title: Risk factors for measles in children younger than age 8 months: A case-control study during an outbreak in Guangxi, China, 2013.
abstract: BACKGROUND
  Following a period (2009-2012) during which zero measles cases were reported, a measles outbreak occurred in 2013 in Bama County, Guangxi, China, that involved more than 100 children younger than age 8 months. We aimed to identify the pitfalls and risk factors while implementing the control measures.
  
  
  METHODS
  An outbreak investigation and a case-control study was conducted among children younger than age 8 months. The serum specimens of the study subjects and their mothers were tested for measles immunoglobulin M and immunoglobulin G.
  
  
  RESULTS
  The attack rate was 2.3/1,000 population. The median (interquartile range) age was 18.6 months (7.9-52.8 months). The coverage of 2-dose measles-containing vaccine was only 34%. The case-control study revealed 2 independent risk factors: low education level of main caregiver (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.31-6.22) and visiting a hospital 7-21 days before the date of symptoms onset (OR, 9.84; 95% CI, 4.27-22.67). The population attributable fraction of the latter was 52.8%. The mothers of the cases had nonsignificantly higher levels of immunoglobulin M and were significantly more likely to have protective levels of immunoglobulin G than those of the controls. This suggests a reactive rather than protective role of the antibody to the child's infection.
  
  
  CONCLUSIONS
  In a near-elimination but low measles-containing vaccine coverage community, supplementary immunization activities should be emphasized for children and women who are potential future mothers. The minimum age of measles-containing vaccine should be further reduced. Hospital measles transmission must also be strictly prevented.
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Zhen-Zhu
authors.initials: ZZ
authors.lastname: Tang
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China; International Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Bangkok, Thailand. Electronic address: wallstreetxie@hotmail.com.
authors.forename: Yi-Hong
authors.initials: YH
authors.lastname: Xie
authors.affiliation: International Field Epidemiology Training Program, Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Bangkok, Thailand.
authors.forename: Chuleeporn
authors.initials: C
authors.lastname: Jiraphongsa
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Xuan-Hua
authors.initials: XH
authors.lastname: Liu
authors.affiliation: Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Zhong-You
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, HatYai, Songkla, Thailand.
authors.forename: Virasakdi
authors.initials: V
authors.lastname: Chongsuvivatwong
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Children; Iatrogenic infection; Immunoglobulin G; Investigation