Risk 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

Abstract

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.

Fig 1. Suspected measles cases by week, Aketi Health Zone, Province Orientale, DRC, 2013 (source: MSF and MoH).

Fig 2

Geospatial representation of CFR from December 25th, 2012 to February 28th 2013 (A), and from March 1st, 2013 to October 9th, 2013 (B) , Aketi Health Zone, Province Orientale, Democratic Republic of Congo. The white cross is at the location of the central hospital of Aketi. The scale represent the CFR expressed in %. The 40 dots represent the cluster locations.