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International Journal of Epidemiology 2009 38(1):192-205; doi:10.1093/ije/dyn224
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Published by Oxford University Press © World Health Organization 2009. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article.

Estimates of measles case fatality ratios: a comprehensive review of community-based studies{dagger}

Lara J Wolfson1,*, Rebecca F Grais2,3,5, Francisco J Luquero3, Maureen E Birmingham4 and Peter M Strebel2

1Health Security and Environment, World Health Organization, Geneva 27, Switzerland.
2Department of Immunization, Vaccines & Biologicals, World Health Organization, Geneva 27, Switzerland.
3Epicentre, Paris, France.
4World Health Organization Thailand Office, Thailand.
5Present address: Epicentre, 8 rue Saint Sabin, 75011 Paris, France.

* Corresponding author. Health Security & Environment, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. E-mail: wolfsonl{at}who.int


  Abstract

Background Global deaths from measles have decreased notably in past decades, due to both increases in immunization rates and decreases in measles case fatality ratios (CFRs). While some aspects of the reduction in measles mortality can be monitored through increases in immunization coverage, estimating the level of measles deaths (in absolute terms) is problematic, particularly since incidence-based methods of estimation rely on accurate measures of measles CFRs. These ratios vary widely by geographic and epidemiologic context and even within the same community from year-to-year.

Methods To understand better the variations in CFRs, we reviewed community-based studies published between 1980 and 2008 reporting age-specific measles CFRs.

Results The results of the search consistently document that measles CFRs are highest in unvaccinated children under age 5 years; in outbreaks; the lowest CFRs occur in vaccinated children regardless of setting. The broad range of case and death definitions, study populations and geography highlight the complexities in extrapolating results for global public health planning.

Conclusions Values for measles CFRs remain imprecise, resulting in continued uncertainty about the actual toll measles exacts.

Keywords Measles, community-based studies, case fatality ratio, mortality, review

{dagger} Some of the results were presented at the WHO meeting ‘Expert review of estimated levels and trends of measles mortality: 1999–2003’ held in Atlanta, GA, 12–13 January 2005.

Accepted 29 September 2008


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