Mortality among primary and secondary cases of measles in Bangladesh

Data were reviewed from an intensive 1975-1976 survey in two Bangladeshi villages that experienced a high incidence of measles. Mortality among secondary cases (four of 50, 8.0%) was significantly higher than that among primary cases (six of 290, 2.1%). In every case in which there was a death in a household with more than one case, it was the youngest patient who died. All children with secondary cases who died had a pre-illness weight-for-height status above the population mean. Measles mortality in Bangladesh appears to be determined by three factors: age, superinfections, and having a secondary case. The last two factors may be due to increased intrafamilial exposure to both the measles virus and the superinfecting pathogens.