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Measles mortality in India: a review of community based studies
J Singh1, R S Sharma, T Verghese
1National Institute of Communicable Diseases, Delhi.
Abstract:
This paper reviews the measles Case Fatality Ratios (CFRs) reported in the community based studies from India. Measles mortality varied considerably in outbreaks, prospective and retrospective studies. A median CFR of 2.5 per cent (0.2-3.7), 0.1 per cent (0-2.2) and 3.7 per cent (0-23.9) was recorded in prospective, retrospective and outbreak studies respectively. The retrospective studies seem to underestimate the measles mortality in Indian setting. Most of the outbreaks recording CFRs equal to or less than the median, 3.7 per cent, occurred in the areas where health care facilities were available for treatment of measles associated complications. Virtually in all studies, the age specific CFRs wherever recorded, were found to be the highest among infants and thereafter the ratios declined progressively. Although suggestive of, the studies did not provide sufficient data to establish an association between malnourishment and the risk of dying from measles. Measles mortality was not consistently high in any particular sex. The study makes a strong case for measles immunization at the earliest recommended age and the provision of better health services as the important public health measures for reducing the measles CFRs.
Insights
This study reviewed measles Case Fatality Ratios (CFRs) in India, finding significant variation. Measles mortality was highest in infants, highlighting the need for early immunization and improved healthcare services to reduce deaths.
Area of Science:
- Epidemiology
- Public Health
- Pediatrics
Background:
- Measles remains a significant public health concern globally, particularly in regions with lower vaccination coverage.
- Understanding measles mortality patterns is crucial for developing effective control strategies.
Purpose of the Study:
- To review and analyze measles Case Fatality Ratios (CFRs) from community-based studies conducted in India.
- To identify factors influencing measles mortality and inform public health interventions.
Main Methods:
- Systematic review of community-based studies reporting measles Case Fatality Ratios (CFRs) in India.
- Analysis of CFR data stratified by study type (prospective, retrospective, outbreak), age, and sex.
Main Results:
- Median CFRs varied across study types: 2.5% (prospective), 0.1% (retrospective), and 3.7% (outbreak).
- Retrospective studies may underestimate measles mortality.
- Infants exhibited the highest age-specific CFRs, with mortality declining progressively with age.
- No consistent association found between malnutrition or sex and increased measles mortality risk.
Conclusions:
- Measles immunization at the earliest recommended age is critical for reducing CFRs.
- Enhanced healthcare services for managing measles complications are essential public health measures.
- Further research is needed to establish the link between malnutrition and measles mortality.