Severe and fatal measles-associated pneumonia during an outbreak in Italy: data from the heart of the epidemic

Introduction: Measles is a contagious disease that re-emerged among young adults as a consequence of suboptimal vaccination coverage. Since in the pre-vaccination era measles affected mainly children, little is known about measles-associated respiratory complications in adults. The aim of this study was to describe clinical and radiological findings in adults affected by measles who developed respiratory complications during a recent measles outbreak.

Material and methods: In this retrospective chart review-based study we analyzed data from patients admitted for measles from January to June 2018 to a large tertiary care hospital, in one of the main cities in the south of Italy. This city has been the country's heart of the epidemic with a high morbidity and mortality rate.

Results: Among 177 patients (mean age 26 ± 9 years), only 2 were vaccinated. Thirty patients (16.9%) had signs of pneumonia on chest radiography. Computed tomography scan showed the following abnormalities: centrilobular nodules (63%), ground-glass attenuation (63%), air-space consolidation (36%), pleural effusion (16%) and pneumothorax (10%). Five patients developed severe lung injury and hypoxemia requiring admission to Intensive Care Unit. Two young unvaccinated women with no past medical history died from acute respiratory failure. The death was sudden and unpredictable.

Conclusions: Measles-associated pneumonia in unvaccinated young adults can cause severe respiratory impairment and death. Our findings support the need for a mandatory vaccination policy.

Keywords: acute hypoxemia; lung injury; measles; viral pneumonia.