PATTERN OF EXPOSURE AND MEASLES MORTALITY IN SENEGAL

In a rural area of Senegal, 1500 cases ofmeasles and 98 deaths (6.5%) were registered during a 4-year period (1983-1986). For children <5 years old, the acute case fatality ratio (CFR) was 9.6%. Compared with index cases who contracted measles in the village, secondary cases infected within the compound had a significantly higher mortality (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.1). The CFR of secondary cases increased with the closeness of contact with the index cases; the ORs were 1.9 (CI, 0.6-6.0) for children living in the same compound but not the same household, 2.3 (CI, 1.0-5.7) for children living in the same household but not in the same hut, and 3.8 (CI, 1.7-8.4) for children living in the same hut. In large compounds with many cases, the CFR increased exponentially through the succession of generations; the ORs were 2.3 (CI, 1.0-5.2) in the second generation, 3.7 (CI, 1.1-3.0) in the third generation, 5.5 (CI, 1.7-18.1) in the fourth generation, and 16.1(C], 5.6-46.3) in the fifth or later generations. Postmeasles mortality through the year following measles infection was also significantly related to the intensity of exposure. Differences in exposure may bea major determinant of child survival, both at time of acute disease and for the long term impact of measles infection. © 1990, University of Chicago. All rights reserved.