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Meta-Analysis
. 2023 Nov 2;23(1):756.
doi: 10.1186/s12879-023-08757-0.

Attack rate, case fatality rate and determinants of measles infection during a measles outbreak in Ethiopia: systematic review and meta-analysis

Mengistie Kassahun Tariku  1 , Daniel Tarekegn Worede  2 , Abebe Habtamu Belete  2 , Simachew Animen Bante  3 , Sewnet Wongiel Misikir  4
Affiliations
Meta-Analysis

Attack rate, case fatality rate and determinants of measles infection during a measles outbreak in Ethiopia: systematic review and meta-analysis

Mengistie Kassahun Tariku et al. BMC Infect Dis. .

Abstract

Background: Although Ethiopia is working towards measles elimination, a recurrent measles outbreak has occurred. To take appropriate measures, previously, many fragmented and inconsistent outbreak investigations were done, but there is no consolidated evidence on attack rate, case fatality rate, and determinants of measles infection during the measles outbreak. This systematic review and meta-analysis aimed to identify cumulative evidence on attack rate, case fatality rate, and determinants of measles infection during the outbreak.

Methods: A systematic literature review and Meta-analysis was used. We searched Google Scholar, Medline/PubMed, Cochrane/Wiley Library, EMBASE, Science Direct, and African Journals Online databases using different terms. Investigations that applied any study design, data collection- and analysis methods related to the measles outbreak investigation were included. Data were extracted in an Excel spreadsheet and imported into STATA version 17 software for meta-analysis. The I2 statistics were used to test heterogeneity, and 'Begg's and 'Egger's tests were used to assess publication bias. The odds ratio (OR) with a 95% confidence interval (CI) was presented using forest plots.

Results: Eight measles outbreak investigations with 3004 measles cases and 33 deaths were included in this study. The pooled attack rate (A.R.) and case fatality rate were 34.51/10,000 [95% CI; 21.33-47.70/10,000] population and 2.21% [95% CI; 0.07-2.08%], respectively. Subgroup analysis revealed the highest attack rate of outbreaks in the Oromia region (63.05 per 10,000 population) and the lowest in the Amhara region (17.77 per 10,000 population). Associated factors with the measles outbreak were being unvaccinated (OR = 5.96; 95% CI: 3.28-10.82) and contact history (OR = 3.90; 95% CI: 2.47-6.15).

Conclusion: Our analysis revealed compelling evidence within the outbreak descriptions, highlighting elevated attack and case fatality rates. Measles infection was notably linked to being unvaccinated and having a contact history. Strengthening routine vaccination practices and enhancing contact tracing measures are vital strategies moving forward.

Keywords: Ethiopia; Measles; Outbreak; Review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow Diagram of measles outbreak investigation included in systematic review and meta-analysis in Ethiopia, 2022
Fig. 2
Fig. 2
Pooled attack rate of measles during an outbreak in Ethiopia. p-value = 0.00047 and ‘Begg’s = 0.00053 (Fig. 2)
Fig. 3
Fig. 3
Pooled case fatality rate during the measles outbreak in Ethiopia
Fig. 4
Fig. 4
Pooled odds ratio between vaccination status and contracting the measles virus
Fig. 5
Fig. 5
Pooled odds ratio between contact history and contracting the measles virus
See this image and copyright information in PMC

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