Measles Case Fatality Rate in Bihar, India, 2011–12

Abstract

BackgroundUpdated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage.MethodsWe systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death.ResultsThe survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths.ConclusionsMeasles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases.

Measles outbreak investigation in Ginnir district of Bale zone, Oromia region, Southeast Ethiopia, May 2019

“…The case fatality rate from measles is estimated to be 3-5% in developing countries but may reach more than 10% during epidemics [ 2 ]. The CFR observed in our study was comparable to the findings of measles outbreak investigations conducted in Guji zone of Ethiopia (CFR=0.2%) [ 21 ] and in Bihar, India (CFR=0.78%) [ 24 ]. However, it is lower than the report of outbreak investigations conducted in Simada district of South Gonder zone, Ethiopia (CFR=13.4%) [ 22 ] and in Kebridehar town of Somali region, Ethiopia (1.8%) [ 15 ], Herena and Dawe-Serer districts of Bale Zone of Ethiopia (9.1%) [ 25 ].…”

Measles in India: Challenges & recent developments

“…Another systematic review of studies in 12 Indian states published over four decades revealed that the median case fatality ratio was 1.63% ( 8 ). Furthermore, the higher case fatality ratio was reported among under-five children and children from the backward class ( 11 ).…”

The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths

“…Thus, substantial downward revisions of WHO modeled estimates are likely needed. The relationship between measles cases and deaths in India is also uncertain, given that WHO incidence estimates are inconsistent with documented case fatality rates in India which range from 0.8–1.4% (Sudfeld and Halsey, 2009; Verguet et al, 2017; Wolfson et al, 2009; World Health Organization, 2016; World Health Organization, 2018b; Murhekar et al, 2014). Our direct data should help to redefine current estimates of measles mortality and number of infections in India.…”