• Challenges in measuring measles case fatality ratios in settings without vital registration.

      Cairns, K Lisa; Nandy, Robin; Grais, RFebecca F; Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-05, Atlanta, GA 30333, USA. kfc4@cdc.gov. (2010)
      ABSTRACT: Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs) have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies.
    • Should outbreak response immunization be recommended for measles outbreaks in middle- and low-income countries? An update.

      Cairns, K Lisa; Perry, Robert T; Ryman, Tove K; Nandy, Robin K; Grais, RFebecca F; Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia 30306, USA. kfc4@cdc.gov (2011-07)
      Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals.