• Estimates of measles case fatality ratios: a comprehensive review of community-based studies.

      Wolfson, Lara J; Grais, RFebecca F; Luquero, Francisco J; Birmingham, Maureen E; Strebel, Peter M; Health Security and Environment, World Health Organization, Geneva 27, Switzerland. wolfsonl@who.int (2009-02)
      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.
    • Measles outbreak response immunization is context-specific: insight from the recent experience of médecins sans frontières.

      Minetti, A; Bopp, C; Fermon, F; François, G; Grais, RF; Grout, L; Hurtado, N; Luquero, F J; Porten, K; Sury, L; et al. (PLoS, 2013-11)
      Andrea Minetti and colleagues compare measles outbreak responses from the Democratic Republic of the Congo and Malawi and argue that outbreak response strategies should be tailored to local measles epidemiology. Please see later in the article for the Editors' Summary.
    • 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.