Epidemiology and Infection

Research Article

Priorities in global measles control: report of an outbreak in N'Djamena, Chad

A. Ndikuyezea1, A. Cooka2, F. T. Cuttsa2 c1 and S. Bennetta2

a1 World Health Organization, Chad

a2 London School of Hygiene and Tropical Medicine. Keppel Street, London WC1E 7HT, UK


In N'Djamena, capital of Chad, measles vaccination coverage of 12–23-month-old children fell from 61% in 1990 to 15% in 1993. A community survey of measles after an outbreak in 1993 showed that among children < 5 years of age, the mean monthly attack rate was 37 per 1000 (95% CI, 32–43) and the mean case fatality rate was 7·4%. Measles incidence was highest (77/1000/month) in children aged 9–11 months and fell among children > 3 years of age. Incidence rates were high (56/1000/month) among 6–8-month-old children, but only 3 deaths occurred in this age group. Measles vaccine efficacy, estimated by comparing attack rates in unvaccinated and vaccinated children, was 71 % (95% CI, 59–80%). Extrapolation of the results to the city population indicated that an estimated 19000 cases and > 1000 measles-associated deaths occurred in 1993. This preventable morbidity and mortality, in a city where coverage was formerly among the highest in Africa, shows the need for sustained global commitment to preventive health care.

(Accepted March 28 1995)


c1 For correspondence and reprints.