Burden and clinical characteristics of measles in pre-vaccination age infants

Pandora Glory; Mashfika Hossain; M. Al Mamun Hossain; M. Hasna Hena; Ajmiri Sultana; Popy Akter; Wahidul Karim; Ayesha Yasmin; M. Tahura Khatun

doi:10.18203/2349-3291.ijcp20263803

Authors

Pandora Glory Department of Pediatrics, Mugda Medical College and Hospital, Dhaka, Bangladesh
Mashfika Hossain Mugda Medical College and Hospital, Dhaka, Bangladesh
M. Al Mamun Hossain Department of Pediatrics, Shaheed Suhrawardi Medical College, Dhaka, Bangladesh
M. Hasna Hena Department of Pediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh
Ajmiri Sultana Department of Pediatrics, Shaheed Suhrawardi Medical College, Dhaka, Bangladesh
Popy Akter Department of Pediatric Neurology and Development, Dhaka Medical College Hospital, Dhaka, Bangladesh
Wahidul Karim Hazrat Shahjalal International Airport, Kurmitola, Dhaka, Bangladesh
Ayesha Yasmin 100 Bed Narshingdi Zilla Hospital, Narshingdi, Bangladesh
M. Tahura Khatun Department of Pediatrics, Mugda Medical College and Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263803

Keywords:

Measle, Infants, Pre-vaccination age, Pneumonia, Clinical characteristics, Vaccination, Children

Abstract

Background: Measles remains an important cause of childhood morbidity, particularly among infants who are below the routine age for measles-rubella vaccination. These infants may be vulnerable because of declining maternal antibodies and absence of vaccine-derived protection. This study assessed the burden and clinical characteristics of measles among hospitalized children, with particular attention to the pre-vaccination-age group.

Methods: This hospital-based cross-sectional study was conducted in the Department of Pediatrics, Mugda Medical College Hospital, Dhaka, from March 2026 to May 2026. A total of 300 children aged 1 month to 12 years admitted to the measles isolation ward were included. Data on demographic characteristics, age, clinical manifestations, complications, management and outcomes were collected using a structured proforma. Measles was diagnosed according to the WHO clinical case definition.

Results: Males constituted 61.7% of participants, while 38.3% were female. Infants younger than 1 year represented 57.1% of cases, including 102 (34.0%) infants below 9 months. Fever and rash were present in all patients. Cough, coryza and conjunctivitis were reported in 82.7%, 78.9% and 73.7%, respectively. Pneumonia was the most frequent complication, affecting 63.9% of patients, followed by diarrhea (45.1%) and vomiting (30.1%). All patients received supportive care, while 18.8% required oxygen therapy. ICU admission was required in 0.72% and mortality was 1.0%.

Conclusions: Measles caused substantial morbidity among hospitalized children, with pre-vaccination-age infants comprising a considerable proportion of cases. Early recognition, prompt supportive management and strengthened preventive strategies are essential to reduce severe measles-related outcomes.

References

Leung J, Munir NA, Mathis AD, Filardo TD, Rota PA, Sugerman DE, et al. The effects of vaccination status and age on clinical characteristics and severity of measles cases in the United States in the postelimination era, 2001–2022. Clin Infect Dis. 2025;80(3):663-72.

Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis. 2004;189(Suppl 1):S4-16.

Gianniki M, Siahanidou T, Botsa E, Michos A. Measles epidemic in pediatric population in Greece during 2017–2018: Epidemiological, clinical characteristics and outcomes. PLoS One. 2021;16(1):e0245512.

Iqbal MJ, Islam MM, Islam MA, Sen T, Modak B, Ghosh K. Clinical characteristics and outcomes in pediatric patients at outdoor experiences with measles. The Insight. 2025;8(1):143-7.

Rahat F, Abiduzzaman MF, Choudhury AM. Clinical characteristics of measles in infancy: A hospital based study. Dhaka Shishu Hosp J. 2020;36(1):20-4.

Mawlood SD, Al-Ani MM, Al-Ani RM, Alshibib A. Impact of measles vaccination on clinical characteristics and outcomes in children in Ramadi, Iraq. World J Clin Pediatr. 2025;14(3):107253.

Aljothery AH, Baiee HA, Hussein KF, Baiee AH, Abdulameer TS, Hadi AA, et al. Epidemiologic and clinical characteristics of children with measles during the year 2019. Indian J Forensic Med Toxicol. 2020;14(3):1399-404.

Stein-Zamir C, Shoob H, Abramson D. Measles clinical presentation, hospitalization and vaccination status among children in a community-wide outbreak. Vaccine. 2023;41(17):2764-8.

Alsulaiman JW, Kheirallah KA, Alrawashdeh A, Abu Sanad Z, Al-Mnayyis AA, Yassin A, et al. Clinical and demographic characteristics of hospitalized pediatric measles cases; the 2023 outbreak in Northern Jordan. Infect Drug Resist. 2025;18:1773-83.

Domai FM, Agrupis KA, Han SM, Sayo AR, Ramirez JS, Nepomuceno R, et al. Measles outbreak in the Philippines: Epidemiological and clinical characteristics of hospitalized children, 2016-2019. Lancet Reg Health West Pac. 2022;19:100334.

Jalal MA, Halboot KM, Lami SA, Gumar EA, Al-Delphi MH, Lami F, et al. Epidemiological trends and clinical characteristics of measles in Iraq (2023–2024): a retrospective cross-sectional study. BMC Infect Dis. 2025;25(1):487.

Ong DS, von Mollendorf C, Mulholland K, Do LA. Measles seroprevalence in infants under 9 months of age in low-and middle-income countries: a systematic review and meta-analysis. J Infect Dis. 2025;232(2):316-26.

Nic Lochlainn LM, de Gier B, van der Maas N, van Binnendijk R, Strebel PM, Goodman T, et al. Effect of measles vaccination in infants younger than 9 months on the immune response to subsequent measles vaccine doses: a systematic review and meta-analysis. Lancet Infect Dis. 2019;19(11):1246-54.

Leuridan E, Hens N, Hutse V, Ieven M, Aerts M, Van Damme P. Early waning of maternal measles antibodies in era of measles elimination: longitudinal study. BMJ. 2010;340:c1626.

Mersha AM, Braka F, Gallagher K, Tegegne AA, Argay AK, Mekonnen MA, et al. Measles burden in urban settings: characteristics of measles cases in Addis Ababa city administration, Ethiopia, 2004-2014. Pan Afr Med J. 2017;27(Suppl 2):11.

Goutam A, Hasan A, Khan MAS, Mahid MAH, Masud SB, Babul H, et al. Vaccination status and its association with complications among the patients admitted with measles in the dedicated measles hospitals, Dhaka, Bangladesh. medRxiv [Preprint]. 2026: 1-28.

Misin A, Antonello RM, Di Bella S, Campisciano G, Zanotta N, Giacobbe DR, et al. Measles: an overview of a re-emerging disease in children and immunocompromised patients. Microorganisms. 2020;8(2):276.

del Moral-Trinidad LE, Trejo-González PE, Acosta-Aguilar CA, Rubio-Mora BR, Avilés-Martínez KI, Herrera-Godina MG, et al. Hospital burden and clinical features associated with admission among confirmed measles cases during the 2025-2026 outbreak at a tertiary care hospital in Mexico. IJID Reg. 2026;20:100965.