Epidemiology of measles in Taiwan: dynamics of transmission and timeliness of reporting during an epidemic in 1988-9.

We analysed nation-wide reported measles cases during the 1988-9 epidemic and found that longer duration and wider spread were two major characteristics of the outbreak. All the 22 county/city index cases were reported with a delay of > 4 days and 64% were aged 5-14 years. This epidemic occurred mainly among 5-14-year-old school-children (59%), infants under 1 year (19%), and pre-school children (18%). The overall attack rate was 0.63 cases per 10,000 population, with the highest attack rate (7.4 cases per 10,000 population) occurring in infants. Among 280 confirmed cases < 15 months of age, 9-month-old infants (42 cases) had a higher risk of measles and peaked at 10 months (49 cases). This epidemic started in March 1988 among 5-9-year-old children in the northern suburban area, then spread to Taipei City and neighbouring counties or cities. It continued to spread from the northern to southern and western areas during the summer vacation and New Year holidays. Multiple logistic regression analysis showed that the delay of measles reporting was strongly associated with the cases infected early in the epidemic (OR = 6.9, P < 0.001) and reported from teaching hospitals (OR = 2.6, P < 0.001). The reappearance of high attack rates among 5-9-year-old children in the 1985 and 1988-9 measles epidemics in Taiwan indicated the persistence of pockets of susceptible individuals even after mass immunization.