Measles complications: the importance of their management in reducing mortality attributed to measles

Abstract

Objective: To determine the effect of rates of complications among cases and management of complicated cases on measles case fatality rates.

Design: Measles disease surveillance.

Setting: City of Gweru, Department of Health.

Subjects: Children aged zero to 15 years.

Main outcome measures: Case fatality rates.

Results: Measles case fatality rates declined from 47.6 in 1967 to zero in 1989. Between 1967 and 1978 respiratory infections were the predominant complications (66.5%), while after 1979 diarrhoea was the predominant complications (60.6%). A significant partial correlation coefficient was observed between rates of mortality among complicated cases and case fatality rates (r = 0.89, df = 20, p < 0.001).

Conclusion: Good management of complicated cases may have contributed towards the decline in measles case fatality rates.

PIP: A measles surveillance study conducted in 1967-89 among children 0-15 years of age in Gweru, Zimbabwe, sought to determine the effect of measles complications and their management on measles case fatality rates. The surveillance system in Gweru records measles cases and deaths reported from the city's health centers as well as those detected through active case searches in the community. Complicated measles cases are managed at the city's infectious disease hospital. In the period under review, the median case fatality rate was 4.2% and the median rate of complications was 25.5%. The measles case fatality rate declined from 47.6% in 1967 to zero in 1989. Between 1967 and 1978, respiratory infections were the predominant complication (66.5% of cases); after 1979, diarrhea was the most common complication (60.6% of cases). A significant partial correlation coefficient was observed between rates of mortality among complicated cases and case fatality rates (p 0.001). The dramatic improvements detected in this study are presumed due to improved case management and treatment (especially vitamin A administration) of measles cases admitted to the infectious disease hospital.