Child Mortality Impact of a Measles Outbreak in a Partially Vaccinated Rural African Community

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Abstract
In spite of a measles vaccination coverage of 58%, 33% of 60 infant and child deaths were attributed to measles in a rural area of Kenya in 1988. Among 252 measles cases, there were 20 acute and 5 late deaths which may have been caused by the measles. Median age at infection was 44 months, with 16% of cases below 1 year of age. The highest age-specific attack rates (43% and 41%) were in unvaccinated children 6–11 months and 1–2-year-olds. The overall case fatality rate for children below 5 years was 12.6%, for unvaccinated children below 5, 16.2% and among children below 9 months, 24%. Children in homes with several cases had a higher case fatality ratio than had isolated cases, although not significantly so (RR 1.93,95% CI 0.71–5.24). The median age of the children who died was 12 months. Overall vaccine efficacy was 62% for children 1–4 years. Our findings suggest that the measles vaccination coverage must be raised considerably in order to reduce mortality rates, and that alternative ways to project infants are needed.