Epidemic measles in the postvaccine era: evaluation of epidemiology, clinical presentation and complications during an urban outbreak.

A total of 440 cases of measles were seen at a single children's hospital during an epidemic in a large urban center. These cases were retrospectively analyzed for demographic characteristics, exposure histories, risk factors for and incidence of complications, outcome and financial consequences. More than 90% of children were < 5 years of age and 56% were < 15 months of age. Ninety-four percent were of Hispanic or African-American ethnic background. A visit to a medical facility was the only source of infection for 83 of the 115 patients for whom exposure histories were available. Four patients with underlying immunodeficiency were among those nosocomially exposed and one died of pulmonary complications. Of the 440 patients 195 (44.3%) required hospitalization for measles complications. The mean age of hospitalized patients, 1.9 +/- 2.4 years, was not different from those not admitted (2.1 +/- 2.5 years; P < 0.25). The most frequent indications for admission were respiratory tract complications (pneumonia and/or croup) seen in 161 patients and dehydration in 25 patients. Fourteen required intensive care and 11 required intubation and mechanical ventilation. Three children died, all of pulmonary involvement. Total hospital and medical charges for care of these patients was more than $1.7 million dollars.