Sultana Habibullah, Junaid Ashraf, Akeel Aamir Mullick M Shakeel.
Case-control study for measles outbreak in a tertiary care hospital.
Pak J Med Res Jan ;55(1):7-10.

Objectives: To compare the profile of measles patients (cases) with non-measles (controls) admitted in Pediatric units of Civil Hospital, Karachi during the measles epidemic. Study type, settings and duration: Retrospective, case control, hospital record analysis of children admitted in pediatric units of Civil Hospital, Karachi from October 2012-March 2013. Subjects and Methods: From the list provided by the ward authorities, case records of children (cases) admitted in pediatric units of Civil Hospital, Karachi with the clinical diagnosis of measles were selected using convenient sampling. From the same wards, age and gender matched non-measles cases (controls) were also selected. The signs, symptoms, mortality and hospital stay of cases and controls were taken from the hospital record, while some information like socio-economic status, vaccination status, symptoms, number of days ill before presenting to health facility, health status of the child, history of similar illness in the family, neighbors, relatives and history of calamity in the area in recent past was taken from the parents or care givers telephonically. Sample size of 300 children (150 cases, 150 controls) was calculated. Results: Out of 150 children having measles, 84 (56%) were females. Most cases reported to health facility after a median of 8 days of onset of symptoms. Almost 98 (65%) children were vaccinated for measles and 52 (35%) were not vaccinated Median age of cases, vaccinated for measles was 30 months while median age of cases not vaccinated for measles was 21 months. All cases had history of fever and maculo-papular rash. Death occurred in 10 (7%) cases due to pneumonia. There was history of measles in their family in 90 (60%) cases, 54 (36%) had measles in neighbors and 30 (20%) in relatives. Out of 150 controls, 76 (51%) were vaccinated for measles and 74 (49%) were not vaccinated. The main reason for admission was pneumonia in 78 (52%) and bronchial asthma in 45 (30%). The risk of measles was 0.83 times higher for cases who were vaccinated for measles as compared to controls who were vaccinated for measles. Using univariate analysis, symptoms of breathlessness and lower respiratory tract infection at the time of admission were significantly associated with measles disease. Using multivariate analysis, children between 9 to 60 months of age, presenting with breathlessness and lower respiratory tract infection had a significantly high chance of suffering from measles disease. Conclusion: Almost 65% who had received measles vaccination as per their mothers statement suffered from measles. Policy message: Measles outbreak occurring in many children despite getting measles vaccine needs further workup both for the timing of vaccination, actual verification of vaccination and its efficacy. Key words: Measles disease, Schedule EPI vaccination, presenting symptoms.

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