Case and research letter
Measles as a Reemerging Disease
El sarampión como enfermedad reemergente
Sección de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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Latorre, M. Blanes" "autores" => array:2 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Latorre" "email" => array:1 [ 0 => "nuria_latorre_martinez@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Blanes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding Author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El sarampión como enfermedad reemergente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1054 "Ancho" => 1583 "Tamanyo" => 225399 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rash consisting of dark red macules and papules on the trunk.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Measles is a highly contagious disease caused by a virus of the <span class="elsevierStyleItalic">Paramyxoviridae</span> family. Since humans are the only reservoir of the virus and an effective vaccine exists, measles is considered to be a potentially eradicable disease. In 1998, the World Health Organization's Regional Office for Europe established the goal of eradicating indigenous measles from the region by 2007. However, since 2009 there have been several outbreaks of the disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> These outbreaks have affected practically all age groups and have been associated with a decrease in vaccination rates, which is probably the result of a fear of possible side effects on the part of parents and the existence of marginal social groupings whose members do not use the public health services.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">An outbreak of measles affecting our area (Alicante, health district 19 in the Community of Valencia) has afforded us the opportunity to observe several cases of measles in our hospital. Preliminary data obtained from the Epidemiology Department of the public health authorities in Alicante indicate that 339 cases of measles were recorded in our health district between January 1 and April 1 2012. In 170 cases, the diagnosis was confirmed by serology and in 112 by epidemiological link. Confirmation is still pending in the remaining cases. The age of affected patients ranges from 2 months to 60 years, with a predominance of patients over 20 years of age (127 cases); both sexes were affected equally (55.16% men). In total, 40 patients (12%) required hospitalization. Complications detected to date include 37 cases of otitis and 9 of pneumonia; there have been no deaths.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We recently attended 2 patients hospitalized with measles. The patients were 2 men of Spanish nationality aged 31 and 28 years who presented with the typical clinical picture: a prodromal phase of fever and general malaise followed by the development of a diffuse nonpruritic rash several days later. In both cases, the rash had started on the head and later spread to the trunk (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and limbs (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The maculopapular and confluent rash was associated with marked involvement of the eyes in the form of nonpurulent bilateral conjunctivitis with photophobia. Of note was the fact that neither of these patients presented the characteristic Koplik spots, which have been described as pathognomonic but actually appear in a variable percentage of cases (50%-70%).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> The reason for admission in both cases was the patient's generally deteriorated condition. Serology for exanthematous viral disease, which yielded a positive result for immunoglobulin M for measles, finally provided the key to the diagnosis. Neither of the 2 patients remembered having been vaccinated against measles. The patients were discharged following symptomatic treatment after 3 and 4 days, respectively.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of this letter is to highlight the continuing presence of measles today, as has been demonstrated by the present outbreak in our health district and those that have occurred elsewhere in Spain and the rest of Europe. Although measles has been somewhat forgotten in recent years because of its low incidence, it should be kept in mind and included in the differential diagnosis in febrile patients presenting with rash.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Latorre N, Blanes M. El sarampión como enfermedad reemergente. Actas Dermosifiliogr. 2013;104:533-4.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1054 "Ancho" => 1583 "Tamanyo" => 225399 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rash consisting of dark red macules and papules on the trunk.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 748 "Ancho" => 1584 "Tamanyo" => 192690 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiple macules and papules, some confluent, on both legs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Increased transmission and outbreaks of measles, European Region, 2011. Wkly Epidemiol Rec. 2011;86:559–64." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ongoing measles outbreak in Elche Spain, 29 January to 9 March 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Delgado de los Reyes" 1 => "M. Arencibia Jimenez" 2 => "J. Navarro Gracia" 3 => "E. Alonso Echabe" 4 => "P. Garcia Puente" 5 => "E. Banqueri Guerrero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Euro Surveill" "fecha" => "2012" "volumen" => "17" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measles outbreak in Barcelona. Clinical and epidemiological characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Monfort" 1 => "D. 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Iglesias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2011" "volumen" => "75" "paginaInicial" => "209" "paginaFinal" => "210" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Los padres frente a la vacunación" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.L. Van Esso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Vacunas" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "133" "paginaFinal" => "134" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Koplik spots as a diagnostic clue in a case of measles" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Jiménez Gómez" 1 => "M.A. Ballester Martínez" 2 => "J. Alcántara González" 3 => "P. Jaén Olasolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2012" "volumen" => "139" "paginaInicial" => "560" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Koplik spots: a clinical sign with epidemiological implications for measles control" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Lefebvre" 1 => "G. Camuset" 2 => "E. Bui" 3 => "D. Christmann" 4 => "Y. Hansmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000277122" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2010" "volumen" => "220" "paginaInicial" => "280" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20110626" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack628116" "titulo" => "Acknowledgments" "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">We would like to thank Dr. María Vicenta Rigo Medrano, Head of the Epidemiology Department of the Public Health Center of Alicante for providing the epidemiological data that appear in this article.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000006/v2_202210010908/S1578219013001285/v2_202210010908/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000006/v2_202210010908/S1578219013001285/v2_202210010908/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013001285?idApp=UINPBA000044" ]
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| 2022 April | 55 | 37 | 92 |
| 2022 March | 40 | 60 | 100 |
| 2022 February | 61 | 31 | 92 |
| 2022 January | 66 | 42 | 108 |
| 2021 December | 43 | 36 | 79 |
| 2021 November | 47 | 45 | 92 |
| 2021 October | 40 | 54 | 94 |
| 2021 September | 25 | 35 | 60 |
| 2021 August | 43 | 26 | 69 |
| 2021 July | 30 | 24 | 54 |
| 2021 June | 29 | 35 | 64 |
| 2021 May | 33 | 42 | 75 |
| 2021 April | 84 | 85 | 169 |
| 2021 March | 57 | 40 | 97 |
| 2021 February | 57 | 37 | 94 |
| 2021 January | 26 | 23 | 49 |
| 2020 December | 36 | 17 | 53 |
| 2020 November | 32 | 18 | 50 |
| 2020 October | 15 | 10 | 25 |
| 2020 September | 49 | 16 | 65 |
| 2020 August | 25 | 33 | 58 |
| 2020 July | 23 | 24 | 47 |
| 2020 June | 42 | 27 | 69 |
| 2020 May | 27 | 17 | 44 |
| 2020 April | 30 | 19 | 49 |
| 2020 March | 35 | 21 | 56 |
| 2020 February | 6 | 2 | 8 |
| 2020 January | 4 | 3 | 7 |
| 2019 December | 9 | 0 | 9 |
| 2019 November | 4 | 3 | 7 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 2 | 6 |
| 2019 June | 6 | 0 | 6 |
| 2019 May | 4 | 7 | 11 |
| 2019 April | 2 | 1 | 3 |
| 2019 March | 2 | 7 | 9 |
| 2019 February | 3 | 0 | 3 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 3 | 0 | 3 |
| 2018 July | 0 | 1 | 1 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 7 | 7 |
| 2018 March | 1 | 1 | 2 |
| 2018 February | 39 | 7 | 46 |
| 2018 January | 40 | 6 | 46 |
| 2017 December | 47 | 10 | 57 |
| 2017 November | 28 | 3 | 31 |
| 2017 October | 34 | 3 | 37 |
| 2017 September | 40 | 14 | 54 |
| 2017 August | 65 | 11 | 76 |
| 2017 July | 50 | 11 | 61 |
| 2017 June | 47 | 10 | 57 |
| 2017 May | 28 | 24 | 52 |
| 2017 April | 38 | 20 | 58 |
| 2017 March | 32 | 28 | 60 |
| 2017 February | 31 | 7 | 38 |
| 2017 January | 24 | 6 | 30 |
| 2016 December | 37 | 8 | 45 |
| 2016 November | 46 | 9 | 55 |
| 2016 October | 48 | 7 | 55 |
| 2016 September | 50 | 6 | 56 |
| 2016 August | 49 | 11 | 60 |
| 2016 July | 33 | 3 | 36 |
| 2016 June | 9 | 5 | 14 |
| 2016 May | 4 | 8 | 12 |
| 2016 April | 6 | 5 | 11 |
| 2016 March | 5 | 7 | 12 |
| 2016 February | 3 | 9 | 12 |
| 2016 January | 8 | 7 | 15 |
| 2015 December | 5 | 10 | 15 |
| 2015 November | 6 | 9 | 15 |
| 2015 October | 14 | 15 | 29 |
| 2015 September | 7 | 6 | 13 |
| 2015 August | 9 | 4 | 13 |
| 2015 July | 45 | 9 | 54 |
| 2015 June | 33 | 2 | 35 |
| 2015 May | 40 | 6 | 46 |
| 2015 April | 25 | 5 | 30 |
| 2015 March | 28 | 7 | 35 |
| 2015 February | 17 | 5 | 22 |
| 2015 January | 17 | 6 | 23 |
| 2014 December | 14 | 2 | 16 |
| 2014 November | 24 | 5 | 29 |
| 2014 October | 26 | 9 | 35 |
| 2014 September | 30 | 4 | 34 |
| 2014 August | 19 | 6 | 25 |
| 2014 July | 22 | 8 | 30 |
| 2014 June | 26 | 6 | 32 |
| 2014 May | 42 | 11 | 53 |
| 2014 April | 28 | 5 | 33 |
| 2014 March | 46 | 8 | 54 |
| 2014 February | 29 | 6 | 35 |
| 2014 January | 26 | 10 | 36 |
| 2013 December | 20 | 2 | 22 |
| 2013 November | 18 | 4 | 22 |
| 2013 October | 8 | 2 | 10 |
| 2013 September | 2 | 1 | 3 |
| 2013 August | 4 | 3 | 7 |
Show all
