Low Use of Vitamin A in Children Hospitalized for Measles in the United States.

Vitamin A reduces measles morbidity/mortality and and is recommended for management. We studied 142 patients hospitalized at US Children's hospitals for measles between January 1, 2004, and March 31, 2019, and found only 47 (33%) received vitamin A. Patients with complex chronic conditions were less likely to be treated. This study highlights a concerning gap between recommendations and practice for hospital management of measles.

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: A clinician's guide to a reemerging disease.

Measles has re-emerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission.

Measles: A clinician's guide to a reemerging disease.

Measles has reemerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission.

Could this be measles?

Infection with the measles virus causes an unpleasant disease with many potentially serious complications. It is predominantly a childhood illness but can affect any age. Measles is extraordinarily contagious, but immunisation with measles containing vaccine provides comprehensive protection. An international programme of universal immunisation from the mid-1980s has been very effective; measles was declared eliminated in the USA nearly two decades ago and became a rarity in other countries with high rates of vaccine uptake. Until recently, this was a forgotten disease in high-income countries, but paediatricians, emergency and primary care physicians worldwide are now encountering measles with increased frequency. Attributed to international travel and pockets of vaccine hesitancy locally, new outbreaks of measles have been recorded in many regions thought to have been free of the disease. Because it was previously so uncommon, measles presents a diagnostic challenge and an unrecognised case may cause infection to spread among communities. The present article presents a case of confirmed measles infection and discusses the epidemiology, clinical features, investigation, management and prevention of measles.

Pneumomediastinum complicating adult-onset measles.

Adult-onset measles is rare in the UK, particularly in patients with a complete vaccination history.We present a case of a UK-born patient who received all childhood vaccinations, had no history of recent travel or unwell contacts who was diagnosed with measles complicated by pneumomediastinum. This case highlights the need to consider measles in any patient presenting with a constellation of a macular rash, fever and conjunctivitis, regardless of vaccination status. The nature of the rash can provide an important clue to the diagnosis. Liaison with infection specialists facilitates early diagnosis, allowing for appropriate initial investigations, improving clinical management and early infection control precautions being instituted.

Childhood measles contributes to post-bronchodilator airflow obstruction in middle-aged adults: A cohort study.

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) has potential origins in childhood but an association between childhood measles and post-bronchodilator (BD) airflow obstruction (AO) has not yet been shown. We investigated whether childhood measles contributed to post-BD AO through interactions with asthma and/or smoking in a non-immunized middle-aged population. METHODS: The population-based Tasmanian Longitudinal Health Study (TAHS) cohort born in 1961 (n = 8583) underwent spirometry in 1968 before immunization was introduced. A history of childhood measles infection was obtained from school medical records. During the fifth decade follow-up (n = 5729 responses), a subgroup underwent further lung function measurements (n = 1389). Relevant main associations and interactions by asthma and/or smoking on post-BD forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC; continuous variable) and AO (FEV1 /FVC < lower limit of normal) were estimated by multiple regression. RESULTS: Sixty-nine percent (n = 950) had a history of childhood measles. Childhood measles augmented the combined adverse effect of current clinical asthma and smoking at least 10 pack-years on post-BD FEV1 /FVC ratio in middle age (z-score: -0.70 (95% CI: -1.1 to -0.3) vs -1.36 (-1.6 to -1.1), three-way interaction: P = 0.009), especially for those with childhood-onset asthma. For never- and ever-smokers of <10 pack-years who had current asthma symptoms, compared with those without childhood measles, paradoxically, the odds for post-BD AO was not significant in the presence of childhood measles (OR: 12.0 (95% CI: 3.4-42) vs 2.17 (0.9-5.3)). CONCLUSION: Childhood measles infection appears to compound the associations between smoking, current asthma and post-BD AO. Differences between asthma subgroups provide further insight into the complex aetiology of obstructive lung diseases for middle-aged adults.

Neuroleptic malignant syndrome as a presenting feature of subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles antibodies in CSF and serum. Atypical presentations of SSPE have been reported including brainstem involvement, ADEM-like presentation, acute encephalitis, and cerebellar ataxia. Presentation with predominant extrapyramidal features is uncommon. We describe a case of SSPE presenting with extensive rigidity with highly elevated CPK values, mimicking neuroleptic malignant syndrome (NMS) which was most probably due to central dopaminergic blockade induced by the disease process. To our knowledge, this is the first case of SSPE presenting with a NMS-like syndrome.

Sporadic cases of adult measles: a research article.

BACKGROUND: Measles caused by a paramyxovirus, characterized by fever, malaise, cough, coryza conjunctivitis, a maculopapular rash is known to result in pneumonia, encephalitis and death. Fatal cases of measles in Sri Lanka are rare after implementation of the National Immunization Programme in 1984. Thereafter 0.1% case fatality rate was observed during October 1999-June 2000 which is a very low figure compared to other regional countries. Immunization guidelines were further revised in 2001, 2011 and in 2012 when additional immunization was recommended to age group 4-21 years; who are likely to have inadequate immunization, in order to achieve elimination of Measles by 2020. However, in 2013-2014, 4690 cases were reported and the majority were children less than 1 year of age. The occurrence in adults is hard to retrieve in published epidemiological reports, however had been 38% (out of 1008 patients) in the 3rd quarter of 2013. During this outbreak 73/101 (72%) reported from the North Central Province of Sri Lanka had been more than 12 years of age with 50% being more than 29 years. 14 Sri lankan adult patients [median age 32 years (range 25-48)] who presented sporadically from June 2014 to March 2016, with confirmed measles infection were enrolled retrospectively after informed consent. Details with regards to their clinical presentation, immunization and other relevant areas were collected using an interviewer administered questionnaire or using patient management records. RESULTS: The patients presented with high fever, headache, severe body aches, sore throat, dry cough, intense tearing, red eyes and posterior cervical lymphadenopathy over 3-5 days duration. Later they developed discrete maculopapular rash helping the diagnosis. They had a variable degree of leucopenia, lymphocytosis, thrombocytopenia and derangements in the liver functions mimicking any other acute febrile illnesses such as dengue, chikungunya, leptospirosis or Zika virus infection. CONCLUSION: At least a 3-5 day delay in the diagnosis was observed (even after the appearance of the rash in some patients), due to non-awareness of its occurrence, unfamiliarity of measles in adults, non-specific nature of the illness and non-availability of rapid diagnostics, risking transmission to the immune-compromised or non-immune staff or patients. Identification of the source of infection in these sporadic adult cases and their virologic surveillance and molecular epidemiology will be important to interrupt the transmission and to achieve the targeted elimination of measles from Sri Lanka by 2020.

Measles.

Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from <0.01% in industrialized countries to >5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.

Measles Virus Infection Inactivates Cellular Protein Phosphatase 5 with Consequent Suppression of Sp1 and c-Myc Activities.

UNLABELLED: Measles virus (MeV) causes several unique syndromes, including transient immunosuppression. To clarify the cellular responses to MeV infection, we previously analyzed a MeV-infected epithelial cell line and a lymphoid cell line by microarray and showed that the expression of numerous genes was up- or downregulated in the epithelial cells. In particular, there was a characteristic comprehensive downregulation of housekeeping genes during late stage infection. To identify the mechanism underlying this phenomenon, we examined the phosphorylation status of transcription factors and kinase/phosphatase activities in epithelial cells after infection. MeV infection inactivated cellular protein phosphatase 5 (PP5) that consequently inactivated DNA-dependent protein kinase, which reduced Sp1 phosphorylation levels, and c-Myc degradation, both of which downregulated the expression of many housekeeping genes. In addition, intracellular accumulation of viral nucleocapsid inactivated PP5 and subsequent downstream responses. These findings demonstrate a novel strategy of MeV during infection, which causes the collapse of host cellular functions. IMPORTANCE: Measles virus (MeV) is one of the most important pathogens in humans. We previously showed that MeV infection induces the comprehensive downregulation of housekeeping genes in epithelial cells. By examining this phenomenon, we clarified the molecular mechanism underlying the constitutive expression of housekeeping genes in cells, which is maintained by cellular protein phosphatase 5 (PP5) and DNA-dependent protein kinase. We also demonstrated that MeV targets PP5 for downregulation in epithelial cells. This is the first report to show how MeV infection triggers a reduction in overall cellular functions of infected host cells. Our findings will help uncover unique pathogenicities caused by MeV.

Renal dysfunction in adults during measles.

BACKGROUND: Many cases of measles in adults were notified during the epidemic in France in 2008. Studying these cases can lead to a better understanding of their potential complications, little data having been reported on renal dysfunction during measles. METHODS: A retrospective study of biologically confirmed measles cases in patients hospitalized for more than 24 hours was carried out in the Nantes Teaching Hospital, between January and December 2011. The renal function was assessed using the modification of diet in renal disease (MDRD) equation. RESULTS: Thirty-eight patients were included, 17 (45%) presented with a clearance below 90 mL/min. One patient presented with acute renal failure, with a clearance at 37 mL/min, and proteinuria at 2.8 g/L. His renal function was restored on day 2. CONCLUSION: Acute renal failure can occur during measles in adults. Serum creatinine should be systematically assessed during the initial medical evaluation.

[The current knowledge of clinical manifestations of measles].

A comparative study was carried out in children with measles aged 1 month to 18 years. They were admitted to the regional infectious diseases hospital in Karaganda during a measles outbreak in 2014 in Central Kazakhstan. 209 children were included into the study, 66 children were under the age of 1 year and 143 children were aged from 1 year to 18 years. The clinical diagnosis of "measles" was diagnosed according to clinical and epidemiological and serological data. In a comparative study of measles in age aspect, it was found that the highest incidence was in age from 1 year to 3 years and from 11 to 18 years. Measles in children older than 1 year were more severe compared with infants due to severe symptoms of intoxication and catarrhal syndrome. The symptom Bielsko-Filatova and measles enanthema the valuable diagnostic and differential diagnostic symptoms, as a pigmentation remains an important retrospective feature of having had measles before.