Hospitalizations during a measles epidemic in the Netherlands, 1999 to 2000

Background.

A measles epidemic occurred in the Netherlands in 1999 to 2000. We collected data on hospitalized and deceased cases to inform the public about the risks associated with measles infection.

Methods.

From the National Medical Registration we extracted hospital discharge diagnoses for measles-related hospitalizations (International Classification of Diseases, 9th revision, Clinical Modification Code 055) during the measles epidemic (April 1999 to May 2000). We also reviewed hospital records to assess reasons for hospitalization and severity of disease as a result of measles infection during this epidemic. In addition we estimated the total number of hospitalized cases by a capture-recapture approach using two surveillance sources.

Results.

Measles without mention of complication (39%) and postmeasles pneumonia (33%) were most often registered as main discharge diagnoses for the 130 cases in the National Medical Registration. Forty-seven (96%) of the 49 patients whose hospital charts were reviewed were not vaccinated. Median admission period was 5 (range, 1 to 26) days, 19 (38%) required mechanical ventilation and 14 (29%) had sequelae at the time of discharge but none was permanent. Three patients died as a result of complications. No association was observed between preexisting illness and either reason for admission (P = 0.5) or residual symptoms at discharge (P = 0.5). The estimated total number of hospitalized measles patients was 157 (95% confidence interval, 145 to 179), leading to an estimated 825 admission days during an epidemic in which 3292 cases were reported.

Conclusions.

Measles infection can still run a severe course even in a prosperous country.