Epidemic Outbreak of Measles in the Region of Plovdiv, Bulgaria (March-July 2017)

Object: To analyze the clinical, epidemiological and laboratory characteristics of the cases with measles in the Plovdiv region, Bulgaria, in the period March-July 2017. Materials and Methods: The study included 139 hospitalized patients with measles, treated in the Clinic of Infectious Diseases, University Hospital “St. George”—Plovdiv, during the observed period. Diagnosis was verified by ELISA in 133 of the patients. The following methods were used: clinical and epidemiological analysis, laboratory, microbiological and imaging tests. Results: The age distribution of the patients was: infants below 1 year were 23.8%; 1 - 3 years—24.5%; 4 - 17 years—30.9%; and over 18 years —20.8%. Ethnicity: from Roma origin were 83.5% and Bulgarians—16.5%. Most of the patients (62%) reported contact with a measles patient. Ninety eight of the patients were over 13 months of age and they should have been immunized, as the vaccine in Bulgaria is applied on the 13 month. Of these 98 patients, 49% were immunized, 28% were not, and for 23% there were not data. The most common clinical symptoms were: fever—97.1%, cough—98.6% and runny nose—82.7%. Conjunctivitis was observed in 82%, asthenia in 46%, and diarrhea in 51.1%. The rash appeared average on the 4th day of the onset of complaints. Koplik’s spots were observed in 71.9%, cervical lymphadenopathy in 56.1%, hepatomegaly—in 25.2%, and splenomegaly—in 7.9%; auscultation data for bronchitis/pneumonia—in 33.1%. Laboratory tests: leucopenia in 32.4%, leukocytosis—2.2%, normal results—in the rest 65.4%. ESR was increased in 39.1% and CRP in 76.5% of the patients. X-ray of the lung was performed under indication and was positive in 28/46. The serological test—anti-measles IgM (ELISA) was positive in 95.7% (133/139). We observed the following complications: pneumonia—12.2%, bronchitis—15.1%, laryngitis—4.3%, otitis—1.4%, gastroenteritis—14.4% and stomatitis—6.5%. The outcome was fatal for one patient. Conclusions: Measles still prevails during the age of childhood, but 20.8% of the patients were adults. The analysis of the patient’s immunity showed that the lap of immunization was the main cause for periodical arising of epidemic outbreaks, although the programs for elimination of measles in Europe until 2020. The disease ran with typical course but we observed a higher rate of complications.