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Lancet Glob Health. 2019 Apr;7(4):e472-e481. doi: 10.1016/S2214-109X(18)30537-0. Epub 2019 Feb 21.

Estimates of case-fatality ratios of measles in low-income and middle-income countries: a systematic review and modelling analysis.

Author information

1
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
2
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK.
3
The Center for Infectious Disease Dynamics, Department of Biology and Department of Statistics, The Pennsylvania State University, University Park, PA, USA.
4
Bill & Melinda Gates Foundation, Seattle, WA, USA.
5
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: verguet@hsph.harvard.edu.

Abstract

BACKGROUND:

In the 21st century, increases in immunisation coverage and decreases in under-5 mortality have substantially reduced the global burden of measles mortality. However, the assessment of measles mortality burden is highly dependent on estimates of case-fatality ratios for measles, which can vary according to geography, health systems infrastructure, prevalence of underlying risk factors, and measles endemicity. With imprecise case-fatality ratios, there is continued uncertainty about the burden of measles mortality and the effect of measles vaccination. In this study, we aimed to update the estimations of case-fatality ratios for measles, to develop a prediction model to estimate case-fatality ratios across heterogeneous groupings, and to project future case-fatality ratios for measles up to 2030.

METHODS:

We did a review of the literature to identify studies examining measles cases and deaths in low-income and middle-income countries in all age groups from 1980 to 2016. We extracted data on case-fatality ratios for measles overall and by age, where possible. We developed and examined several types of generalised linear models and determined the best-fit model according to the Akaike information criterion. We then selected a best-fit model to estimate measles case-fatality ratios from 1990 to 2015 and projected future case-fatality ratios for measles up to 2030.

FINDINGS:

We selected 124 peer-reviewed journal articles published between Jan 1, 1980, and Dec 31, 2016, for inclusion in the final review-85 community-based studies and 39 hospital-based studies. We selected a log-linear prediction model, resulting in a mean case-fatality ratio of 2·2% (95% CI 0·7-4·5) in 1990-2015. In community-based settings, the mean case-fatality ratio was 1·5% (0·5-3·1) compared with 2·9% (0·9-6·0) in hospital-based settings. The mean projected case-fatality ratio in 2016-2030 was 1·3% (0·4-3·7).

INTERPRETATION:

Case-fatality ratios for measles have seen substantial declines since the 1990s. Our study provides an updated estimation of case-fatality ratios that could help to refine assessment of the effect on mortality of measles control and elimination programmes.

FUNDING:

Bill & Melinda Gates Foundation.

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