Measles Hospitalizations at a United States Children’s Hospital 2011–2017

Abstract

Background: There are no recent descriptions of measles hospitalizations and complications in US children despite outbreaks within the past decade—including 2 in Minnesota (2011 and 2017). The objective of our study was to describe complications, hospital management and resource utilization for children hospitalized for measles at a US children’s hospital. Methods: Retrospective case series of children (0–18 years of age) hospitalized for measles (observation/inpatient diagnosis code for measles) at Children’s Minnesota, January 1, 2011, to September 1, 2017. Descriptive statistics were performed. Results: Thirty-three patients were included (7 from 2011 and 21 from 2017 outbreaks). Median age was 27 months (range, 6–95 months), 94% were Black or African American (73% Somali ethnicity), 88% had medical assistance and 91% were unvaccinated to measles. Poor feeding was a primary reason for admission (97%); additional complications included otitis media (42%), pneumonia (30%), tracheitis (6%) and keratitis (3%). Additional testing was common [chest radiographs (70%), blood cultures (64%), nonmeasles viral testing (42%)]. Seventy-three percent received antibiotics, 30% required oxygen and 21% received vitamin A. Median length of stay was 3.7 days (range, 1.1–26.2 days); 1 patient was readmitted. Median direct cost in 2017 was $5291 (interquartile range : $3907–$7519), and estimated total cost to the hospital for the 2017 outbreak was $1.3 million. Conclusions: Clinicians should be aware of measles complications and treatment. Public and private health efforts should continue to focus on immunization, given significant implications of measles infections for patients and healthcare systems. Future studies may assess complications of measles across the United States as individual outbreaks often occur in specific populations, making generalization of results challenging.

Measles epidemic in pediatric population in Greece during 2017–2018: Epidemiological, clinical characteristics and outcomes

“…Regarding laboratory parameters of hospitalized children with measles, there was a significant number of children with mild (26%) or severe (3.8%) hyponatremia at presentation, a finding that is not regularly described. Elevated transaminases were detected in 40.6% of measles cases, which was also found in other studies [29,31].…”

“…In the present study a high hospitalization rate of 59.2% was found, but rates lower than 20%, or higher than 60% have also been reported [11,12,17,25,29,30]. This wide range of hospitalization rates worldwide may be related to differences in management and surveillance systems, health policies and the affected age groups.…”

Inpatient morbidity and mortality of measles in the United States

“…From 1996 to 2002 measles hospitalizations were at an all-time low in US history with an estimated �23 cases annually [27]. While more recent data is lacking, an analysis of measles hospitalizations in a single children's hospital in Minnesota from 2011-2017 showed 33 total cases, driven largely by a 2017 outbreak in the Somali-American community [30]. Despite measles being officially declared eliminated from the US in 2000 [23,24], this study found 1,018 weighted hospitalizations for measles (mean of 68 cases per year) and rising number of measles hospitalizations from 2002-2016.…”

“…The average cost per measles-related hospitalization was $7,438 with total cost from 2002-2016 of $16,973,795. There was an estimated $10,000 cost per hospitalization during the 1989-1991 US measles outbreak [11], and while recent cost estimates are limited, the median cost per measles hospitalization in a single children's hospital from 2011-2017 was $5,291 [30]. Measles hospitalization costs include infection control required to stop nosocomial spread, such as isolation precautions, testing of exposed individuals, vaccine/immunoglobulin administration, tracing of cases, and the personnel hours required to carry out these tasks [43,44].…”

Vaccination Policies and Disease Incidence Across the Pond: Implications for the United States

“…Importantly, these types of financial penalties may also be fair because it is clear that persons unvaccinated by parental choice place an unneeded financial burden on our health care system. [7][8][9] A limitation is that this study was limited to European Union member states, Norway, and Iceland, which leaves out several European countries that have had high rates of measles in recent years (Ukraine, in particular). 10 A strength of the study was adjusting for several covariates likely to impact vaccination uptake to better understand the consequences of these policies.…”