Risk factors for measles infection in 0–7 month old children in China after the 2010 nationwide measles campaign: A multi-site case–control study 2012–2013

Monday, 17th of October 2016

Risk factors for measles infection in 0–7 month old children in China after the 2010 nationwide measles campaign: A multi-site case–control study 2012–2013 

• Chao Ma^a 1 
• Christopher J. Gregory^b 1 
• Lixin Hao^a 1 
• Kathleen A. Wannemuehler^b 
• Qiru Su^a 
• Zhijie An^a
• Linda Quick^b 
• Lance Rodewald^c 
• Fubao Ma^d 
• Rui Yan^e 
• Lizhi Song^f 
• Yanyang Zhang^g 
• Yi Kong^h 
• Xiaoshu Zhangⁱ 
• Huaqing Wang^a 
• Li Li^a 
• Lisa Cairns^b 
• Ning Wang^j 
• Huiming Luo^a  

Abstract

Introduction

Endemic measles persists in China despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated more than 100 million children in 2010. We performed a case–control study in six Chinese provinces during January 2012 through June 2013 to identify risk factors for measles infection among children aged 0–7 months.

Methods

Children with laboratory-confirmed measles were neighborhood matched with three controls. We interviewed parents of case and control infants on potential risk factors for measles. Adjusted matched odds ratios (mOR) and 95% confidence intervals (CIs) were calculated by multivariable conditional logistic modeling. We calculated attributable fractions for risk factors that could be interpreted as causal.

Results

Eight hundred thirty cases and 2303 controls were enrolled. In multivariable analysis male sex (mOR 1.6 [1.3 2.0]) age 5–7 months (mOR 3.9 [3.0 5.1]) migration between counties (mOR 2.3 [1.6 3.4]) outpatient hospital visits (mOR 9.4 [6.6 13.3]) and inpatient hospitalization (mOR 107.1 [48.8 235.1]) were significant risk factors. The calculated attributable fractions for hospital visits was 43.1% (95% CI: 40.1 47.5%) adjusted for age sex and migration.

Conclusions

Hospital visitation was the largest risk factor for measles infection in infants. Improved hospital infection control practices would accelerate measles elimination in China.