Measles case fatality rate in Bihar, India, 2011-12

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Control

Background:

• Measles case fatality rates (CFR) are crucial for global measles elimination efforts.
• India contributed significantly to global measles deaths in 2011.
• Bihar, a north Indian state with historically low vaccination coverage, was chosen for this study.

Purpose of the Study:

• To estimate measles CFR in Bihar.
• To identify risk factors associated with measles mortality.

Main Methods:

• A retrospective cohort study was conducted.
• 16 laboratory-confirmed measles outbreaks in Bihar (Oct 2011-Apr 2012) were systematically selected.
• Household visits identified measles cases and deaths; multivariate analysis identified risk factors.

Main Results:

• A total of 3670 measles cases and 28 deaths were recorded, yielding a CFR of 0.78%.
• CFR was elevated in children under five (1.22%) and Scheduled Caste/Tribe (SC/ST) populations (1.72%).
• Independent risk factors for death included age <5 years, SC/ST status, and lack of vitamin A administration during illness.

Conclusions:

• The measles CFR in Bihar was found to be low.
• Targeting SC/ST populations with immunization programs is recommended.
• Outbreak investigations should prioritize vitamin A treatment for high-risk groups and ensure regular health worker visits for case management.