Conference abstract

Risk factors for measles death during an outbreak: Kyegegwa District, Uganda

Pan African Medical Journal - Conference Proceedings. 2017:1(8).11 Dec 2017.
doi: 10.11604/pamj-cp.2017.1.8.2

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Keywords: Measles death, outbreak, Uganda
Oral presentation

Risk factors for measles death during an outbreak: Kyegegwa District, Uganda

Richardson Mafigiri1,&, Fred Nsubuga1, Alex Riolexus Ario1

1Uganda Public Health Fellowship Program, Kampala, Uganda

&Corresponding author
Richardson Mafigiri, Uganda Public Health Fellowship Program, Kampala, Uganda


Introduction: on 18 August 2015, Kyegegwa District reported 8 deaths during a suspected measles outbreak. We investigated this cluster of deaths to verify the cause, identify risk factors, and inform public health interventions.

Methods: we conducted active community case-finding to identify probable measles patients, defined as a Kyegegwa District resident with fever (> 39C) and generalized rash during 1 February - 15 September, plus ≥ one of the following: coryza, conjunctivitis, and cough. A deceased measles case was defined as death to a probable measles patient. In a case-control study, we compared risk factors between 16 deceased measles cases and 48 probable measles patients who survived (i.e., controls), matched by age ( 4 years) and village of residence. Blood specimens from probable measles patients were tested for measles-specific IgM.

Results: we identified 94 probable measles patients. Children aged < 5 years accounted for 68% (64/94) of probable measles patients and all 16 deaths (case fatality ratio = 25%, 16/64). In the case-control study, 63% (10/16) of deceased measles cases and 33% (16/48) of controls received no vitamin A supplementation during illness (ORM-H = 7.1; 95% CI = 1.3-37); 31% (5/16) of deceased measles cases and 2.1% (1/48) of controls were not treated according to guidelines (adjORML = 8; 95% CI = 80-8); 6.3% (1/16) of deceased measles cases and 46% (22/48) of controls were vaccinated against measles (adjORML = 0.0; 95% CI = 0.0-0.33). Of blood specimens collected from probable measles patients, 71% (10/14) were positive for measles-specific IgM.

Conclusion: no vaccination, lack of vitamin A supplementation and inappropriate treatment increased risk for measles deaths. The one-dose measles vaccination currently in the national EPI schedule, although providing inadequate protection against infection, did protect against measles death. We recommended enhancing measles vaccination, providing universal vitamin A supplementation, and enforcing treatment guidelines.