Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30333, USA.
National Public Health Institute, Bucharest, Romania.
BMC Infect Dis. 2021 Mar 19;21(1):279. doi: 10.1186/s12879-021-05966-3.
Case fatality ratio (CFR) among all age groups during the 2016-2018 measles outbreak in Romania was increased compared with previous outbreaks. To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles.
National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged < 59 months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases ("cases") and 250 non-fatal cases ("controls") matched by age, sex, district of residence, and urban/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors.
Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21 day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0-24.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4-35.3]).
Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania.
与以往疫情相比，2016-2018 年罗马尼亚所有年龄段麻疹的病死率（CFR）均有所上升。为了确定麻疹死亡的危险因素，我们对因麻疹住院的婴儿和儿童进行了病例对照研究。
利用国家监测数据，确定了 2016 年 1 月至 2018 年 7 月期间发病年龄<59 个月、有皮疹的实验室确诊或流行病学相关麻疹住院婴儿和儿童病例。我们摘录了 50 例死亡病例（“病例”）和 250 例非死亡病例（“对照”）的病历，这些病例按年龄、性别、居住地和城市/农村居住地进行匹配。我们计算了危险因素的单变量和多变量匹配比值比（OR）和 95%置信区间（CI）。
93%的病例患者和对照者均未接受一剂含麻疹疫苗；仅有 5%的病例患者在确诊麻疹后接受过一次维生素 A 补充。在单变量分析中，与对照者相比，病例者更有可能因肺炎而有与医疗相关的麻疹暴露，表现为麻疹潜伏期 7-21 天内的住院治疗（OR：3.0；95%CI [1.2，7.2]），有营养不良史（OR：3.4；95%CI [1.1，9.9]），麻疹并发症为肺炎（OR：7.1；95%CI [2.0-24.8]）。在多变量分析中，麻疹并发症肺炎仍然是死亡的危险因素（OR：7.1；95%CI [1.4-35.3]）。
实施感染预防和控制措施，确保卫生保健工作者免疫接种，并仅对重症麻疹病例住院治疗，可能会最大程度地降低医院内麻疹传播的风险。实施世界卫生组织（WHO）关于维生素 A 补充的建议，改善儿童免疫接种，以预防流感、肺炎球菌和其他细菌性呼吸道疾病，可能会降低罗马尼亚麻疹的并发症和死亡率。
