Premaratna Ranjan, Luke Nathasha, Perera Harsha, Gunathilake Mahesh, Amarasena Pubudu, Chandrasena T G A Nilmini
Professorial Medical Unit, Colombo North Teaching Hospital, Ragama and Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
Professorial Medical Unit, Colombo North Teaching Hospital, Ragama and Department of Clinical Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
BMC Res Notes. 2017 Jan 10;10(1):38. doi: 10.1186/s13104-017-2374-6.
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.
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.
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.
麻疹由副粘病毒引起，其特征为发热、不适、咳嗽、鼻炎、结膜炎，伴有斑丘疹，已知可导致肺炎、脑炎甚至死亡。自1984年斯里兰卡实施国家免疫规划后，麻疹致死病例较为罕见。此后，1999年10月至2000年6月期间观察到的病死率为0.1%，与其他地区国家相比这一数字非常低。2001年、2011年及2012年免疫指南进一步修订，建议对4至21岁免疫可能不充分的年龄组进行额外免疫，以期到2020年消除麻疹。然而，2013年至2014年报告了4690例病例，其中大多数为1岁以下儿童。已发表的流行病学报告中难以查到成人病例情况，但在2013年第三季度成人病例占38%（1008例患者中）。在此次疫情中，斯里兰卡中央省报告的101例中有73例（72%）年龄超过12岁，其中50%年龄超过29岁。对2014年6月至2016年3月期间偶发的14例确诊麻疹感染的斯里兰卡成年患者[中位年龄32岁（范围25 - 48岁）]在获得知情同意后进行回顾性纳入研究。通过使用访谈者管理的问卷或患者管理记录收集有关其临床表现、免疫接种及其他相关方面的详细信息。
患者在3至5天内出现高热、头痛、全身剧痛、咽痛、干咳、流泪、眼红及颈后淋巴结肿大。随后出现散在斑丘疹，有助于诊断。他们有不同程度的白细胞减少、淋巴细胞增多、血小板减少及肝功能紊乱，类似登革热、基孔肯雅热、钩端螺旋体病或寨卡病毒感染等其他急性发热性疾病。
由于对麻疹在成人中发病情况不了解、对成人麻疹不熟悉、疾病的非特异性以及缺乏快速诊断方法，观察到诊断至少延迟3至5天（甚至在一些患者出现皮疹后），这有将病毒传播给免疫功能低下或未免疫的医护人员或患者的风险。确定这些散发性成人病例的感染源及其病毒学监测和分子流行病学对于阻断传播以及到2020年在斯里兰卡实现消除麻疹的目标至关重要。
