There is a global resurgence of measles, consequent upon worldwide stagnating measles vaccination coverage. The study aim was to document trends and characteristics of reported cases of measles, measles-related deaths, and measles vaccination coverage (MCV1—first dose of measles-containing vaccine and MCV2—second dose of measles-containing vaccine) at national and sub-national level in Myanmar over a five year period between 2014 and 2018. This was a descriptive study using routine data collected and submitted to the Expanded Programme on Immunization. Between 2014 and 2018, there were 2673 measles cases of which 2272 (85%) occurred in 2017 and 2018. Five adjacent regions in lower Myanmar were the most affected: in 2017 and 2018, these regions reported 1647 (73%) of the 2272 measles cases in the country. Overall, 73% of measles cases were laboratory confirmed, 21% were epidemiologically linked, and 6% were clinically compatible (clinical diagnosis only), with more laboratory confirmed cases in recent years. Annual measles-related deaths were either zero or one except in 2016 when there were 21 deaths, all occurring in one remote village. In the recent years, the most commonly affected age groups were 0–8 months, 9 months to 4 years, and ≥ 15 years. Among 1907 measles cases with known vaccination status, only 22% had been vaccinated and 70% of those had only received one dose of vaccine. Annual MCV1 coverage nationally varied from 83 to 93% while annual MCV2 coverage nationally varied from 78 to 87%, with no clear trends over the years. Between 2014 and 2018, a high proportion of the 330 townships had MCV coverage < 95%. Over 80% of measles cases were reported from townships that had MCV coverage < 95%. There have been a large number of measles cases in recent years associated with sub-optimal measles vaccine coverage. Myanmar has already conducted supplemental immunization activities in October and November, 2019. Myanmar also needs to improve routine immunization services and targeted responses to measles outbreaks.

/pdf/reported-measles-cases-measles-related-deaths-and-measles-54rzjd8ohh.pdf

Reported measles cases, measles-related deaths and measles vaccination coverage in Myanmar from 2014 to 2018.

OBJECTIVE: To estimate the case-fatality ratio (CFR) for measles in Nepal, determine the role of risk factors, such as political instability, for measles mortality, and compare the use of a nationally representative sample of outbreaks versus routine surveillance or a localized study to establish the national CFR (nCFR) METHODS: This was a retrospective study of measles cases and deaths in Nepal Through two-stage random sampling, we selected 37 districts with selection probability proportional to the number of districts in each region, and then randomly selected within each district one outbreak among all those that had occurred between 1 March and 1 September 2004 Cases were identified by interviewing a member of each and every household and tracing contacts Bivariate analyses were performed to assess the risk factors for a high CFR and determine the time from rash onset until death Each factor's contribution to the CFR was determined through multivariate logistic regression From the number of measles cases and deaths found in the study we calculated the total number of measles cases and deaths for all of Nepal during the study period and in 2004 FINDINGS: We identified 4657 measles cases and 64 deaths in the study period and area This yielded a total of about 82 000 cases and 900 deaths for all outbreaks in 2004 and a national CFR of 11% (95% confidence interval, CI: 05-23) CFR ranged from 01% in the eastern region to 34% in the mid-western region and was highest in politically insecure areas, in the Ganges plains and among cases < 5 years of age Vitamin A treatment and measles immunization were protective Most deaths occurred during the first week of illness CONCLUSION: To our knowledge, this is the first CFR study based on a nationally representative sample of measles outbreaks Routine surveillance and studies of a single outbreak may not yield an accurate nCFR Increased fatalities associated with political insecurity are a challenge for health-care service delivery The short period from disease onset to death and reduced mortality from treatment with vitamin A suggest the need for rapid, field-based treatment early in the outbreak

/pdf/measles-deaths-in-nepal-estimating-the-national-case-5ez319kelk.pdf

Measles deaths in Nepal: estimating the national case-fatality ratio

To ascertain whether measles vaccination was associated with reduced measles associated mortality and morbidity in the Yangon Children's Hospital (YCH), the hospital records of children admitted to YCH in 1985 and 1989 with the diagnosis of measles or measles associated conditions, were analysed retrospectively. Measles vaccination was associated with a 90.7% reduction of deaths directly attributed to measles or ascribed to diarrhoea, respiratory illness, malnutrition or fits. An 85% reduction in the percentage of medical admissions related to measles and measles associated conditions was also seen. The case-fatality rate from measles declined from 25.3% to 15.6%. We conclude that measles immunization has been associated with a marked reduction in morbidity and mortality.

The Impact of National Measles Immunization Programme on Measles Admissions to the Major Children'S Hospital in Yangon:

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The Impact of National Measles Immunization Programme on Measles Admissions to the Major Children'S Hospital in Yangon: