Clinical characteristics and outcome of children evaluated and treated at Tygerberg Children’s Hospital during a measles epidemic

Ferreira-Van Der Watt, Talita Aletta (2014-04)

Thesis (MMed)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Objective: To describe the clinical characteristics and outcome of children presenting to Tygerberg Children’s Hospital with measles infection Methods: This was a retrospective, descriptive study of children presenting to Tygerberg Children’s Hospital, from 1 February to 31 March 2010 with a diagnosis of measles, during the measles epidemic of 2009/2010. Folders of every second admission were reviewed. Data was analysed using Statistica version 10 of 2012. The study was approved by Stellenbosch University Ethics Committee. Results: Five hundred and eighty five children were seen and evaluated for complicated measles, 239 patients were included. Seventy nine percent (n=189/239) were admitted of which 54.3% were male. The median age at admission was 9 (Interquartile range 6 to 19) months. Children less than 9 months accounted for 50.2% (n=120) and 25.9% (n=62) were less than 6 months of age. The median WHO weight-for-age Z-score (WAZ) was 0.69 (IQR - 1.82 to 0.29), malnutrition was found in 39.9% (n=81) of children less than 5 years. Children residing in the Khayelitsha sub-district accounted for 43.1% (n=103) of the study population. Uptake of the first dose of measles vaccine was 31.1% and of the second dose of measles vaccine was 23.8%. The median length of stay (LOS) was 3 days (IQR 2 – 5 days). Gastroenteritis (67.4%; n=161) and pneumonia (54.4%; n=130) were the most common complications. The majority assessment. A single dose of children had more than one complication at the time of of vitamin A was received by 71.1% (n=170/239) of children during evaluation and 47.6% (n=114/239) received 2 doses. Seven (2.9%; n=7/239) patients required ICU care. Four (57.1%; n= 4/7) were less than 9 months of age. Pneumonia (85.7%; n=6) was the most common reason for admission. Four (1.7%; n=4/239) children died. The median age at death was 9 months (IQR 7 – 14 months). Pneumonia (75%; n=3/4) was the most common cause of death. HIV testing was done in 40.6% (n=97/239) of children. HIV exposure was found in 28.9% (n=69/239) on history. HIV infection was present in 8.4% (n=20/239) of children, of these, 60% (n=12/20) were on HAART. HIV-infected children were older than HIV-uninfected children (median 40 and 9 months respectively, p=0.003). Thirty percent (n=6/20) of HIV- infected children had received any measles vaccination prior to admission. Five percent (n=1/20) of HIV-infected children died vs 4.2% (n=3/72) of children who were confirmed HIV negative. Conclusion: Our study showed that measles causes a significant burden of morbidity and mortality in children. HIV infection however did not increase the morbidity and mortality due to measles co-infection. Interventions to improve vaccination rates and practices at community level are required in order to prevent further epidemics in the future. Further research is needed to determine whether the first measles vaccine dose should be given earlier rather than 9 months of age in order to prevent early infection.

AFRIKAANSE OPSOMMING: Objektief: Beskrywing van kliniese eienskappe en uitkoms van kinders wat aan Tygerberg Kinderhospitaal presenteer het, met masels infeksie. Metodiek: Hierdie was ‘n retrospektiewe, beskrywende studie van kinders wat aan Tygerberg Kinderhospitaal presenteer het met ‘n diagnose van masels vanaf 1 Februarie tot 31 Maart 2010. Dit vind plaas gedurende die 2009/2010 masels epidemie. Leers van elke tweede opname is gebruik. Data is geanaliseer met Statistica weergawe 10 van 2012. Die studie is goedgekeur deur die Stellenbosch Universiteit Etiese Kommittee. Resultate: Vyf honderd vyf en tagtig kinders is gesien en evalueer vir gekompliseerde masels, 239 pasiente is in die studie ingesluit. Nege en sewentig persent (n=189/239) is opgeneem waarvan 54.3% (Interkwartielvariasiewydte 6 manlik was. Die mediaan ouderdom met opname was 9 tot 19) maande. Kinders jonger as 9 maande het 50.2% (n=120) van die studiepopulasie verteenwoordig. Die mediaan Wereld Gesondheids Organisasie gewig-vir-ouderdom was 0.69 (IKR -1.82 tot 0.29), wanvoeding is gevind in 39.9% (n=81) van kinders onder 5 jaar ouderdom. Kinders woonagtig in Khayelitsha woongebied het 43.1% (n=103) van die studiepopulasie verteenwoordig. Opname van die eerste masels entstof dosis was 31.1% en van die tweede dosis was 23.8%. Die median duur van opname (DVO) was 3 dae (IKR 2 – 5 dae). Gastro-enteritis (67.4%; n=161) en pneumonie (54.4%; n=130) was die mees algemene komplikasies. Die meerderheid van kinders het meer as een komplilkasie gehad ten tye van hul evaluasie. ‘n Enkele dosis vitamien A is ontvang deur 71.1% (n=170/239) van kinders gedurende evaluasie en 47.6% (n=114/239) het 2 dosisse ontvang. Kinders wat ‘n enkele dosis vitamien A ontvang het, het ‘n korter DVO gehad as kinders wie geen (mediaan 2 vs 5 dae, p=<0.001) of twee dosisse van vitamien A (mediaan 2 vs 3 days, p=<0.001) ontvang het. Sewe (2.9%; n=7/239) kinders het intensiewe sorg benodig. Vier (57.1%; n= 4/7) was jonger as 9 maande oud. Pneumonie (85.7%; n=6) was die mees algemene rede vir toelating. Vier (1.7%; n=4/239) kinders het gesterf. Die mediaan ouderdom by sterfte was 9 maande (IKR 7 – 14 maande). Pneumonie (75%; n=3/4) was die mees algemene oorsaak van dood. MIV toetse is gedoen op 40.6% (n=97/239) van kinders. ‘n Geskiedenis van MIV blootstelling is gevind in 28.9% (n=69/239) van kinders. MIV infeksie was teenwoordig in 8.4% (n=20/239) van kinders, van hierdie was 60% (n=12/20) op HAART. MIV positiewe kinders was ouer as MIV negatiewe kinders (mediaan 40 en 9 maande, p=0.003). Dertig persent (n=6/20) van MIV positiewe kinders het ‘n masels inenting ontvang voor opname. Vyf persent (n=1/20) van MIV positiewe kinders het gesterf, teenoor kinders wat MIV negatief bevestig was. 4.2% (n=3/72) van Gevolgtrekking: Ons studie wys dat masels noemenswaardige morbiditeit en mortaliteit in kinders veroorsaak. MIV infeksie het egter nie die morbiditeit en mortaliteit verhoog as gevolg van masels ko-infeksie nie.

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