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Arch Dis Child. 2019 Jan 12. pii: archdischild-2018-315290. doi: 10.1136/archdischild-2018-315290. [Epub ahead of print]

Complications and risk factors for severe outcome in children with measles.

Author information

1
Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy.
2
Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy.
3
Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy.
4
Pediatrics Branch, Department of Women and Child Health, 'A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy.
5
Department of Pediatrics, University of Chieti, Chieti, Italy.
6
Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy.
7
Department of Pediatrics and Neonatology, Ospedale Civile di Ciriè, Turin, Italy.
8
Pediatric Infectious Disease Unit, Children Hospital 'ISMEP Di Cristina', Palermo, Italy.
9
Pediatric Clinic, Department of Surgical and Biomedical Sciences, Universita degli Studi di Perugia, Perugia, Italy.
10
Pediatric Unit and Neonatal Intensive Care Unit, Azienda Ospedaliera Santa Maria, Terni, Italy.
11
Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy.
12
Department of Medical and Surgical Sciences - Pediatric Emergency Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
13
Pediatric Unit, Hospital of Negrar 'Sacro Cuore Don Calabria', Verona, Italy.
14
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
15
Pediatric Unit, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy.
16
Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy.
17
Pediatric Unit, Research Institute Hospital 'Casa Sollievo della Sofferenza' San Giovanni Rotondo, Foggia, Italy.
18
Pediatric Unit, University Hospital 'S. Anna', Ferrara, Italy.
19
Pediatric Unit, Hospital of Dolo, Verona, Italy.
20
Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Florence, Italy.
21
National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy.

Abstract

OBJECTIVE AND DESIGN:

Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death.

RESULTS:

Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01).

CONCLUSION:

The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.

KEYWORDS:

children; complication; genotype; measles; severe outcome

Conflict of interest statement

Competing interests: None declared.

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