Agents affecting health of mother and child in a rural area of Kenya. III. The epidemiology of measles.

Between April 1974 and March 1976 surveillance of measles has been conducted by 12 fieldworkers making fortnightly home visits among a total population of 24,000 living in nearly 4000 households scattered in variable density throughout an area of 87 sq km in the northern division of the Machakos district, Kenya. The diagnosis of measles was verified by one of the project's physicians according to standardized procedures and was, whenever possible, supported by virus isolation and serum antibody level determination. Because not all reported patients were actually seen during the period of clinical manifestations, the diagnosis remained doubtful in a number of cases. Incidence and mortality figures have been estimated with 95% confidence limits based on the assumption that doubtful cases represent a probability of measles of .33 and probable cases a probability of .67. The estimated attack rate for the susceptible population 0-15 years of age was 13.5%. When related to all children--susceptible or not--the attack rate was highest in the 1-2 years age group (11%). Almost 15% of cases occurred below the age of one year, 1% below 6 months of age and 6% between 6 and 8 months. The estimated case fatality rate was 6.5%, fatality being highest between 1 and 2 years of age. For the age group 0-15 years measles accounted for 16.7% of all deaths. The estimated death rate per 100,000 total population was 113. The epidemiological pattern of measles suggests continuous re-introduction of the measles virus in a dispersed population causing micro-outbreaks of the disease in geographically widely separated spots throughout the year which tends to keep the proportion of susceptibles down and the attack rate during a protracted epidemic relatively low.