Case and research letter
Measles as a Reemerging Disease
El sarampión como enfermedad reemergente
N. Latorre
, M. Blanes
Autor para correspondencia
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. Muñoz" 2 => "V. Trenchs" 3 => "S. Hernández" 4 => "J.J. García" 5 => "A.C. Aguilar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2009.05.006" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "82" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19664857" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why don’t parents vaccinate their children? Reflections on a measles outbreak in a neighbourhood of Granada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.M. Romero" 1 => "S.M. Diz" 2 => "F.G. 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 Octubre | 21 | 22 | 43 |
| 2022 Septiembre | 22 | 35 | 57 |
| 2022 Agosto | 18 | 34 | 52 |
| 2022 Julio | 26 | 42 | 68 |
| 2022 Junio | 25 | 27 | 52 |
| 2022 Mayo | 38 | 42 | 80 |
| 2022 Abril | 55 | 37 | 92 |
| 2022 Marzo | 40 | 60 | 100 |
| 2022 Febrero | 61 | 31 | 92 |
| 2022 Enero | 66 | 42 | 108 |
| 2021 Diciembre | 43 | 36 | 79 |
| 2021 Noviembre | 47 | 45 | 92 |
| 2021 Octubre | 40 | 54 | 94 |
| 2021 Septiembre | 25 | 35 | 60 |
| 2021 Agosto | 43 | 26 | 69 |
| 2021 Julio | 30 | 24 | 54 |
| 2021 Junio | 29 | 35 | 64 |
| 2021 Mayo | 33 | 42 | 75 |
| 2021 Abril | 84 | 85 | 169 |
| 2021 Marzo | 57 | 40 | 97 |
| 2021 Febrero | 57 | 37 | 94 |
| 2021 Enero | 26 | 23 | 49 |
| 2020 Diciembre | 36 | 17 | 53 |
| 2020 Noviembre | 32 | 18 | 50 |
| 2020 Octubre | 15 | 10 | 25 |
| 2020 Septiembre | 49 | 16 | 65 |
| 2020 Agosto | 25 | 33 | 58 |
| 2020 Julio | 23 | 24 | 47 |
| 2020 Junio | 42 | 27 | 69 |
| 2020 Mayo | 27 | 17 | 44 |
| 2020 Abril | 30 | 19 | 49 |
| 2020 Marzo | 35 | 21 | 56 |
| 2020 Febrero | 6 | 2 | 8 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 9 | 0 | 9 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 2 | 6 |
| 2019 Junio | 6 | 0 | 6 |
| 2019 Mayo | 4 | 7 | 11 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 3 | 0 | 3 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 7 | 7 |
| 2018 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 39 | 7 | 46 |
| 2018 Enero | 40 | 6 | 46 |
| 2017 Diciembre | 47 | 10 | 57 |
| 2017 Noviembre | 28 | 3 | 31 |
| 2017 Octubre | 34 | 3 | 37 |
| 2017 Septiembre | 40 | 14 | 54 |
| 2017 Agosto | 65 | 11 | 76 |
| 2017 Julio | 50 | 11 | 61 |
| 2017 Junio | 47 | 10 | 57 |
| 2017 Mayo | 28 | 24 | 52 |
| 2017 Abril | 38 | 20 | 58 |
| 2017 Marzo | 32 | 28 | 60 |
| 2017 Febrero | 31 | 7 | 38 |
| 2017 Enero | 24 | 6 | 30 |
| 2016 Diciembre | 37 | 8 | 45 |
| 2016 Noviembre | 46 | 9 | 55 |
| 2016 Octubre | 48 | 7 | 55 |
| 2016 Septiembre | 50 | 6 | 56 |
| 2016 Agosto | 49 | 11 | 60 |
| 2016 Julio | 33 | 3 | 36 |
| 2016 Junio | 9 | 5 | 14 |
| 2016 Mayo | 4 | 8 | 12 |
| 2016 Abril | 6 | 5 | 11 |
| 2016 Marzo | 5 | 7 | 12 |
| 2016 Febrero | 3 | 9 | 12 |
| 2016 Enero | 8 | 7 | 15 |
| 2015 Diciembre | 5 | 10 | 15 |
| 2015 Noviembre | 6 | 9 | 15 |
| 2015 Octubre | 14 | 15 | 29 |
| 2015 Septiembre | 7 | 6 | 13 |
| 2015 Agosto | 9 | 4 | 13 |
| 2015 Julio | 45 | 9 | 54 |
| 2015 Junio | 33 | 2 | 35 |
| 2015 Mayo | 40 | 6 | 46 |
| 2015 Abril | 25 | 5 | 30 |
| 2015 Marzo | 28 | 7 | 35 |
| 2015 Febrero | 17 | 5 | 22 |
| 2015 Enero | 17 | 6 | 23 |
| 2014 Diciembre | 14 | 2 | 16 |
| 2014 Noviembre | 24 | 5 | 29 |
| 2014 Octubre | 26 | 9 | 35 |
| 2014 Septiembre | 30 | 4 | 34 |
| 2014 Agosto | 19 | 6 | 25 |
| 2014 Julio | 22 | 8 | 30 |
| 2014 Junio | 26 | 6 | 32 |
| 2014 Mayo | 42 | 11 | 53 |
| 2014 Abril | 28 | 5 | 33 |
| 2014 Marzo | 46 | 8 | 54 |
| 2014 Febrero | 29 | 6 | 35 |
| 2014 Enero | 26 | 10 | 36 |
| 2013 Diciembre | 20 | 2 | 22 |
| 2013 Noviembre | 18 | 4 | 22 |
| 2013 Octubre | 8 | 2 | 10 |
| 2013 Septiembre | 2 | 1 | 3 |
| 2013 Agosto | 4 | 3 | 7 |
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