#34: Measles Outbreak in Pediatric Oncology Patients in Hue Central Hospital, Vietnam

Abstract Background Measles outbreaks in immunocompromised populations present a significant challenge, and to interrupt endemic transmission can be difficult. This study aimed to investigate measles in pediatric oncology patients at Hue Central Hospital, Vietnam to describe demographic, epidemiological, and clinical features. Methods Potential measles infections among children with cancer were prospectively identified between April 20 to July 10, 2019 at Hue Central Hospital. Measles diagnoses were based on both clinical features and IgM laboratory evaluation. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From April 20 to July 10 in 2019, a total of 11 patients with malignancies were identified as having measles, with a median age of 4.0 years (range: 1 years to 9 years). Of these 11 patients, 2 (18.2%) had not received any dose of measles vaccine, 4 (36.4%) had received 1 dose of measles vaccine, and 5 (45.5%) had received the recommended 2 doses. All patients had fever with the median temperature of 39 degrees Celsius (range: 38.5–39.5), and median fever duration of 7 days. All patients had cough and rash, while 3 (27.3%) were complicated by pneumonia, and 2 (18.2%) had elevated liver transaminases. All patients had hospital visits or were hospitalized before measles onset, with the median length of stay of 10 days (range: 7–24 days). All patients were likely to exposed each other. 100% of these patients recovered. Conclusions Children with cancer are at extra risk of measles infection due to their immunocompromised status. Getting vaccinated is the best way to prevent measles, and improved infection control is critical for the prevention of measles in patients with malignancies. Following this measles outbreak, a designated outpatient area was established to separate the inpatient unit and limit hospital transmission.

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Measles Outbreak in Pediatric Oncology Patients at Hue Central Hospital

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3814 ◽

2020 ◽

Vol 8 (B) ◽

pp. 81-84

Author(s):

Tran Kiem Hao ◽

Nguyen Thi Kim Hoa

Keyword(s):

Clinical Data ◽

Pediatric Oncology ◽

Immunoglobulin M ◽

Measles Vaccine ◽

Oncology Patients ◽

Liver Transaminase ◽

Measles Outbreak ◽

Immunocompromised Status ◽

Endemic Transmission ◽

Dose Vaccine

AIM: Measles outbreak in the immunocompromised population is a big challenge to interrupt endemic transmission. This study aimed to investigate of measles in pediatric oncology patients and find the reason behind the outbreak. METHODS: A descriptive study was conducted on 11 pediatric oncology patients with measles. We collected demographic, epidemiological, and clinical data. Most of suspected measles cases were done measles immunoglobulin M test and clinical data were followed up and analyzed by SPSS. RESULTS: From April 20, 2018, to July 10, 2019, a total of 11 patients with malignancies were notified to develop measles in Hue. Of these 11 patients with the median age of 4.0 years (range: 1–9 years), two patients had not received any dose of measles vaccine, five patients received two doses, and four patients had received 1 dose of measles vaccine; all patients had fever with the median fever of 39°C (range: 38.5–39.5), the median fever duration was 7 days. All patients had cough and rash, three patients had pneumonia complication and two patients had elevated liver transaminase levels. All patients had hospital visits or were hospitalized before measles onset, with the median time: 10 days (range: 7–24 days); all patients were likely to expose each other. All 11 patients recovered. CONCLUSIONS: The measles outbreak was occurred among children with cancer, especially for children without prior measles vaccine or without two prior doses. Moreover, even children received two prior dose vaccine, their immunocompromised status caused them to be infected. There was not a different area for outpatient and inpatient in the hospital, so measles transmission occurred.

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Are Male Children with Cancer More Prone to Severe Sepsis?.

Blood ◽

10.1182/blood.v108.11.3866.3866 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3866-3866

Author(s):

Satya Prakash Yadav ◽

Gaurav Kharya ◽

Satyender Katewa ◽

Krishan Chugh ◽

Anil Sachdev ◽

...

Keyword(s):

Severe Sepsis ◽

Gender Difference ◽

Pediatric Oncology ◽

Consensus Conference ◽

Immune Functions ◽

Sexual Hormones ◽

Oncology Patients ◽

Children With Cancer ◽

Human Sepsis ◽

Post Surgery

Abstract Sexual hormones are potent regulators of various immune functions. Although androgens are immunosuppressive, estrogens protect against septic challenges in animal model. In human sepsis studies post surgery, post trauma in adults have shown survival advantage for female sex with sepsis. Other reality is that in a developing country like India with a population of 1 billion, sex ratio has been gradually falling in the general population. In year 1901 females per 1000 males were 972 and in 2001 females per 1000 males are 933. Neglect of female child and unwillingness on the part of parents to spend money for treatment of girl child is one of the main reason for less number of girls getting treatment for cancer as compared to males. This study was done to find gender difference in incidence of severe sepsis in children with cancer in a single centre in Delhi, India. It was a retrospective analysis of children with and without cancer admitted to the Pediatric Intensive care Unit (PICU) at Sir Ganga Ram Hospital from January 2003 to January 2006, who met the following criteria: 1) severe sepsis by American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria and 2) receipt of fluid boluses of >30 mL/kg or receipt of a dopamine infusion of >5 ug/kg/min. Data evaluated were demographic variables, oncologic diagnosis and time from diagnosis to PICU admission, Pediatric Risk of Mortality I (PRISM I) score, neutropenia, use of inotropes, use of mechanical ventilation, culture results, survival to PICU discharge, and 6-month survival. Total admissions in PICU were 1450 out of which 977 were males (M) and 473 females (F) with M:F =2:1.Total number of children admitted with sepsis in PICU were 517 out of which males were 342 and females 175 with M:F= 2:1. Total number of pediatric oncology admissions in hospital (PICU and Ward) were 420 out of which males were 294 and females 126 with M:F = 2.3:1. Total number of pediatric oncology patients admitted in PICU were 60 out of which 44 were males and 16 were females with M:F = 2.8:1. Total number of consecutive pediatric oncology patients admitted to PICU with severe sepsis were 20 out of which 18 were males and 2 females with M:F =9:1. Overall mortality was 40 % at PICU discharge and 50% at 6 months follow up. 6 /18 (33%) males died as compared to 2/2 (100%) deaths in females. Mean PRISM I score was 11.9 among survivors and 19.4 among non-survivors. Mean Prism score for females was 16 as compared to 14.8 in males. We looked at gender distribution of 35 consecutive pediatric oncology patients with febrile neutropenia in the hospital. 28 were males and 7 females (Ratio M:F = 4:1) We looked at 30 consecutive non-oncology patients admitted with severe sepsis in PICU which showed 25 males and 5 females with a ratio of M:F = 5:1.In conclusion, m ale children with cancer have increased incidence of severe sepsis. This small study may reflect a bias of parents not electing to admit female patients with severe sepsis in hospital but as compared to ratio in total admission in PICU and admissions of oncology patients in ward and PICU the ratio is markedly increased to 9:1 which may indicate gender difference due to genetic basis.

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Evaluating Supportive Care for Children with Cancer: A Multi-Institutional Survey Study of Pediatric Oncology Patients and Parents (TH346-C)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2014.11.070 ◽

2015 ◽

Vol 49 (2) ◽

pp. 350

Author(s):

Deena Levine ◽

Belinda Mandrell ◽

Heather Symons ◽

Dave Wendler ◽

Justin Baker

Keyword(s):

Supportive Care ◽

Pediatric Oncology ◽

Survey Study ◽

Oncology Patients ◽

Children With Cancer

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Early palliative care for children with cancer: A multi-institutional survey study of pediatric oncology patients and parents.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.10582 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 10582-10582 ◽

Cited By ~ 2

Author(s):

Deena R. Levine ◽

Justin N. Baker

Keyword(s):

Palliative Care ◽

Pediatric Oncology ◽

Survey Study ◽

Oncology Patients ◽

Children With Cancer ◽

Early Palliative Care

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Improving the Quality of End-of-Life Care in Pediatric Oncology Patients Through the Early Implementation of Palliative Care

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454217713451 ◽

2017 ◽

Vol 34 (6) ◽

pp. 374-380 ◽

Cited By ~ 12

Author(s):

Lauren Ranallo

Keyword(s):

Palliative Care ◽

Supportive Care ◽

End Of Life ◽

Pediatric Oncology ◽

End Of Life Care ◽

Terminal Phase ◽

Clear Understanding ◽

Life Care ◽

Oncology Patients ◽

Children With Cancer

Providing end-of-life care to children with cancer is most ideally achieved by initiating palliative care at the time of diagnosis, advocating for supportive care throughout the treatment trajectory, and implementing hospice care during the terminal phase. The guiding principles behind offering palliative care to pediatric oncology patients are the prioritization of providing holistic care and management of disease-based symptoms. Pediatric hematology-oncology nurses and clinicians have a unique responsibility to support the patient and family unit and foster a sense of hope, while also preparing the family for the prognosis and a challenging treatment trajectory that could result in the child’s death. In order to alleviate potential suffering the child may experience, there needs to be an emphasis on supportive care and symptom management. There are barriers to implementing palliative care for children with cancer, including the need to clarify the palliative care philosophy, parental acknowledgement and acceptance of a child’s disease and uncertain future, nursing awareness of services, perception of availability, and a shortage of research guidance. It is important for nurses and clinicians to have a clear understanding of the fundamentals of palliative and end-of-life care for pediatric oncology patients to receive the best care possible.

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