Laure Barthod, Jacques Fourgeaud, Mathilde Puges, Anne-Marie Rogues, Maïder Coppry, Jean Sarlangue, Alexandre Boyer, Didier Neau, Astrid Vabret, Julia Dina, Marie-Edith Lafon, Cazanave Charles
Infectious and Tropical Diseases Department, Bordeaux University Hospital, Bordeaux, France.
Virology Department, CHU Bordeaux, CNRS UMR 5234, University of Bordeaux, Bordeaux, France.
Open Forum Infect Dis. 2020 Aug 17;7(9):ofaa332. doi: 10.1093/ofid/ofaa332. eCollection 2020 Sep.
Measles remains endemic worldwide, despite current vaccination recommendations, and is associated with high morbidity and mortality rates. We describe all cases hospitalized in Bordeaux University Hospital (BUH), the starting point of a national significant measles outbreak in 2017-2018.
In this retrospective study, we included all patients hospitalized in BUH from September 1, 2017, to May 31, 2018. Inclusion criteria were age >1 year, clinical symptoms, and biological confirmation by measles immunoglobulin M or measles reverse transcription polymerase chain reaction positivity.
We included 171 patients. Most patients were immunocompetent; only 19% had preexisting medical histories. Most patients had rash and fever (97%), but some cases were atypical and difficult to diagnose. Köplik's spots were reported in 66 cases (38%). The most frequent biological markers were blood inflammation markers (96%) and lymphopenia (81%). Unexpectedly, we found hyponatremia (<135 mmol/L) in 40% of patients. We identified peaks in January and March, corresponding to 76 D8 genotypes and 28 B3 strains. The following complications were reported in 65 patients (38%): pneumonia, hepatitis, and keratitis; 10 had neurological symptoms. One patient had Guillain-Barré syndrome, and a young immunocompromised patient died from measles inclusion-body encephalitis. Most of the patients (80%) had not been correctly vaccinated, including 28 health care workers. Some patients (n = 43, 25%) developed measles despite having plasma IgG. These included 12 possible vaccination failure cases.
During the BUH outbreak, measles was often complicated and sometimes atypical. Vaccination coverage was dramatically insufficient. We also describe vaccination failure cases that must be better investigated.
尽管有当前的疫苗接种建议，但麻疹在全球范围内仍然流行，并与高发病率和死亡率相关。我们描述了在波尔多大学医院（BUH）住院的所有病例，该医院是2017 - 2018年全国重大麻疹疫情的发源地。
在这项回顾性研究中，我们纳入了2017年9月1日至2018年5月31日在BUH住院的所有患者。纳入标准为年龄>1岁、有临床症状以及通过麻疹免疫球蛋白M或麻疹逆转录聚合酶链反应阳性进行生物学确认。
我们纳入了171例患者。大多数患者免疫功能正常；只有19%有既往病史。大多数患者有皮疹和发热（97%），但有些病例不典型且难以诊断。66例（38%）报告有科氏斑。最常见的生物学标志物是血液炎症标志物（96%）和淋巴细胞减少（81%）。出乎意料的是，我们发现40%的患者有低钠血症（<135 mmol/L）。我们确定了1月和3月的高峰，对应76种D8基因型和28种B3毒株。65例患者（38%）报告有以下并发症：肺炎、肝炎和角膜炎；10例有神经系统症状。1例患者患有格林 - 巴利综合征，1例年轻免疫功能低下患者死于麻疹包涵体脑炎。大多数患者（80%）未正确接种疫苗，其中包括28名医护人员。一些患者（n = 43，25%）尽管有血浆IgG仍患麻疹。其中包括12例可能的疫苗接种失败病例。
在BUH疫情期间，麻疹常伴有并发症，有时不典型。疫苗接种覆盖率严重不足。我们还描述了必须更好地进行调查的疫苗接种失败病例。
