Measles Outbreak in Pediatric Oncology Patients at Hue Central Hospital
AIM: Measles outbreak in the immunocompromised population is a big challenge to interrupt endemic transmission. This study aimed to investigate of measles in pediatric oncology patients and find the reason behind the outbreak.
METHODS: A descriptive study was conducted on 11 pediatric oncology patients with measles. We collected demographic, epidemiological, and clinical data. Most of suspected measles cases were done measles immunoglobulin M test and clinical data were followed up and analyzed by SPSS.
RESULTS: From April 20, 2018, to July 10, 2019, a total of 11 patients with malignancies were notified to develop measles in Hue. Of these 11 patients with the median age of 4.0 years (range: 1â€“9 years), two patients had not received any dose of measles vaccine, five patients received two doses, and four patients had received 1 dose of measles vaccine; all patients had fever with the median fever of 39Â°C (range: 38.5â€“39.5), the median fever duration was 7 days. All patients had cough and rash, three patients had pneumonia complication and two patients had elevated liver transaminase levels. All patients had hospital visits or were hospitalized before measles onset, with the median time: 10 days (range: 7â€“24 days); all patients were likely to expose each other. All 11 patients recovered.
CONCLUSIONS: The measles outbreak was occurred among children with cancer, especially for children without prior measles vaccine or without two prior doses. Moreover, even children received two prior dose vaccine, their immunocompromised status caused them to be infected. There was not a different area for outpatient and inpatient in the hospital, so measles transmission occurred.
Plum Analytics Artifact Widget Block
Fadic RR, Repetto DG. Measles: Historical background and current situation. Rev Chil Pediatr. 2019;90(3):253-9. PMid:31344184
UNICEF. Alarming Global Surge of Measles Cases a Growing Threat to Children; 2018. Available from: http://www.unicef.org. [Last accessed on 2019 Feb 28].
Ge YL, Zhai XW, Zhu YF, Wang XS, Xia AM, Li YF, et al. Measles outbreak in pediatric hematology and oncology patients in Shanghai, 2015. Chin Med J (Engl). 2017;130(11):1320-6. https://doi.org/10.4103/0366-6999.206358 PMid:28524832
Giannini EG, Testa R, Savarino V. Liver enzyme alteration: A guide for clinicians. CMAJ. 2005;172(3):367-79. PMid:15684121
Kaplan LJ, Daum RS, Smaron M, McCarthy CA. Severe measles in immunocompromised patients. JAMA. 1992;267(9):1237-41. PMid:1538561
Nakano T, Shimono Y, Sugiyama K, Nishihara H, Higashigawa M, Komada Y, et al. Clinical features of measles in immunocompromised children. Acta Paediatr Jpn. 1996;38(3):212- 7. https://doi. org/10.1111/j.1442-200x.1996. tb03472.x PMid:8741308
Bochennek K, Allwinn R, Langer R, Becker M, Keppler OT, Klingebiel T, et al. Differential loss of humoral immunity against measles, mumps, rubella and varicella-zoster virus in children treated for cancer. Vaccine. 2014;32(27):3357-61. https://doi. org/10.1016/j.vaccine.2014.04.042 PMid:24793952
van Tilburg CM, Sanders EA, Rovers MM, Wolfs TF, Bierings MB. Loss of antibodies and response to (re-)vaccination in children after treatment for acute lymphocytic leukemia: A systematic review. Leukemia. 2006;20(10):1717-22. https:// doi.org/10.1038/sj.leu.2404326 PMid:16888619
Zignol M, Peracchi M, Tridello G, Pillon M, Fregonese F, Dâ€™Elia R, et al. Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis B, measles, rubella, and mumps in children after chemotherapy. Cancer. 2004;101(3):635-41. https://doi. org/10.1002/cncr.20384 PMid:15274078
Cesaro S, Giacchino M, Fioredda F, Barone A, Battisti L, Bezzio S, et al. Guidelines on vaccinations in paediatric haematology and oncology patients. Biomed Res Int. 2014;2014:707691. https:// doi.org/10.1155/2014/707691 PMid:24868544
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309-18. https://doi.org/10.1093/cid/cit816 PMid:24421306
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
Hyde TB, Nandy R, Hickman CJ, Langidrik JR, Strebel PM, Papania MJ, et al. Laboratory confirmation of measles in elimination settings: Experience from the Republic of the Marshall Islands, 2003. Bull World Health Organ. 2009;87(2):93- 8. https://doi.org/10.2471/blt.07.045484 PMid:19274360
Copyright (c) 2020 Tran Kiem Hao, Nguyen Thi Kim Hoa (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.