Risk factors for measles death: Kyegegwa District, western Uganda, February–September, 2015

摘要

Background On 18 August 2015, Kyegegwa District reported eight deaths during a measles outbreak to the Uganda Ministry of Health (MoH). We investigated this death cluster to verify the cause, identify risk factors, and inform public health interventions. Methods We defined a probable measles case as onset of fever and generalised rash in a Kyegegwa District resident from 1 February – 15 September 2015, plus ≥1 of the following: coryza, conjunctivitis, and cough. A confirmed measles case was a probable case with measles-specific IgM positivity. A measles death was a death of a probable or confirmed case-person. We conducted an active case-finding to identify measles patients who survived or died. In a case-control study, we compared risk factors between 16 measles patients who died (cases) and 48 who survived (controls), matched by age (±4?years) and village of residence. Results We identified 94 probable measles cases, 10 (11%) were confirmed by positive measles-specific IgM. Of the 64 probable measles patients aged M-H?=?12; 95% CI?=?1.6–104), while 56% (9/16) of case-persons and 67% (17/48) of controls (OR_M-H?=?2.3; 95% CI =0.74–7.4) did not receive vitamin A supplementation during illness. 63% (10/16) among the case-persons and 6.3% (3/48) of the controls (OR_M-H?=?33; 95% CI?=?6.8–159) were not treated for measles illness at a health facility (a proxy for more appropriate treatment), while 38% (6/16) of the case-persons and 25% (12/48) of the controls (OR_M-H?=?2.5; 95% CI?=?0.67–9.1) were malnourished. Conclusion Lack of vaccination and no treatment in a health facility increased the risk for measles deaths. The one-dose measles vaccination currently in the national vaccination schedule had a protective effect against measles death. We recommended enhancing measles vaccination and adherence to measles treatment guidelines.