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Risk factors associated with severe measles in Puerto Rico
T Diaz1, J C Nuñez, J V Rullan
1Epidemiology Program Office, Centers for Disease Control, Atlanta, GA 30333.
Abstract:
From January to April, 1990, 695 measles cases were reported to the Puerto Rico Health Department; there were 12 measles-associated deaths (case fatality ratio, 17/1000), more than in any year since 1967. We conducted a case-control study of risk factors for severe measles. We identified 16 children (ages 5 to 34 months) with severe measles and selected children with nonsevere measles as controls (39 hospitalized and 38 nonhospitalized). Controls were frequency matched to severe measles cases by region of residence. One case and two controls had been vaccinated. An underlying illness was present in 50% of cases and 16% of nonhospitalized controls (Mantel-Haenszel weighted odds ratio 5.3; 95% confidence interval 1.4, 20.2). In a multivariate analysis cases were significantly more likely than hospitalized controls to be from families with an annual income of < $5000 (odds ratio (OR), 26.9), to have a mother without a high school degree (OR 11.1), to be anemic (hemoglobin < 10 g/dl) (OR 15.9) and have an underlying illness (OR 18.3). During measles outbreaks preventing severe illness requires aggressive control measures and strategies to increase vaccine coverage of children with underlying illnesses and of low socioeconomic status.
Insights
Severe measles disproportionately affected children with underlying illnesses and those from low socioeconomic backgrounds. Increased vaccination coverage in these vulnerable groups is crucial for outbreak control.
Area of Science:
- Epidemiology
- Public Health
- Pediatrics
Background:
- Measles outbreaks can lead to severe illness and death, particularly in vulnerable populations.
- Puerto Rico experienced a significant measles outbreak from January to April 1990, with 12 associated deaths.
Purpose of the Study:
- To identify risk factors associated with severe measles in children.
- To inform public health strategies for measles outbreak control.
Main Methods:
- A case-control study was conducted involving children aged 5 to 34 months.
- Cases included children with severe measles, and controls included those with nonsevere measles (hospitalized and nonhospitalized).
- Multivariate analysis was used to assess risk factors.
Main Results:
- Children with severe measles were more likely to have underlying illnesses (OR 5.3).
- Risk factors for severe measles included low family income (< $5000) (OR 26.9), maternal education level (OR 11.1), anemia (OR 15.9), and underlying illness (OR 18.3).
- Vaccination status was low among severe cases and controls.
Conclusions:
- Underlying illness, low socioeconomic status, and anemia are significant risk factors for severe measles.
- Aggressive control measures, including increased vaccination coverage for high-risk children, are essential during measles outbreaks.