Measles case fatality rate in Bihar, India, 2011-12.
BACKGROUND
Updated 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.


METHODS
We 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.


RESULTS
The 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.


CONCLUSIONS
Measles 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.
National Institute of Epidemiology, ICMR, Chennai, India.
Manoj V
MV
Murhekar
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Mohammad
M
Ahmad
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India; World Health Organization, Geneva, Switzerland.
Hemant
H
Shukla
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Kunwar
K
Abhishek
World Health Organization, Geneva, Switzerland.
Robert T
RT
Perry
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India; Bill and Melinda Gates Foundation, New Delhi, India.
Anindya S
AS
Bose
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Rahul
R
Shimpi
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Arun
A
Kumar
National Institute of Epidemiology, ICMR, Chennai, India.
Kanagasabai
K
Kaliaperumal
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Raman
R
Sethi
National Institute of Epidemiology, ICMR, Chennai, India.
Vadivoo
V
Selvaraj
National Institute of Epidemiology, ICMR, Chennai, India.
Pattabi
P
Kamaraj
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Satyabrata
S
Routray
Rajendra Memorial Research Institute for Medical Sciences, Patna, Bihar.
Vidya Nand
VN
Das
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Nata
N
Menabde
World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India.
Sunil
S
Bahl
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008457:Measles / Q000401:mortality*; D008458:Measles Vaccine; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate
D008458:Measles Vaccine