Assessment and possible control of endemic measles in urban Nigeria

Measles remains as a serious problem of infancy and childhood in the developing world, despite the availability of a vaccine. Increasing urbanization is changing patterns of endemicity.

A survey of measles in an urban area of Nigeria, using a rapid assessment approach, was carried out to characterize measles in this community.

An annual incidence rate of 11.8% among under-fives was found, associated with an acute case fatality rate of 3.3%. This level of endemicity was two orders of magnitude greater than that suggested by official case reports. An endemic, rather than epidemic, pattern was found over the six-month period of the study. Vaccine efficacy was estimated at 26%. Risk factor analyses showed the major risks for measles to be clinic attendance in the month preceding disease, households with more than one mother, and having under-five siblings. Measles itself was the principal risk factor for malnutrition and against survival.

Improved understanding of measles epidemiology and risk factors are prerequisites for effective control. Possible strategies should include vertical vaccination efforts in addition to routine programmes.