| Abstract: | An evaluation of the public health importance of measles in Burma was carried out in 1983 to formulate recommendations regarding the feasibility of incorporating measles vaccine into the country's Expanded Program on Immunization (EPI). A review of available medical, serological, and epidemiological data as well as a sample study of childhood deaths indicated measles is a major killer of infants and young children in Burma. Since 1978, there have been over 20,000 cases of measles per year, and almost all children are infected with the measles virus by age 10 years. The clinical attack rate for measles is highest during the 2nd year of life. During the measles season, this virus accounts for 20% of all pediatric admissions and places an acute strain on the hospital system. Respiratory complications are noted in 50-90% of all measles admissions, while gastrointestinal complications range from 5-25%. The case-fatality rate of hospitalized measles cases averages 8.2%. Measles accounted for 87 (35%) of 280 childhood deaths occurring in selected townships in Rangoon in 1982-83, and less than 20% of these children had been hospitalized before death. Taking into account all available survey and study data, the overall case-fatality rate for measles in Burma can be conservatively estimated at 1-2%. Since about 1 million cases of measles occur each year, 10,000-20,000 measles deaths/year can be expected. It is concluded that measles' heavy toll in terms of child deaths will not change until measles' vaccine is routinely provided to all infants and young children. The use of measles vaccine on a wide scale is justified not only by morbidity and mortality considerations, but by the burden this disese places on hospital and outpatient resources. |
