Clinical characteristics and outcomes of measles outbreak in adults: a multicenter retrospective observational study of 93 hospitalized adults in Greece

Fragkou, Paraskevi C.; Thomas, Konstantinos; Sympardi, Styliani; Liatsos, George D.; Pirounaki, Maria; Sambatakou, Helen; Marantos, Theodoros; Karofylakis, Emmanouil; Dourakis, Spyridon P.; Tsiodras, Sotirios; Kavvatha, Dimitra

OBJECTIVES: Measles outbreaks are increasingly reported among countries that were close-to-eliminate measles infection. There are few reports of clinical characteristics of adult measles in the contemporary literature. In this study we aim to describe the clinical characteristics and complications of measles infection in hospitalized adults during the recent epidemic in Greece. METHODS: A multicentre observational retrospective study was conducted in three tertiary hospitals in Greece. All adult hospitalized patients (≥18 years old) with serologically confirmed and/or clinical features compatible with measles were included. Pediatric patients and patients with missing data were excluded. RESULTS: In total, 93 patients, 40 males (43%) and 53 females (57%), mostly young patients were included. Most of them (87%) had no past medical history. Among women, 4 were pregnant. 56 (60.2%) and 25 (26.9%) patients reported either unknown or incomplete vaccination for measles. Ribavirin was administered in 8 (8.6%) patients. Pneumonitis and hepatic involvement were the most common complications, occurring in 43 (46.2%) and 75 (80.6%) patients respectively. Pneumonitis was significantly associated with male sex, older age, lower lymphocyte counts and higher C-reactive protein (CRP) on admission. One pregnant woman suffered spontaneous fetal miscarriage and one patient died due to acute respiratory distress syndrome (ARDS) and high-risk pulmonary embolism. CONCLUSION: Considerable proportions of incompletely vaccinated or unvaccinated adults have led to the re-emergence of measles in countries with reported close-to-elimination rates. Pneumonitis is a major complication among adults with measles. More studies are imperative in order to explore the role of immune paresis in measles.