Resurging Measles Attendances from the Perspective of a Paediatric Emergency Department

Background: Viral exanthemas in the paediatric age group are common. The worldwide resurgence of measles infection in recent years and its impact on the paediatric population of a small cosmopolitan city-state, with high volume of migrational traffic like Singapore is unknown. Our study aims to describe epidemiological trends of proven measles infection cases that presented to our emergency department and identify risk factors that can influence our emergency department isolation policies.

Methods: This study is a retrospective observational cohort study, looking at laboratory-confirmed measles infection in patients. Patients admitted through our paediatric emergency department from January 2010 to December 2016 were included. Data was collected on demographics, clinical features at presentation, isolation precautions implementation, admission duration, and vaccination records.

Results: A total of 277 patients were hospitalised for measles infection. Of these, 90 (32%) patients were isolated at triage at initial presentation. Eighty-one (29%) patients attended the emergency department more than once, prior to admission. Patients presented to the emergency department at an average of 4.3 day of illness at presentation. At initial presentation, 75 (27%) patients did not have rash. Out of all the admitted patients with measles, only 1 patient had completed 2-dose measles vaccination.

Conclusions: Our study found that it is difficult to adequately identify and isolate all patients with measles infection, even with strict isolation strategies. As such, there is an urgent need for global healthcare systems to promote vaccination uptake to increase herd immunity and curb the spread of infection, especially to at-risk population groups.