Measles deaths in Nepal: estimating the national case-fatality ratio

Joshi, Ashok; Luman, Elizabeth T.; Nandy, Robin; Subedi, Bal Krishna; Liyanage, Jayantha; Wierzba, Thomas F.

doi:10.2471/blt.07.050427

Cited by 13 publications

(26 citation statements)

References 17 publications

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“…However, our active case investigation yielded high numbers of deaths compared to those that had been reported in the national surveillance system. In line with our study, Anand et al (2009) in a study measles deaths in Nepal also found that measles deaths and cases were being under reported by the routine surveillance system [ 20 ]. This could be probably due to the fact that most deaths occurred at home, and hence were not captured by the system as there is lack of systematic procedures to report such incidences at local level or villages even in the presence of the village health teams.…”

Section: Discussionsupporting

confidence: 91%

Risk factors for measles death: Kyegegwa District, western Uganda, February–September, 2015

2017

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BackgroundOn 18 August 2015, Kyegegwa District reported eight deaths during a measles outbreak to the Uganda Ministry of Health (MoH). We investigated this death cluster to verify the cause, identify risk factors, and inform public health interventions.MethodsWe defined a probable measles case as onset of fever and generalised rash in a Kyegegwa District resident from 1 February – 15 September 2015, plus ≥1 of the following: coryza, conjunctivitis, and cough. A confirmed measles case was a probable case with measles-specific IgM positivity. A measles death was a death of a probable or confirmed case-person. We conducted an active case-finding to identify measles patients who survived or died. In a case-control study, we compared risk factors between 16 measles patients who died (cases) and 48 who survived (controls), matched by age (±4 years) and village of residence.ResultsWe identified 94 probable measles cases, 10 (11%) were confirmed by positive measles-specific IgM. Of the 64 probable measles patients aged <5 years, 16 died (case-fatality rate = 25%). In the case-control study, no history of vaccination against measles was found in 94% (15/16) among the case-persons (i.e., measles patients who died) and 54% (26/48) among the controls (i.e., measles patients who survived) (ORM-H = 12; 95% CI = 1.6–104), while 56% (9/16) of case-persons and 67% (17/48) of controls (ORM-H = 2.3; 95% CI =0.74–7.4) did not receive vitamin A supplementation during illness. 63% (10/16) among the case-persons and 6.3% (3/48) of the controls (ORM-H = 33; 95% CI = 6.8–159) were not treated for measles illness at a health facility (a proxy for more appropriate treatment), while 38% (6/16) of the case-persons and 25% (12/48) of the controls (ORM-H = 2.5; 95% CI = 0.67–9.1) were malnourished.ConclusionLack of vaccination and no treatment in a health facility increased the risk for measles deaths. The one-dose measles vaccination currently in the national vaccination schedule had a protective effect against measles death. We recommended enhancing measles vaccination and adherence to measles treatment guidelines.

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Section: Discussionsupporting

confidence: 91%

Risk factors for measles death: Kyegegwa District, western Uganda, February–September, 2015

2017

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“…Most previous surveys in India did not clearly describe use of household lists and lists of cases in order to maximize the ascertainment of deaths. The CFR in Bihar was comparable to that found in Nepal, where the CFR was 1.1% (95% CI: 0.5–2.3) overall, 3.5% in cases <1 year of age, 2% in cases 1–4 years, and 0.2 in cases 5–14 years of age [2]. Methods for ascertainment of measles cases and death in the current study were similar to the study conducted in Nepal.…”

Section: Discussionsupporting

confidence: 78%

“…It has been suggested that higher measles vaccination coverage lower mortality rates directly through reduced disease incidence and indirectly by increasing the median age at infection, resulting in more cases in older age groups with lower mortality rates, or by decreasing incidence, resulting in a lower intensity of transmission [11] . These studies often relied on records of vaccination status before the outbreak [21] or had higher proportions of cases vaccinated [2] , [23] . No difference in CFR between vaccinated and unvaccinated children was found in our study, with only 27% of cases with a history of vaccination.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…The estimated time at infection in this study starts after the incubation period, as the appearance the measles rash is the starting point to estimating whether a death should be classified as acute or delayed (Aaby 1995). There is a limited amount of literature on the time from infection until death, but one study found that most acute deaths occurred within 1 to 2 weeks of the onset of the measles rash (Joshi et al 2009).…”

Section: Study Populationmentioning

confidence: 99%

Delayed measles mortality among exposed children who survived the epidemic of 1714–15 in New France

Mazan

2013

CSP

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This follow-up study examines delayed mortality of children under age 5 who were exposed to measles and survived the acute phase ofthe 1714–15 epidemic in Quebec. The objective of the study was to assess whether exposed children had higher long-term mortality thanunexposed children, by following them for 25 months past the estimated date of infection. Overall, children exposed before age 3 had higher long-term mortality than unexposed children. The difference remained significant while assessing other risk factors. Delayed mortality also varied by age and sex. Only exposed female infants had a significantly higher risk of dying, while both exposed male and female toddlers had higher mortality. No significant difference was found among children exposed after age 3. Findings are explained in terms of modern post-measles studies in Africa and of previous measles studies in New France.

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Measles deaths in Nepal: estimating the national case-fatality ratio

Cited by 13 publications

References 17 publications

Risk factors for measles death: Kyegegwa District, western Uganda, February–September, 2015

Risk factors for measles death: Kyegegwa District, western Uganda, February–September, 2015

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

Delayed measles mortality among exposed children who survived the epidemic of 1714–15 in New France

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