Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA.
Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA.
J Infect Dis. 2019 Oct 22;220(11):1771-1779. doi: 10.1093/infdis/jiz140.
Surveillance data from a large measles outbreak in Mongolia suggested increased case fatality ratio (CFR) in the second of 2 waves. To confirm the increase in CFR and identify risk factors for measles death, we enhanced mortality ascertainment and conducted a case-control study among infants hospitalized for measles.
We linked national vital records with surveillance data of clinically or laboratory-confirmed infant (aged <12 months) measles cases with rash onset during March-September 2015 (wave 1) and October 2015-June 2016 (wave 2). We abstracted medical charts of 95 fatal cases and 273 nonfatal cases hospitalized for measles, matched by age and sex. We calculated adjusted matched odds ratios (amORs) and 95% confidence intervals (CIs) for risk factors.
Infant measles deaths increased from 3 among 2224 cases (CFR: 0.13%) in wave 1 to 113 among 4884 cases (CFR: 2.31%) in wave 2 (P < .001). Inpatient admission, 7-21 days before measles rash onset, for pneumonia or influenza (amOR: 4.5; CI, 2.6-8.0), but not other diagnoses, was significantly associated with death.
Measles infection among children hospitalized with respiratory infections likely increased deaths due to measles during wave 2. Preventing measles virus nosocomial transmission likely decreases measles mortality.
蒙古大规模麻疹疫情的监测数据显示，在第 2 波疫情中，病死率（CFR）有所增加。为了确认 CFR 的增加并确定麻疹死亡的危险因素，我们加强了死亡率的确定，并在因麻疹住院的婴儿中进行了病例对照研究。
我们将国家生命记录与 2015 年 3 月至 9 月（第 1 波）和 2015 年 10 月至 2016 年 6 月（第 2 波）期间出现皮疹的临床或实验室确诊的婴儿（年龄<12 个月）麻疹病例的监测数据进行了关联。我们摘录了 95 例麻疹死亡病例和 273 例麻疹住院非死亡病例的病历，按年龄和性别进行了匹配。我们计算了危险因素的调整匹配比值比（amOR）和 95%置信区间（CI）。
第 1 波的 2224 例病例中有 3 例（CFR：0.13%），第 2 波的 4884 例病例中有 113 例（CFR：2.31%），麻疹死亡人数有所增加（P<0.001）。麻疹皮疹发病前 7-21 天住院，因肺炎或流感（amOR：4.5；95%CI：2.6-8.0），而不是其他诊断，与死亡显著相关。
因呼吸道感染住院的儿童中麻疹感染可能增加了第 2 波麻疹死亡人数。预防麻疹病毒医院内传播可能会降低麻疹死亡率。
