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

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusions</p><p>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.</p></div

Measles case fatality rate among SC/ST and G/OBC cases stratified by age group and vitamin A administration, Bihar, India.

<p>Measles case fatality rate among SC/ST and G/OBC cases stratified by age group and vitamin A administration, Bihar, India.</p

Laboratory confirmed measles outbreaks detected during October 2011 and April 2012 and sampling details.

<p>*One serum sample from an outbreak in Banka and another sample from an outbreak in Supaul were positive for IgM antibodies against rubella.</p

Measles case fatality rate by selected variables, in 16 outbreaks, Bihar, India, October 2011 to April 2012.

<p>*MCV1 status of 455 (12.4%) of children was unknown, **Vitamin A administration status of 179 (4.9%) children was unknown.</p

Flowchart showing measles case ascertainment, Bihar, India, 2011–12.

<p>Flowchart showing measles case ascertainment, Bihar, India, 2011–12.</p