A Major Regional Measles Outbreak: Description of Hospitalized Cases in 2017-2018 at Bordeaux University Hospital, France

Background

Measles remains endemic worldwide, despite current vaccination recommendations, and is associated with high morbidity and mortality rates. We describe all cases hospitalized in Bordeaux University Hospital (BUH), the starting point of a national significant measles outbreak in 2017–2018.

Methods

In this retrospective study, we included all patients hospitalized in BUH from September 1, 2017, to May 31, 2018. Inclusion criteria were age >1 year, clinical symptoms, and biological confirmation by measles immunoglobulin M or measles reverse transcription polymerase chain reaction positivity.

Results

We included 171 patients. Most patients were immunocompetent; only 19% had preexisting medical histories. Most patients had rash and fever (97%), but some cases were atypical and difficult to diagnose. Köplik’s spots were reported in 66 cases (38%). The most frequent biological markers were blood inflammation markers (96%) and lymphopenia (81%). Unexpectedly, we found hyponatremia (<135 mmol/L) in 40% of patients. We identified peaks in January and March, corresponding to 76 D8 genotypes and 28 B3 strains. The following complications were reported in 65 patients (38%): pneumonia, hepatitis, and keratitis; 10 had neurological symptoms. One patient had Guillain-Barré syndrome, and a young immunocompromised patient died from measles inclusion-body encephalitis. Most of the patients (80%) had not been correctly vaccinated, including 28 health care workers. Some patients (n = 43, 25%) developed measles despite having plasma IgG. These included 12 possible vaccination failure cases.

Conclusions

During the BUH outbreak, measles was often complicated and sometimes atypical. Vaccination coverage was dramatically insufficient. We also describe vaccination failure cases that must be better investigated.

Measles-What's Old Is New Again

Measles (rubeola) was once nearly eradicated in the United States. Unfortunately, it has reappeared, with more than three times the number of confirmed cases in 2019 than in 2018. The virus, which produces a distinct rash that appears within days of exposure, can spread quickly and can produce severe complications. There is no cure; treatment is supportive care. Measles was once a minimal concern in the United States due to high vaccination rates. The Centers for Disease Control and Prevention reports that, because of the increase in individuals traveling to countries with high rates of measles and the fact that fewer U.S. children are being immunized against measles, the incidence of measles will likely continue to rise in the United States. It is vital that nurses and other health care providers educate individuals about the importance of the prevention and treatment of measles.

Measles during arbovirus outbreak: a diagnostic challenge

Introduction.

Dengue fever is a major public health problem in New Caledonia, like in many Pacific Islands Countries and territories. In 2017 New Caledonia faced multiple circulations of arboviruses with a major outbreak of dengue and a co-circulating Zika virus. New Caledonia is considered as a non-endemic territory for measles since the mid 1990’s.

Case presentation.

A 41-year-old male presented fever, headache, sinusitis and exanthematous maculopapular rash. A clinical diagnosis of arbovirus was first suspected due to the local epidemic context. A few days later the patient was admitted to the main hospital. The real time RT-PCR for dengue and Zika virus were negative on the first blood sample. A drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and other infectious diseases including measles were then suspected. ELISA tests for measles were positive for IgM and equivocal for IgG. A throat swab was immediately shipped to a reference laboratory for measles nucleic acid testing. After a week, the patient recovered and the presence of measles RNA was confirmed. No secondary cases were reported among contacts of the patient and the source of his infection could not be ascertained.

Conclusion.

Diagnosis of measles during an arbovirus outbreak in a country where measles disease is rare can be a pitfall for healthcare professionals. The introduction of measles via returned travellers or tourists from areas where measles remains endemic is a real threat to countries with high vaccine coverage.

Dermatological signs and symptoms of measles: a prospective case series and comparison with the literature

BACKGROUND/AIMS

Because of high vaccination rates, population immunity against measles increased in the western world. Nevertheless, outbreaks are still observed. The aim of this article is to document and describe the natural course of dermatological manifestations and compare it with the literature.

METHODS

After detecting a measles index case, the dermatological onset of the disease in the non-vaccinated siblings was prospectively monitored and documented with a digital camera.

RESULTS

Our findings show that dermatological symptoms are only limited consistently from one case to another and described heterogeneously in the literature as well.

CONCLUSION

Dermatological manifestations do not seem conclusive in our clinical data set as well as in the literature. Especially the exact onset of the Koplik spots should be further explored in detail. In future, a larger population should be observed and clinical diagnostics for measles defined.