Analysis of Measles surveillance data- Bangladesh, 2013-2017

  • Vaccine preventable diseases
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Background:
Bangladesh targets to eliminate measles by year 2020. Expanded Program on Immunization (EPI) in Bangladesh provides two doses of measles-rubella (MR) vaccine routinely at nine months and 15 months of age, since 2012. With technical support from World Health Organization, EPI conducts measles surveillance consisting of immediate case-based reporting along with weekly active and passive reporting from 768 static health facilities all over the country. Health facilities report suspected measles patients having fever and rash with any one of cough or coryza or conjunctivitis and send specimens to national laboratory for confirmation of measles and rubella. In 2016, surveillance reported increasing incidence of measles. Our objectives were to estimate the incidence of measles and to identify the risk population.

Methods:
We analyzed the measles surveillance data of Bangladesh from 2013-2017. We defined confirmed measles as patients having either laboratory confirmation of measles or epidemiological link with laboratory confirmed measles patients. Measles incidence per 1,000,000 population was calculated and compared with vaccine coverage data. Z-test was performed for comparison of proportions in two groups. For a case control study, we defined non-measles, non-rubella patients from the surveillance as controls. Multivariable regression model was performed to identify high-risk groups. Odds ratio (OR) and 95% confidence interval (95%CI) was calculated.

Results:
During 2013-2017, 20% (5,303/24,029) of suspected patients were confirmed for measles. The reported incidence of confirmed measles was 1.3/1,000,000 in 2013, which increased to 22/1,000,000 in 2017, the highest in five years. Among confirmed patients of 2017, 13.4% (482/3,594) were <9 months of age. We found 43% (1558/3,594) of confirmed measles patients between age 9 months-5 years and of them 21% (329/1558) completed vaccination as per schedule. Cities had higher incidence (51.7/1,000,000) than non-cities (18.7/1,000,000) [p-value<0.0001]. Dhaka city had highest incidence (83.6/1,000,000) in 2017 with lowest MR vaccine coverage (67.3%) in 2016. Unvaccinated children (OR=4.2, 95%CI=3.9-4.6), age <5 years (OR=2.4, 95%CI=2.3-2.6) and city-dwellers (OR=2.2, 95%CI=2.0-2.4) were more likely to develop measles.

Conclusion:
The reported incidence of measles is increasing in Bangladesh in recent years. Vaccination program should identify factors for incomplete or no vaccination among eligible children and evaluate the vaccination strategies, especially in Dhaka.

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