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Pediatrics |

Pulmonary Complications in Last Measles Outbreak Among Unvaccinated Children From Nomad Collectivities, in Constanta County, Romania

Simona Cambrea, PhD; Margareta Ilie, MD; Elena Dantes, PhD; Ioan Arghir, MS; Stela Halichidis, PhD; Oana Arghir, PhD
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Faculty of Medicine "Ovidius" University, Constanta, Romania


Chest. 2013;144(4_MeetingAbstracts):759A. doi:10.1378/chest.1704230
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Abstract

SESSION TITLE: Hot Topics in Pediatic Pulmonology

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM

PURPOSE: In Romania, there is a Measles National Program of Vaccination, but in the nomad collectivities of gypsies, vaccination is very difficult to apply. In the last 10 years in Constanta County we noticed two measles outbreaks, 2005/2006 and 2011/2012. The aim consists in assessing the impact of measles non vaccination on pulmonary complications in children, in the last measles outbreak, related with the nomad collectivities of gypsies.

METHODS: We performed a retrospective study of 291 medical files of children mean aged 4.89 yrs +/- 2.34 std dev. (limits 4 months to 14 years): 162 boys and 129 girls, diagnosed with measles and hospitalised in The Paediatric Infectious Diseases Department of The Infectious Diseases Clinical Hospital, of Constanta, Romania, in the last outbreak, which was 2 consecutive years: 2011-2012. All cases were immunocompetent. Clinical diagnosis of the disease was confirmed in the acute phase by serological tests of measles-specific IgM antibodies. All complications were assessed. Etiologic fraction in exposed (EFe) unvaccinated children was evaluated.

RESULTS: Measles vaccine was not performed in 266 children (91.40%). The gypsies represented 86.94% of the cases (n=253/291) and 79.69% of the unvaccinated children (n=212/266). Measles complications were associated with the disease especially in unvaccinated gypsy children under the age of four (n1=145/179; 81% vs n2= 6/21; 28.57%; OR= 10.66; RR= 2.835; EFe= 64.73%; χ2= 27.8; p< 0.000). The most serious complications included meningoencephalitis (0.68%) and severe respiratory infections such as pneumonia and bronchopneumonia (n= 234/291; 80.41%). Measles was associated with Pulmonary Primary Tuberculosis (TB) in 5 children (1.7%). In this outbreak, pulmonary complications, including TB, were more frequent in unvaccinated gypsies (n= 204/212; 96.22% vs 35/54; 64.81%; OR= 13.84; RR= 1.485; EFe= 32.64%; χ2=46.39; p< 0.000). No death was registered.

CONCLUSIONS: Unvaccinated gypsies under 4 are at highest risk of measles (EFe=64.73%) and most exposed to pulmonary complications (EFe= 32.64%) versus study paediatric population (p< 0.000).

CLINICAL IMPLICATIONS: Unvaccinated young children are at highest risk of measles and its complications, including death. In gipsy collectivities, it is necessary to perform a better epidemiological survey for correct implementation of measles vaccination program.

DISCLOSURE: The following authors have nothing to disclose: Simona Cambrea, Margareta Ilie, Elena Dantes, Ioan Arghir, Stela Halichidis, Oana Arghir

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