Clinical characteristics of measles in patients hospitalized during the epidemic rise

Abstract

Background. Measles is one of the infections that have become more prevalent in the post-pandemic period. This highly contagious disease, characterized by a high risk of severe symptoms and complications, is now being reported more frequently, including in adults, and has acquired a number of clinical and laboratory features. Studying the current clinical manifestations of measles in adults and children will help improve the effectiveness of measures to combat this infection. Objective. Analysis of the current clinical manifestations of measles in patients of an infectious hospital during a tense epidemiological situation in the Kemerovo Region-Kuzbass. Materials and methods. A retrospective analysis of the clinical and laboratory manifestations of measles in patients of an infectious hospital with a verified diagnosis was carried out. The blood was tested for IgM antibodies to the measles virus using the ELISA method using the VektoKor-IgM test systems produced by Vector-Best (Russia). The protocols of the laboratory test results of the Testing Laboratory Center of the Federal State Budgetary Institution "Center for Hygiene and Epidemiology in the Krasnoyarsk Region" were used. Statistical analysis of the data was performed using the MedStat software.Pro v0.9.4 (Russian Federation). The normality of the distribution was checked using the Shapiro – Wilk criterion. To assess the accuracy of the proportion determination, a 95% confidence interval (95% CI) was constructed using the Wilson score interval. The statistical significance of the differences was assessed using the exact Fisher criterion or the chi-squared criterion (with the Yates correction for expected frequencies of less than 5). The level of statistical significance was taken at p < 0.05. Results. Unvaccinated patients prevailed in the structure of measles patients. Contacts were established in 80.3%. Children accounted for 60.66%, adults – 39.34%. A directional diagnosis in 66% did not suggest measles. The clinical picture corresponded to the typical course. Classical periods were traced in 83.6% of patients. Belsky – Filatov – Koplik spots were detected in 24.6%. The stage of the rash was recorded in 93.4%. The hemogram showed a moderate increase in ESR, leukopenia, relative lymphocytosis, and thrombocytopenia in adults, and normocytosis in children. The increase in CRP was observed in 72%, and a transient increase in liver enzymes was observed in 50% of adults (1.5-5 times the normal value or higher) and 60% of children (1.5-3 times the normal value). In complex therapy, human recombinant interferon alpha-2b with antioxidants (vitamins C and E) was used in the form of rectal suppositories in age-appropriate doses. The course of the disease was smooth, and complications were not observed. Conclusion. The emergence of measles outbreaks is associated with low vaccination coverage, high contact rates, and imported cases. The clinical presentation of measles is typical. In adults, the main symptoms are significantly more pronounced. Laboratory tests confirm the viral nature of the disease and reveal transient changes in liver enzymes, which are more pronounced in adults. The main preventive measures should focus on increasing vaccination coverage and strengthening epidemiological surveillance in the context of interregional population mobility.