Open AccessRisk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013
Author(s) -
Etienne Gignoux,
Jonathan Polonsky,
Iza Ciglenečki,
Mathieu Bichet,
Matthew E. Coldiron,
Enoch Thuambe Lwiyo,
Innocent Akonda,
Micaela Serafini,
Klaudia Porten
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0194276
Subject(s) - measles , case fatality rate , vaccination , attack rate , mortality rate , outbreak , demography , medicine , environmental health , measles vaccine , democracy , immunology , virology , population , political science , politics , surgery , law , sociology
In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting.