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| Bissau (unpublished) | 1991 | PCS; children 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.