Chao Ma1, Christopher J Gregory2, Lixin Hao1, Kathleen A Wannemuehler2, Qiru Su1, Zhijie An1, Linda Quick2, Lance Rodewald3, Fubao Ma4, Rui Yan5, Lizhi Song6, Yanyang Zhang7, Yi Kong8, Xiaoshu Zhang9, Huaqing Wang1, Li Li1, Lisa Cairns2, Ning Wang10, Huiming Luo11. 1. National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China. 2. Global Immunization Division, Centers for Disease Control and Prevention, United States. 3. Expanded Program on Immunization, World Health Organization Office in China, Beijing, China. 4. Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, China. 5. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China. 6. Shandong Provincial Center for Disease Control and Prevention, Shangdong Province, China. 7. Henan Provincial Center for Disease Control and Prevention, Henan Province, China. 8. Yunnan Provincial Center for Disease Control and Prevention, Yunnan Province, China. 9. Gansu Provincial Center for Disease Control and Prevention, Gansu Province, China. 10. National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. 11. National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: luohm@chinacdc.cn.
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. Copyright Â
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. Copyright Â
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