Risk Factors for Measles Mortality in Southern Border Provinces of Thailand, 2018-2019

Abstract

In 2018 - 2019, the southern border provinces of Thailand were affected with large measles epidemic with 30 death cases (CFR 0.68 percent). We initiated an epidemiological study in order to identify risk factors for measles mortality and recommend the prevention and control measures. We conducted a case-control study in 4 provinces where 30 measles death cases notified. A case was defined as an inpatient aged lower than 15 years old who dead with final diagnosed as measles or positive measles IgM and having onset during 1 August 2018 – 28 February 2019. Controls were randomly selected from the same community of cases who positive measles IgM and survived after treatment as inpatient. Parents of all 30 cases and 231 controls were face-to-face interviewed by using a standard questionnaire. Among 30 death cases, there were 93.33 percent aged lower than 5 years old, 46.43 percent had malnutrition and 96.15 percent unvaccinated. Pneumonia with respiratory failure was a major cause of all measles death cases. Average duration from the death cases onset to measles diagnosis was 5 days and to vitamin A treatment was 8 days. The study revealed that preadmission pneumonia and previous hospitalized with infection in 14 day before the onset of measles were associated with measles mortality (Adj OR= 8.08, 95%CI=1.66-39.35 and Adj OR= 3.24, 95%CI=1.04-10.10, respectively). High dose vitamin A treatment before developing respiratory failure was a significant preventive factor (Adj OR= 0.27, 95%CI= 0.09-0.81). Pneumonia complication was a major risk of measles mortality. Early diagnosis of measles cases with early vitamin A treatment was important prevention measures. To provide a standard clinical practice guideline for clinicians and public health authorities in the area, to improve hospital infection control, use of immunoglobulin to prevent measles in exposed susceptible high-risk persons and vitamin A deficiency prevalence survey in the area are important for prevention measles mortality.