Title: The Clincico – Epidemiologic profile and the correlation of nutrition and immunization status with outcome of Measles patients during an outbreak

Abstract:

Objectives: To describe the demographic and clinical profile of pediatric patients diagnosed with measles during the recent measles outbreak in a tertiary hospital in Central Luzon, Philippines; and to investigate the relationship of nutrition and measles immunization status with the outcomes of measles infection

Methods: Cross sectional analytic study.

Setting: Tertiary training government hospital in Pampanga.

Participants: Patients less than 19 years old, admitted between January to April 2019; manifested the following criteria for suspected measles:  fever, generalized maculopapular rash, cough, coryza, conjunctivitis.

Main Outcome Measure:  Descriptive statistics was used to present data for the clinico-demographic profile of patients. Correlation study was done by determining statistical significance of the relationship of nutrition and vaccination status with measles complications and outcomes; and the relationship of major complications with outcomes of patients.

Results: A total of 373 patients were included in this study, 60% were males and 40% were females. Majority were under 0-6 months (40%). Most cases came from Pampanga (89.2%).  Three Hundred fifty five (95%) were classified as clinically compatible measles and seven (2%) were laboratory confirmed cases and all had Measles IgM antibodies. Most of the cases manifested the classic symptoms of measles: fever 100%, rashes 99%, cough 96%, colds 84%, conjunctivitis 55% while Koplik’s spots was seen in only 13% of cases. As to exposure, those with exposure (49%) and without exposure (51%) are almost the same.  Majority of the patients (76%) had no measles vaccine and the top reason for non-immunization is the issue on the patients being too young for vaccination. Majority had normal nutritional status (72.4%). Three Hundred Twelve reported the occurrence of clinical complications in patients with measles. Pneumonia was seen in 75% of cases and 9.3% had diarrhea. The occurrence of diarrhea is not directly correlated (p-value=0.823) with the outcome of measles while Pneumonia shows significant correlation with outcome of measles (p-value<0.001). Death was seen among patients with pneumonia. The occurrence of pneumonia is not significantly correlated with nutritional status (p-value=0.083) while diarrhea is significantly correlated with nutritional status (p-value=0.027). Two hundred forty eight patients with normal nutritional status did not develop diarrhea. Vaccination status shows significant correlation with occurrence of pneumonia (p-value=0.001). Out of the 285 non-vaccinated cases, 223 developed pneumonia. Vaccination status did not show significant correlation with occurrence of diarrhea (p-value=0.946). Nutritional status and vaccination status was not significantly correlated with measles outcome(p-value=0.605 and 0.120). In terms of outcomes, 90% of the patients were discharged while10% of the patients died.

Conclusion: Most were males, aged 0 to 6 months. There were clustering of cases in Pampanga. Majority were classified as clinically compatible measles. The most common complication seen was pneumonia. About half had exposure to measles. Majority had no measles immunization and the most common reason for failure for immunization is young age of patients during the time of vaccination. The presence of diarrhea is significantly related with nutritional status. Pneumonia is significantly correlated with vaccination status and outcome of measles. Most were discharged well improved.

Keywords: Measles, Outbreak, Pneumonia.

Biography:

Princess Alexandra B. Duque-David completed Doctor of Medicine at the age of 24 years at Far Eastern University- NRMF, Quezon City, Philippines. Recently, completed her residency training in Pediatrics at Jose B. Lingad Memorial Regional Hospital, Pampanga, Philippines.