Measles case fatality ratio in India a review of community based studies
1Harvard School of Public Health, Department of Epidemiology, Boston, USA. csudfeld@hsph.harvard.edu
Context:
Measles remains a major cause of child mortality in India. Measles case fatality ratios (CFRs) vary substantially between countries and even within the same community over time. We present a review of Indian community-based measles CFR studies conducted from 1975 to 2008.
Evidence Acquisition:
PubMed, Cochrane Libraries, and all WHO databases were searched using a combination of terms. All community-based studies were abstracted into a database.
Results:
We identified 25 studies with data on 27 communities. The median CFR was 1.63 per 100 cases (Q1= 0.00 and Q3= 5.06). Studies conducted after 1994 had significantly lower CFRs (P=0.031). Studies in rural settings had significantly higher CFRs compared to urban studies (P=0.015). No differences were found by study design or outbreak/endemic setting.
Conclusions:
This review suggests measles CFR may be declining in India. We hypothesize that increased measles vaccination coverage is the main factor contributing to the decline. Widespread vaccination increases both the average age of infection and the proportion of total measles cases previously vaccinated. Vitamin A treatment/supplementation is also likely to have contributed. In order to further reduce measles burden in India, vaccination and vitamin A treatment/supplementation coverage should be increased and a two dose vaccine strategy should be implemented in all areas.
Insights
Measles case fatality ratios in India appear to be declining, likely due to increased vaccination coverage and Vitamin A supplementation. Further efforts should focus on expanding these interventions and implementing a two-dose vaccine strategy.
Area of Science:
- Epidemiology
- Public Health
- Pediatrics
Background:
- Measles significantly contributes to child mortality in India.
- Measles case fatality ratios (CFRs) exhibit considerable variation across regions and time.
- This review analyzes community-based measles CFR studies in India from 1975 to 2008.
Purpose of the Study:
- To review and analyze trends in community-based measles case fatality ratios in India.
- To identify factors influencing measles CFR in the Indian context.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Cochrane Libraries, and WHO databases.
- Relevant terms were used to identify community-based measles studies.
- Data from selected studies were abstracted into a database.
Main Results:
- Twenty-five studies encompassing 27 communities were identified.
- The median measles CFR was 1.63 per 100 cases.
- Studies published after 1994 showed significantly lower CFRs compared to earlier studies (P=0.031).
- Rural studies reported significantly higher CFRs than urban studies (P=0.015).
Conclusions:
- Measles CFR in India may be decreasing, with increased vaccination coverage hypothesized as the primary driver.
- Vitamin A treatment/supplementation is also considered a contributing factor to the observed decline.
- Recommendations include increasing vaccination and Vitamin A coverage, and implementing a two-dose vaccine strategy to further reduce measles burden.
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