Andrea Lo Vecchio1, Carlotta Montagnani2, Andrzej Krzysztofiak3, Piero Valentini4, Nadia Rossi5, Elena Bozzola3, Guido Castelli Gattinara3, Fabio Magurano6, Alfredo Guarino1, Luisa Galli2,7. 1. Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Florence. 2. Pediatric Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence. 3. Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children Hospital. 4. Pediatrics Branch, Department of Woman and Child Health, "A. Gemelli" University Hospital, Rome. 5. Department of Pediatrics, University of Chieti and Pescara. 6. National Measles Reference Laboratory, Istituto Superiore di Sanità (ISS) and the Network of Subnational Reference Laboratory for Measles and Rubella, MoRoNet, Rome. 7. Department of Health Sciences, University of Florence, Meyer Children's University Hospital, Italy.
Abstract
BACKGROUND: Measles is a highly communicable infection with potentially severe complications. It is rarely reported in high-income countries and the limited awareness and experience of pediatricians may result in misdiagnosis. The present study aimed at investigating physician's ability and timing to reach diagnosis during a recent outbreak in Italy. METHODS: The Italian Society for Pediatric Infectious Diseases conducted a retrospective, multicenter study in children hospitalized for measles between 1 January 2016 and 30 August 2017 in secondary and tertiary care hospitals. The appropriateness of diagnosis at admission, the time to reach clinical diagnosis, and serological confirmation of measles were recorded. RESULTS: At hospital admission, measles was misdiagnosed in 101 (40.5%) of the 249 children (median age, 14.5 months) enrolled. The appropriate diagnosis increased from 30% to 72.5% during the period of observation (P < .001). A greater chance of receiving an appropriate diagnosis was demonstrated in children who reported a contact with measles (odds ratio [OR], 5.2; 95% confidence interval [CI], 3.0-9.2) or in those seen in institutions that managed more cases (OR, 7.39; 95% CI, 3.22-16.9; P = .0001). In contrast, children with underlying chronic conditions had a higher risk of misdiagnosis (appropriate diagnosis OR, 0.19; 95% CI, 0.10-0.33). The mean time from the onset of symptoms to clinical diagnosis was 4.55 ± 2.2 days and to serological confirmation was 7.0 ± 3.4 days. CONCLUSIONS: Measles is frequently misdiagnosed in low-prevalence settings. Specific measures to increase pediatricians' awareness about vaccine-preventable infections need to be implemented.
BACKGROUND: Measles is a highly communicable infection with potentially severe complications. It is rarely reported in high-income countries and the limited awareness and experience of pediatricians may result in misdiagnosis. The present study aimed at investigating physician's ability and timing to reach diagnosis during a recent outbreak in Italy. METHODS: The Italian Society for Pediatric Infectious Diseases conducted a retrospective, multicenter study in children hospitalized for measles between 1 January 2016 and 30 August 2017 in secondary and tertiary care hospitals. The appropriateness of diagnosis at admission, the time to reach clinical diagnosis, and serological confirmation of measles were recorded. RESULTS: At hospital admission, measles was misdiagnosed in 101 (40.5%) of the 249 children (median age, 14.5 months) enrolled. The appropriate diagnosis increased from 30% to 72.5% during the period of observation (P < .001). A greater chance of receiving an appropriate diagnosis was demonstrated in children who reported a contact with measles (odds ratio [OR], 5.2; 95% confidence interval [CI], 3.0-9.2) or in those seen in institutions that managed more cases (OR, 7.39; 95% CI, 3.22-16.9; P = .0001). In contrast, children with underlying chronic conditions had a higher risk of misdiagnosis (appropriate diagnosis OR, 0.19; 95% CI, 0.10-0.33). The mean time from the onset of symptoms to clinical diagnosis was 4.55 ± 2.2 days and to serological confirmation was 7.0 ± 3.4 days. CONCLUSIONS: Measles is frequently misdiagnosed in low-prevalence settings. Specific measures to increase pediatricians' awareness about vaccine-preventable infections need to be implemented.
Authors: Francesco Paolo Bianchi; Pasquale Stefanizzi; Giusy Diella; Andrea Martinelli; Antonio Di Lorenzo; Maria Serena Gallone; Silvio Tafuri Journal: Vaccine X Date: 2022-08-07