Risk factors for severe complications and mortality among hospitalized children with measles during a major outbreak in Northern Vietnam, 2017 - 2019

Abstract

SummaryIntroductionMeasles outbreaks increased worldwide during the period of 2017-2019. Similarly, Vietnam experienced one of the largest measles outbreaks in recent decades, with various paediatric patients presenting severe complications. In this study, we aim to identify factors associated with death and severity among children with measles admitted to Vietnam National Children’s Hospital (VNCH) in Hanoi, Vietnam between 2017 and 2019.MethodThis single-center retrospective cohort study included 2, 072 patients with measles admitted to VNCH from 1/1/2017 to 31/12/2019. Data on epidemiological, clinical characteristics, vaccine status, and outcomes were collected and summarised. We conducted both univariable and multivariable logistic regression analyses to examine the correlations between various characteristics of hospitalized children and mortality.FindingsIn total, there were 2, 072 patients, including 1, 297 (62.6%) males and 775 (37.4%) females. The median age was 9 months (interquartile range 7−17). 87.3% of cases had not received any measles-containing vaccine (MCV). 30 (1.4%) patients died, with 40% aged less than 9 months. Only 3 among 30 (10%) who died had received at least 1 dose of MCV. Bronchopneumonia was the most common complication, occurring in 1, 413 (68.2%) patients. The following characteristics were significantly associated with mortality in the multivariable analysis: age under 9 months and age from 9 months to 5 years, residing 20 to 200 kilometres from VNCH, and having co-infection with adenovirus or other hospital acquired infections. Age group was also significantly associated with severity in the multivariable analysis.InterpretationVietnam continues to face the threat of future measles epidemics, given the burden of hospitalization and the high rate of complications observed in hospitalized patients. This highlights the critical need to maintain high measles vaccine coverage, particularly by targeting the unvaccinated population. To prevent future outbreaks and lower measles incidence, routine immunization needs to be strengthened, and earlier scheduling of MCV1 needs to be further evaluated. The comprehensive analysis of the 2017-19 measles outbreak presented in this study will contribute to informed decision-making regarding appropriate measures to counteract future resurgences of measles in Vietnam.FundingNo specific grant from funding agencies in the public, commercial or not-for-profit sectors supported the submission and publication of this manuscript.