643 - Single-Center Tertiary-Level Children’s Hospital Experience with a Measles Outbreak in Columbus, Ohio

Measles is a highly contagious, vaccine-preventable illness that was declared eliminated in the US in 2000. The Columbus, Ohio outbreak began in daycare facilities among unvaccinated children < 5 years of age likely from an index case with travel to East Africa, per genotype analysis, and rapidly spread via community transmission. A relatively high percentage of children were hospitalized in Columbus, Ohio (42.6%), compared to recent outbreaks in Minnesota and New York (29% and 7.6% respectively). Vitamin A deficiency is a recognized risk factor for severe measles in resource-limited settings.

Objective:

To describe the clinical characteristics of children hospitalized for measles, and to assess their Vitamin A levels.

Design/Methods:

We reviewed the electronic medical records of children admitted to Nationwide Children’s Hospital (NCH) with PCR-confirmed measles. Demographic, clinical, laboratory, and radiographic data were reviewed, including age, complications, MMR vaccination status, and Vitamin A levels.

Results:

82 cases of PCR-confirmed measles occurred between October and December 2022. 35 patients (42.6%) were hospitalized.  26 patients (74.3%) were from the Somali American community. 34 patients (97.1%) were < 5 years of age (median, 18 months), with 6 patients (17%) < 12 months of age (vaccine-ineligible). 33 patients (94%) were unvaccinated against measles, with 2 patients (6%) receiving the vaccine as post-exposure prophylaxis. Presenting symptoms in all patients included fever, cough, and coryza, followed by a cephalocaudal rash in 32 (91.4%), and conjunctivitis in 29 (82.8%) patients. Complications requiring admission included dehydration in 33 patients (94.1%), acute otitis media in 15 patients (42.8%), croup in 9 patients (25.7%), and pneumonia, bronchiolitis, and diarrhea in 3 patients (8.5%) each, respectively. 29 patients (82.8%) received Vitamin A, with 25 patients (71%) receiving 2 doses. Baseline serum Vitamin A levels were measured in 10 patients (28.5%), ranging from 0.06 mg/L to 0.32 mg/L, with only 2 patients (5.7%) in the normal range (0.2-0.5 mg/L) prior to Vitamin A administration.

Conclusion(s):

Community transmission of measles due to measles in unvaccinated children led to serious illness requiring hospitalization. This outbreak emphasizes the importance of routine MMR vaccination in vaccine-eligible patients to prevent disease and provide herd immunity for the vaccine-ineligible. Low serum Vitamin A levels in a high-resource setting demonstrated the importance of Vitamin A supplementation to mitigate measles complications per the WHO guidelines.