Materiały źródłowe

• #1 Measles: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/966220-overview

  The prognosis for measles is generally good, with infection only occasionally being fatal. The CDC reports that the childhood mortality rate from measles infection in the United States is 0.1-0.2%. However, many complications and sequelae may develop, and measles is a major cause of childhood blindness in developing countries. […] Globally, measles remains one of the leading causes of death in young children. According to the CDC, measles caused an estimated 107,500 deaths worldwide in 2023, and most occurred in children. […] Case-fatality rates are higher among children younger than 5 years. The highest fatality rates are among infants aged 4-12 months and in children who are immunocompromised because of human immunodeficiency virus (HIV) infection or other causes. […] Complications of measles are more likely to occur in persons younger than 5 years or older than 20 years, and morbidity and mortality are increased in persons with immune deficiency disorders, malnutrition, vitamin A deficiency, and inadequate vaccination.

• #2

  https://www.who.int/news-room/fact-sheets/detail/measles

  Measles is a highly contagious, serious airborne disease caused by a virus that can lead to severe complications and death. […] An estimated 107 500 people died from measles in 2023 mostly children under the age of five years, despite the availability of a safe and cost-effective vaccine. […] Most deaths from measles are from complications related to the disease. […] Complications are most common in children under 5 years and adults over age 30. […] Unvaccinated young children and pregnant persons are at highest risk of severe measles complications. […] Measles outbreaks can result in severe complications and deaths, especially among young, malnourished children. […] There is no specific treatment for measles. […] All children or adults with measles should receive two doses of vitamin A supplements, given 24 hours apart.

• #3 Complications and risk factors for severe outcome in children with measles – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30636224/

  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, p0.01). […] 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.

• #4 Measles: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/966220-overview

  Croup, encephalitis, and pneumonia are the most common causes of death associated with measles. Measles encephalitis, a rare but serious complication, has a 10% mortality. […] Most complications of measles occur because the measles virus suppresses the hosts immune responses, resulting in a reactivation of latent infections or superinfection by a bacterial pathogen. Consequently, pneumonia, whether due to the measles virus itself, to tuberculosis, or to another bacterial etiology, is the most frequent complication. […] Approximately 1 of every 1000 patients develops acute encephalitis, which often results in permanent brain damage and is fatal in about 10% of patients. In children with lymphoid malignant diseases, delayed-acute measles encephalitis may develop 1-6 months after the acute infection and is generally fatal.

• #5 Expanding Measles Outbreak in the United States and Guidance for the Upcoming Travel Season | HAN | CDC

  https://www.cdc.gov/han/php/notices/han00522.html

  The risk for widespread measles in the United States remains low due to robust U.S. immunization and surveillance programs and outbreak response capacity supported by federal, state, tribal, local, and territorial health partners. […] Measles can cause severe health complications, including pneumonia, encephalitis (inflammation of the brain), and death. […] The incubation period for measles, from exposure to fever, is usually about 7-10 days, and from exposure to rash onset is usually about 10-14 days (with a range of 7 to 21 days). […] There is no specific antiviral therapy for measles. Medical care is supportive to help relieve symptoms and address complications such as pneumonia and secondary bacterial infections. […] Consider measles as a diagnosis in anyone with fever (101F or 38.3C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently traveled internationally, or domestically to a region with a known measles outbreak, or has other known or suspected exposure to measles. […] Post-exposure prophylaxis (PEP): In coordination with local or state health departments, provide appropriate measles PEP to close contacts without evidence of immunity, as soon as possible after exposure, either with MMR vaccine (within 72 hours) or immunoglobulin (within 6 days).

• #6 Measles: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/966220-overview

  An even rarer complication is SSPE, a degenerative CNS disease that can result from a persistent measles infection. SSPE is characterized by the onset of behavioral and intellectual deterioration and seizures years after an acute infection (the mean incubation period for SSPE is approximately 10.8 years).

• #7 C-Reactive Protein as a Predictor of Severe Respiratory Complications in Measles

  https://www.mdpi.com/1648-9144/60/7/1031

  C-reactive protein (CRP) levels in the serum of patients with measles increase concurrently with the onset of the rash. […] The results of a study that analyzed 72 children with measles showed that mean CRP values were significantly lower in measles without complications than in severe forms of measles with complications, from which the conclusion was drawn that CRP values can indicate the course and possible development of measles complications. […] The present study aimed to evaluate the levels of CRP in severe measles complicated by primary morbillous pneumonia with various degrees of respiratory insufficiency and to determine its potential utility as a predictor of the severity of morbillous infection. […] The obtained results point to a general predictive usefulness of serum CRP since its increase, compared to a baseline, might be indicative of the development of an underlying pulmonary complication, which is still clinically unmanifested.

• #8 An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-1908-6

  The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. […] Hyperpigmented maculopapular rashes were noted in 89% of all the subjects. […] The various combinations of the three to six different clinical signs and symptoms involving hyperpigmented rashes showed sensitivity and specificity ranges from 41.3-90.7% and 0-28.6%, respectively. […] The highest sensitivity and specificity values were found in the combination of fever, maculopapular and hyperpigmented rash (90.7 and 28.6%), followed by the combination of fever, rash, cough, coryza, and hyperpigmentation (with 81.3% sensitivity and 28.6% specificity). […] The combination of fever, maculopapular rash, and the hyperpigmented rash had 90.7% sensitivity, 28.6% specificity, 93.2% positive predictive value and 22% negative predictive value. […] Hyperpigmented rash was noted in most subjects with measles in this study. Combined symptoms of fever, maculopapular rashes, and hyperpigmented rashes can be used as a screening tool to detect measles infection, even before the confirmatory serology test of anti-measles Ig M takes place.

• #9 Prediction of measles patients using machine learning classifiers: a comparative study | Bulletin of the National Research Centre | Full Text

  https://bnrc.springeropen.com/articles/10.1186/s42269-023-01079-w

  Our findings showed that, despite all the six methods had good performance in classifying measles patients, the RF model outperformed all the other classifiers in terms of different criteria in prediction accuracy. Accordingly, this approach is an effective classifier for predicting measles in the early stage. […] The RF model achieved the highest sensitivity (0.88) specificity (0.96), ROC (0.92) and total accuracy (0.92). […] According to the results in Fig. 4, Random Forest (RF) achieved a True Positive Rate (TPR/ Sensitivity) of 0.883, which was higher than Decision Tree (DT), which achieved 0.787 and the traditional GLM method, which also achieved a TPR of 0.738. […] The overall performance or accuracy of the predicted model was estimated to be 92.11%. The model correctly classified about 88.11% as positive (sensitivity), while about 96.41% was the proportion of individuals correctly classified as negative (specificity). The models probability of predicting an individual being infected with measles was 0.9633 (96.33%), whereas the probability of predicting an individual being negatively infected with measles was 0.8832 (88.32%). The overall predictive power of the model (AUC) was estimated to be 92.3%. […] Our findings suggest that the random forest (RF) algorithm was the most effective model for predicting measles, based on multiple criteria. Specifically, the RF algorithm demonstrated superior accuracy, precision, recall, sensitivity, and specificity compared to the other models.

• #10 Measles may be making a comeback in the U.S., Stanford Medicine-led research finds

  https://med.stanford.edu/news/all-news/2025/04/measles-vaccination.html

  If immunization rates drop further over a prolonged period of time, measles and even other wiped-out diseases such as rubella and polio could one day make a comeback in the United States, according to a new study by researchers at Stanford Medicine and other universities. […] Even at current immunization rates, researchers predict that measles may become endemic again circulating in the U.S. within two decades; with small declines in vaccination, this could happen more quickly. […] For current rates, we took a conservative approach by using average vaccination levels between 2004 and 2023. With measles, we found that we’re already on the precipice of disaster. If vaccination rates remain the same, the model predicts that measles may become endemic within about 20 years. That means an estimated 851,300 cases over 25 years, leading to 170,200 hospitalizations and 2,550 deaths.

• #11 Measles may be making a comeback in the U.S., Stanford Medicine-led research finds

  https://med.stanford.edu/news/all-news/2025/04/measles-vaccination.html

  If vaccination were to fall by even 10% today, measles cases would skyrocket to 11.1 million over the next 25 years. […] Measles would become endemic in less than five years, and rubella would become endemic in less than 20. […] One that’s conceivable is that vaccine coverage continues to drop, measles outbreaks become larger and more frequent, and eventually measles becomes endemic again. […] With measles, we’re right on the cusp. Increasing vaccination levels by just 5% brings the number of measles cases down, safely away from returning to endemic levels.

• #12 Estimating the optimal age for infant measles vaccination | Nature Communications

  https://www.nature.com/articles/s41467-024-53415-x

  The persistence of measles in many countries demonstrates large immunity gaps, resulting from incomplete or ineffective immunization with measles-containing vaccines (MCVs). […] Infants who receive dose 1 (MCV1) at older ages have a reduced risk of vaccine failure, but also an increased risk of contracting infection before vaccination. […] We predict a large heterogeneity in the optimal MCV1 ages (range: 6-20 months), contrasting the homogeneity of observed recommendations worldwide. […] Furthermore, we show that the optimal age depends on the local epidemiology of measles, with a lower optimal age predicted in populations having lower vaccination coverage or suffering higher transmission. […] Overall, our results suggest the scope for public health authorities to tailor the recommended schedule for better measles control.

• #13 Estimating the optimal age for infant measles vaccination | Nature Communications

  https://www.nature.com/articles/s41467-024-53415-x

  The optimal MCV1 age depends on the local epidemiology of measles. […] Specifically, we predict that populations with high measles transmission require a lower vaccination age. […] Overall, our results suggest that in addition to increasing vaccine coverage, adjusting the recommended vaccination age could help minimize immunity gaps and reduce measles incidence, taking steps toward eventual elimination.

• #14

  https://www.who.int/news-room/fact-sheets/detail/measles

  Community-wide vaccination is the most effective way to prevent measles. […] Routine measles vaccination, combined with mass immunization campaigns in countries with high case rates are crucial for reducing global measles deaths. […] Without sustained attention, hard-fought gains can easily be lost. Where children are unvaccinated, outbreaks occur. […] Based on current trends of measles vaccination coverage and incidence, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) concluded that measles elimination is under threat, as the disease resurged in numerous countries that achieved, or were close to achieving, elimination.

• #15 Machine learning algorithms for prediction of measles one vaccination dropout among 12–23 months children in Ethiopia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11575239/

  The measles dropout rate in the country exceeded the recommended threshold of 10%. […] Approximately 39.9% of children had dropped out of measles vaccination, which is significantly higher than the 10% threshold recommended by the WHO. […] The model predicted that the younger mothers age, religion-Jehovah/Adventist, husband with no and mother with primary education, unemployment of the mother, residence in the Oromia and Somali regions, large family size and older paternal age have a strong positive impact on the measles vaccination dropout. […] Factors, such as young maternal age, Jehovah/Adventist religion, husbands with no education, mothers with primary education, unemployed mothers, residents of the Oromia and Somali regions, large family size and husbands older than 61, were the most influential features positively affecting measles dropout status.

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