi.org/10.1097/00006454-199802000-00002  PMID: 9493801 
  29. Hang LKN, Do LP, Van TTT, Nguyen SV, Hoang PVM, Pham HT, et al. Viral co-infections among children with confirmed measles at hospitals in Hanoi, Vietnam, 2014. Asian Pac J Trop Med. 2017;10(2):171-4.  https://doi.org/10.1016/j.apjtm.2017.01.015  PMID: 28237484 
  30. Brostoff JM, Weir W, Roche S. An unusual cause of fever and rash in an adult. Eur J Intern Med. 2008;19(1):67-9.  https://doi.org/10.1016/j.ejim.2007.06.005  PMID: 18206607 
  31. Arulraj R, Venkatesh C, Chhavi N, Soundararajan P. Hypersensitivity due to ceftriaxone mimicking measles in a child. Indian J Pharmacol. 2013;45(5):528-9.  https://doi.org/10.4103/0253-7613.117756  PMID: 24130394 
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