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

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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.

Lo Vecchio A1 Krzysztofiak A2 Montagnani C3 Valentini P4 Rossi N5 Garazzino S6 Raffaldi I7 Di Gangi M8 Esposito S9 Vecchi B10 Melzi ML11 Lanari M12 Zavarise G13 Bosis S14 Valenzise M15 Cazzato S16 Sacco M17 Govoni MR18 Mozzo E19 Cambriglia MD1 Bruzzese E1 Di Camillo C220 Pata D4 Graziosi A5 Sala D11 Magurano F21 Villani A2 Guarino A1 Galli L321; SITIP Measles Study Group.

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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.

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS:

children; complication; genotype; measles; severe outcome

PMID: 30636224 DOI: 10.1136/archdischild-2018-315290