Introduction of measles into a highly immunised West African community: the role of health care institutions.

In an urban area of Guinea-Bissau, where more than 80% of the children have been vaccinated, measles continues to be a major cause of child mortality. Compared with the period before the introduction of vaccination, more cases occur outside the community, while more cases within the district are now guests and newcomers. Half of the new introductions of measles into the community and 30% of the measles deaths can be traced back to the paediatric ward. Contact with health care institutions plays an important role in the transmission of measles, particularly among the youngest children. This consequence of health care may be avoidable, however, since several studies suggest that sick children can be vaccinated safely and effectively.