Hospitalized Cases Analysis And Preventive Strategies For Child Measles

Objective Measles is still a global public health problem that seriously threatens children’s health and life, especially in developing countries. In our study, the hospitalized cases of child measles from clinical manifestation, epidemiological situation and parents’ awareness of vaccination were analyzed, in order to investigate the influencing factors of measles’ recurrence and provide preventive strategies for the further control of measles epidemics.Part Ⅰ A clinical epidemiology study of666hospitalized cases of child measlesMethod Clinical data from666hospitalized cases of child measles treated in Affiliated Yuying Children’s Hospital of Wenzhou Medical College from2006to2010were retrospectively analyzed. The cases’ age of onset, season of onset, area of distribution, history of measles vaccination (MV), clinical manifestation, laboratory examination, complications and the data of misdiagnosis and mistreatment were statistically analyzed, and we analyzed the change of epidemiological characteristics and clinical characters and the reason of misdiagnosis and mistreatment.Result Males were more likely to be measles patients, and the male to female ratio was2.43:1. The age of onset is11.6±15.9month, The minimum age of onset was just six days, with both illness of mother and child. The maximum age of onset was156month.Children under one-year-old had higher rate of measles (616cases,92.5%of the total), in which371cases (55.7%) were under8-month-old. Cases living in suburbs, peripheral counties and county-level cities accounted for67.8%of the total. There was no obvious seasonality in the incidence of measles. It was a year-round event, attacking relatively more in March, April, August and September. The first half year of2008was a period of high incidence. After supplementary immunization in the second half year of2008, the incidence was obviously reduced in the forth quarter of2008and in the year of2009, but rose again in the forth quarter of2010. A low immunization rate of measles was found. Among the295cases which were8-month-old or older and matched the condition of planned immunization of measles, only48cases (16.3%) were vaccinated, including10cases who had been vaccinated in recent10days.61cases were hospitalized for emergency, while590cases were from outpatient and15cases were emergency admissions.99.7%of the cases were improved or even cured, and2cases died. Clinical symptoms were more likely to be found in typical cases. Prodromal symptoms appeared before rash in all cases, and fever, coughing, catarrh, Koplik spot and generalized maculopapular rash were considered as the main symptoms.88.9%of the cases were tested positive for the antibody of measles virus Immunoglobulin M.610cases (about91.6%) had complications:405cases were with bronchitis or pulmonary infection as shown by chest X-ray;106cases were with hepatosplenomegaly detected by ultrasound;204cases whose liver function were tested,57.9%were with changed in liver function parameters. There was a high misdiagnosis rate in the initial diagnosis. Totally264cases (39.6%) were given intravenous infusion or other treatments in the outpatient section after misdiagnosed in local hospital or Affiliated Yuying Children’s Hospital of Wenzhou Medical College.12cases were given outpatient treatments as non-measles in more than two hospitals,69cases (10.4%) were initially assigned in non-infection and transferred to the non-isolation wards after diagnosed to be measles.Part Ⅱ An investigation of risk factors in hospitalized children with measlesMethod Parents of the100hospitalized cases in Affiliated Yuying Children’s Hospital of Wenzhou Medical College from January to July in2012completed the questionnaires. The investigation contained three aspects:general information, epidemiological situation and vaccination history, as well as parents’ awareness of vaccination. Age of onset, history of measles vaccination (MV), exposure history in medical institutions, contact history, treatment situation and the degree of parents’ awareness of vaccination were described.Result Cases within one-year-old accounted for78%,63%of them were with8-month-old. With the month of age growing older, numbers of cases within8-month-old increased.89%of the total cases had suffered exposure history in medical institutions;14cases were comfirmed that they have been exposed to the measles. Among the total cases,22cases had ever been to one hospital for treatment,50cases were in two hospitals for treatment, and28cases were in more than two hospitals. However, only9cases were diagnosed as measles at the first time, the first diagnostic coincidence rate was only9%.78%of the cases were given intravenous treatment in outpatient section. There were other patients in the consulting room when83%of the cases were seeing the doctor.72%of the cases felt that the air quality of the infusion room was poor or general.92%cases had vaccination cards.10cases of37cases with more than8-month-old completed vaccination, and vaccination rate was27%. Most parents had a high awareness of vaccination.Conclusion The seasonality of measles appear some new changes:measles is a year-round event and no obvious incidence peak is seen; Children under1-year-old are the high-risk group of measles. The tendency of younger patients suggests that some adjustments might be needed in vaccination administration and therapeutic strategy. Children more than8-month-old and meet up with the condition of planned immunization of measles are in a low vaccination rate. The misdiagnosed rate at the first time was high, with a confusion of diagnosis and therapy. Contact infection in hospital was one of the reasons of measles epidemics. Elimination of measles is a whole work which requires a multisectoral participation to formulate and implement the strategy of eliminating measles. Supplementary immunization and prevention of contact infection within hospital are the key points to prevent the spread of measles.