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Complications and risk factors for severe outcome in children with measles
  1. Andrea Lo Vecchio1,
  2. Andrzej Krzysztofiak2,
  3. Carlotta Montagnani3,
  4. Piero Valentini4,
  5. Nadia Rossi5,
  6. Silvia Garazzino6,
  7. Irene Raffaldi7,
  8. Maria Di Gangi8,
  9. Susanna Esposito9,
  10. Barbara Vecchi10,
  11. Maria Luisa Melzi11,
  12. Marcello Lanari12,
  13. Giorgio Zavarise13,
  14. Samantha Bosis14,
  15. Mariella Valenzise15,
  16. Salvatore Cazzato16,
  17. Michele Sacco17,
  18. Maria Rita Govoni18,
  19. Elena Mozzo19,
  20. Maria Donata Cambriglia1,
  21. Eugenia Bruzzese1,
  22. Chiara Di Camillo2,20,
  23. Davide Pata4,
  24. Alessandro Graziosi5,
  25. Debora Sala11,
  26. Fabio Magurano21,
  27. Alberto Villani2,
  28. Alfredo Guarino1,
  29. Luisa Galli3,21
  30. for the SITIP Measles Study Group
  1. 1 Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
  2. 2 Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Children’s Hospital Bambino Gesù, Rome, Italy
  3. 3 Pediatric Infectious Diseases Unit, Anna Meyer Children’s University Hospital, Florence, Italy
  4. 4 Pediatrics Branch, Department of Women and Child Health, ’A. Gemelli' University Hospital, Catholic University of the Sacred Heart, Rome, Italy
  5. 5 Department of Pediatrics, University of Chieti, Chieti, Italy
  6. 6 Infectious Diseases Unit, Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy
  7. 7 Department of Pediatrics and Neonatology, Ospedale Civile di Ciriè, Turin, Italy
  8. 8 Pediatric Infectious Disease Unit, Children Hospital ’ISMEP Di Cristina', Palermo, Italy
  9. 9 Pediatric Clinic, Department of Surgical and Biomedical Sciences, Universita degli Studi di Perugia, Perugia, Italy
  10. 10 Pediatric Unit and Neonatal Intensive Care Unit, Azienda Ospedaliera Santa Maria, Terni, Italy
  11. 11 Pediatric Department, Milano-Bicocca University MBBM Foundation, Monza, Italy
  12. 12 Department of Medical and Surgical Sciences - Pediatric Emergency Unit, Alma Mater Studiorum - University of Bologna, Bologna, Italy
  13. 13 Pediatric Unit, Hospital of Negrar ’Sacro Cuore Don Calabria', Verona, Italy
  14. 14 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  15. 15 Pediatric Unit, Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
  16. 16 Pediatric Unit, Department of Mother and Child Health, Salesi Children’s Hospital, Ancona, Italy
  17. 17 Pediatric Unit, Research Institute Hospital ’Casa Sollievo della Sofferenza' San Giovanni Rotondo, Foggia, Italy
  18. 18 Pediatric Unit, University Hospital ’S. Anna', Ferrara, Italy
  19. 19 Pediatric Unit, Hospital of Dolo, Verona, Italy
  20. 20 Department of Health Sciences, University of Florence, Meyer Children’s University Hospital, Florence, Italy
  21. 21 National Measles Reference Laboratory (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome, Italy
  1. Correspondence to Professor Alfredo Guarino, Section of Pediatrics – Unit of Pediatric Infectious Diseases, Department of Translational Medical Sciences, University of Naples Federico II, Napoli NA 80138, Italy; alfguari{at}


Objective and design Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death.

Results Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01).

Conclusion The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.

  • measles
  • complication
  • severe outcome
  • genotype
  • children

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  • Contributors Conceptualisation: ALV, AGu. Project administration: ALV, LG. Database creation and curation: ALV, MDC. Formal analysis: ALV, LG, CM. Methodology: ALV, LG. Data collection: AK, PV, NR, SG, IR, MDG, EM, GZ, MRG, MS, MLM, BV, SC, SE, ML, MV, SB, MDC, CM, DS, CDC, AGr, DP. Laboratory genotype analysis: FM. Writing original draft: AVL, LG, CM. Writing, review and editing: AGu, LG, CM, EB, AVL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was conducted according to the principles of the Declaration of Helsinki and approved by the Paediatric Ethics Committee of the Tuscany region.

  • Provenance and peer review Not commissioned; externally peer reviewed.