Atypical measles in children

Measles remains one of the most highly contagious viral infections, despite the widespread availability of effective vaccines. In recent years, there has been a notable resurgence in reported cases, including atypical forms of the disease characterized by mild or non-specific symptoms. According to the Republican Center for Immunoprophylaxis of the Ministry of Health of Kyrgyzstan, as of May 27, 2025, a total of 7,342 cases of measles have been registered in the country. The highest incidence is observed among children aged 1 to 4 years, of whom 94.0% were unvaccinated. Atypical measles frequently presents with mildly expressed catarrhal symptoms, a non-classical rash distribution, or a complete absence of rash. These atypical manifestations complicate early diagnosis and facilitate further transmission of the virus. In children under three years of age, atypical presentations are often associated with the immaturity of the immune system and the presence of maternal antibodies, which can partially protect the child but also alter the typical clinical picture. Contributing factors include partial or delayed immunization and failure to adhere to recommended vaccination schedules. This study analyzed 55 pediatric cases of atypical measles admitted to a hospital in Bishkek between September 2024 and April 2025. Most patients (67.3%) had a moderate disease course, while 32.7% developed severe forms. Complications were identified in 69.1% of cases, with pneumonia (52.6%) and acute stenosing laryngotracheitis (47.4%) being the most common. The low rate of vaccination (only 21.8% of children had received the first dose) and unique aspects of immune response in young children contributed to the development of atypical presentations and increased risk of complications. Administration of vitamin A as part of a comprehensive treatment regimen helped reduce disease severity and hastened recovery. All patients were discharged in satisfactory condition, with an average hospital stay of 8 ± 2.6 days. These findings underscore the critical need to improve vaccination coverage, enhance healthcare provider awareness of atypical measles manifestations, and ensure prompt recognition and management of such cases to better control disease spread and prevent complications among pediatric populations.