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.

Highlights

  • Since 1990, measles incidence has significantly decreased in every region of the world[1]

  • The sub-section “description of the epidemic” present the estimate of measles attack rates, measles-specific mortality during the epidemic and the vaccination coverage; in the sub-section “risk factors for measles mortality, we explore the potential risk factors associated with the measles fatality through logistic regression and geospatial analysis

  • We remind the burden caused by a measles epidemic, we discuss the effectiveness of a comprehensive case management system where the combination of decentralized health care and referral seems to have reduced significantly the case fatality; we report the weakness of the implementation of the prevention and control measures

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Summary

Introduction

Since 1990, measles incidence has significantly decreased in every region of the world[1]. This progress has been mitigated since 2007, most of the cases have been reported in sub-Saharan Africa [2][3]. The Democratic Republic of Congo (DRC) has followed this trend: in 2009, only 3364 cases were reported, a minimum for the country, but since 2010, a prolonged epidemic has affected the country, and the number of cases has substantially increased.

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