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Risk factors for transmission of measles during an outbreak: matched case-control study
D Hungerford1, P Cleary1, S Ghebrehewet2
1Field Epidemiology Services North West, Public Health England, Liverpool, UK.
Background:
In 2012, an outbreak of measles occurred in Merseyside, UK with 359 confirmed cases by 30 June. Numerous cases reported visits to healthcare and social settings.
Aim:
To identify risk factors associated with measles transmission during the outbreak.
Methods:
In April 2012, a retrospective matched case-control study was conducted. Fifty-five confirmed cases and 55 community controls, matched 1:1 for age and geography, were selected at random. Data on exposures in the two weeks before illness, including attendance at a healthcare setting, were collected via telephone interview. Univariate and multi-variate analyses were conducted and odds ratios were calculated.
Findings:
Forty-two cases and 42 matched controls were contacted successfully. Univariate exact conditional logistic regression analysis identified that cases were more likely to have attended an emergency department, been admitted to hospital and be incompletely vaccinated (for age). Multi-variate analysis found three factors to be independently associated with measles infection: incomplete/partial vaccination for age [adjusted odds ratio (aOR) 22.1, 95% confidence interval (CI) 3.8-∞, P < 0.001], under age for routine vaccination (aOR 20.4, 95% CI 2.0-∞, P = 0.009) and hospital admission (aOR 20.2, 95% CI 1.4-∞, P = 0.025).
Conclusions:
Incomplete/partial vaccination, under age for routine vaccination and hospital admission were associated with measles infection. These findings highlight the importance of timely vaccination of eligible individuals, early diagnosis, timely isolation of cases, and implementation of strict infection control measures.
Insights
Measles outbreaks are linked to incomplete vaccination and hospital admissions. Timely vaccination and infection control are crucial for preventing measles transmission.
Area of Science:
- Epidemiology
- Infectious Disease Control
- Public Health
Background:
- A significant measles outbreak occurred in Merseyside, UK, in 2012, with 359 confirmed cases.
- Many infected individuals reported recent visits to healthcare and social settings.
Purpose of the Study:
- To determine the risk factors contributing to measles transmission during the 2012 Merseyside outbreak.
- To identify key epidemiological factors associated with measles infection.
Main Methods:
- A retrospective, matched case-control study was conducted in April 2012.
- Fifty-five confirmed measles cases were matched 1:1 with 55 community controls based on age and geography.
- Data on exposures, including healthcare visits, were collected via telephone interviews, followed by univariate and multivariate analyses.
Main Results:
- Incomplete vaccination for age was strongly associated with measles infection (adjusted odds ratio [aOR] 22.1).
- Being under the routine vaccination age also increased risk (aOR 20.4).
- Hospital admission was independently associated with measles infection (aOR 20.2).
Conclusions:
- Incomplete vaccination, being too young for routine immunization, and hospital admission are significant risk factors for measles infection.
- The findings underscore the importance of prompt vaccination, early diagnosis, and isolation of cases.
- Strict infection control measures in healthcare settings are vital to prevent measles spread.
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