Table 2.
Acute measles case death ratio for measles-vaccinated and measles-unvaccinated cases in African prospective community studies and community surveys
| Country | Period | Study | Vaccinated cases, % (deaths/cases) | Unvaccinated cases, % (deaths/cases) | Measles case death ratio (95% CI) |
| Bissau32 | 1980–1982 | PCS; urban | 9 (5/53) | 17 (18/108) | 0.58 (0.23–1.49)* |
| Bissau32 † | 1980–1982 | PCS; urban (only secondary cases) | 14 (3/21) | 46 (11/24) | 0.30 (0.10–0.86)* |
| Guinea-Bissau33 | 1983–1984 | PCS; urban | 4 (4/90) | 9 (21/234) | 0.41 (0.14–1.22)* |
| Guinea-Bissau34 | 1984–1987 | PCS; 2-year follow-up | 0 (0/4) | 13 (2/16) | 0 (0–23.10) |
| Bissau35 | 1985–1987 | PCS; children <2 years; urban | 5 (1/22) | 11 (10/90) | 0.41 (0.06–3.03)‡ |
| Bissau (unpublished) | 1991 | PCS; children <10 years; urban | 2 (10/412) | 13 (64/478) | 0.24 (0.12–0.49)* |
| Senegal36 | 1987–1994 | PCS; rural | 0 (0/127) | 2 (18/1085) | 0 (0–1.94)* |
| Ghana37 | 1989–1991 | PCS; rural; vitamin A trial with measles surveillance | 10 (15/153) | 17 (136/808) | OR=0.42 (0.21–0.83)§ ¶ |
| Kenya22 | 1986 | SUR; all ages; rural | 2 (2/41) | 11 (11/98) | 0.51(0.08–3.08)* |
| Kenya38 | 1988 | SUR; children <5 years; rural | 0 (0/23) | 10 (18/182) | 0 (0–1.54)* |
| Chad39 | 1993 | SUR; rural | 0 (0/23) | 8 (61/801) | 0 (0–2.18) |
| Niger40 | 2003–2004 | SUR**; urban | 0.4 (1/286) | 6 (29/481) | 0.06 (0.01–0.42) |
| Chad40 | 2004–2005 | SUR**; urban | 0.4 (2/494) | 8 (18/212) | 0.05 (0.01–0.20) |
| Nigeria40 | 2004–2005 | SUR**; rural | 9 (1/11) | 7 (79/1131) | 1.30 (0.20–8.54) |
| Sudan41 | 2004 | SUR | 0.4 (2/556) | 1 (7/568) | 0.29 (0.06–1.40) |
| Niger42 | 1991–1992 | SUR; rural | 17 (20/118) | 15 (61/410) | 1.14 (0.72–1.81) |
| Zimbabwe43 | 1980–1989 | SUR; urban | 2 (8/335) | 7 (20/302) | 0.36 (0.16–0.81) |
| Total | 0.39 (0.31–0.49) |
Sources: Reviews of measles case death studies27–31 and PubMed search for measles mortality/case death in vaccinated children; compiled by Henning Andersen shortly before he died.
Adjusted for age.
Mortality is high because only secondary cases are included in the analysis. Since this analysis is a subgroup within the larger study, it has not been included in the combined estimate.
Adjusted for district.
Case death ratio calculated by the authors, the remaining studies have been calculated by us.
Adjusted for age, sex, weight-for-age z-score, paternal education and season.
Mortality was only reported for children with at least 30 days of follow-up, whereas the proportion of vaccinated was reported among all cases. It has been assumed that the proportion of vaccinated cases was the same among those with follow-up as among all cases.
PCS, prospective community studies; SUR, community surveys or outbreak investigations.