Measles Outbreak in a High-Income Country: Are Pediatricians Ready?
Adolescent
Child
Child, Hospitalized
Child, Preschool
Diagnosis, Differential
Diagnostic Errors
/ statistics & numerical data
Disease Outbreaks
Female
Humans
Infant
Italy
/ epidemiology
Length of Stay
/ statistics & numerical data
Male
Measles
/ diagnosis
Measles Vaccine
/ administration & dosage
Retrospective Studies
diagnosis
epidemics
viral infections
Journal
Journal of the Pediatric Infectious Diseases Society
ISSN: 2048-7207
Titre abrégé: J Pediatric Infect Dis Soc
Pays: England
ID NLM: 101586049
Informations de publication
Date de publication:
17 Sep 2020
17 Sep 2020
Historique:
received:
02
05
2019
pubmed:
8
11
2019
medline:
16
6
2021
entrez:
8
11
2019
Statut:
ppublish
Résumé
Measles is a highly communicable infection with potentially severe complications. It is rarely reported in high-income countries and the limited awareness and experience of pediatricians may result in misdiagnosis. The present study aimed at investigating physician's ability and timing to reach diagnosis during a recent outbreak in Italy. The Italian Society for Pediatric Infectious Diseases conducted a retrospective, multicenter study in children hospitalized for measles between 1 January 2016 and 30 August 2017 in secondary and tertiary care hospitals. The appropriateness of diagnosis at admission, the time to reach clinical diagnosis, and serological confirmation of measles were recorded. At hospital admission, measles was misdiagnosed in 101 (40.5%) of the 249 children (median age, 14.5 months) enrolled. The appropriate diagnosis increased from 30% to 72.5% during the period of observation (P < .001). A greater chance of receiving an appropriate diagnosis was demonstrated in children who reported a contact with measles (odds ratio [OR], 5.2; 95% confidence interval [CI], 3.0-9.2) or in those seen in institutions that managed more cases (OR, 7.39; 95% CI, 3.22-16.9; P = .0001). In contrast, children with underlying chronic conditions had a higher risk of misdiagnosis (appropriate diagnosis OR, 0.19; 95% CI, 0.10-0.33). The mean time from the onset of symptoms to clinical diagnosis was 4.55 ± 2.2 days and to serological confirmation was 7.0 ± 3.4 days. Measles is frequently misdiagnosed in low-prevalence settings. Specific measures to increase pediatricians' awareness about vaccine-preventable infections need to be implemented.
Sections du résumé
BACKGROUND
BACKGROUND
Measles is a highly communicable infection with potentially severe complications. It is rarely reported in high-income countries and the limited awareness and experience of pediatricians may result in misdiagnosis. The present study aimed at investigating physician's ability and timing to reach diagnosis during a recent outbreak in Italy.
METHODS
METHODS
The Italian Society for Pediatric Infectious Diseases conducted a retrospective, multicenter study in children hospitalized for measles between 1 January 2016 and 30 August 2017 in secondary and tertiary care hospitals. The appropriateness of diagnosis at admission, the time to reach clinical diagnosis, and serological confirmation of measles were recorded.
RESULTS
RESULTS
At hospital admission, measles was misdiagnosed in 101 (40.5%) of the 249 children (median age, 14.5 months) enrolled. The appropriate diagnosis increased from 30% to 72.5% during the period of observation (P < .001). A greater chance of receiving an appropriate diagnosis was demonstrated in children who reported a contact with measles (odds ratio [OR], 5.2; 95% confidence interval [CI], 3.0-9.2) or in those seen in institutions that managed more cases (OR, 7.39; 95% CI, 3.22-16.9; P = .0001). In contrast, children with underlying chronic conditions had a higher risk of misdiagnosis (appropriate diagnosis OR, 0.19; 95% CI, 0.10-0.33). The mean time from the onset of symptoms to clinical diagnosis was 4.55 ± 2.2 days and to serological confirmation was 7.0 ± 3.4 days.
CONCLUSIONS
CONCLUSIONS
Measles is frequently misdiagnosed in low-prevalence settings. Specific measures to increase pediatricians' awareness about vaccine-preventable infections need to be implemented.
Identifiants
pubmed: 31697374
pii: 5614432
doi: 10.1093/jpids/piz061
doi:
Substances chimiques
Measles Vaccine
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
416-420Investigateurs
Garazzino Silvia
(G)
Raffaldi Irene
(R)
Di Gangi Maria
(DG)
Esposito Susanna
(E)
Vecchi Barbara
(V)
Melzi Maria Luisa
(MM)
Lanari Marcello
(L)
Zavarise Giorgio
(Z)
Bosis Samantha
(B)
Valenzise Mariella
(V)
Cazzato Salvatore
(C)
Sacco Michele
(S)
Govoni Maria Rita
(G)
Mozzo Elena
(M)
Cambriglia Maria Donata
(C)
Davide Pata
(D)
Alessandro Graziosi
(A)
Debora Sala
(D)
Melissa Baggieri
(M)
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.