Healthcare exposure linked to 59.4% of measles cases in Chattogram study

More than half of measles-infected children studied in southern Bangladesh had links to hospitals or healthcare facilities, while severe malnutrition was associated with a nearly 24-fold higher risk of severe measles, according to a new study.

The study, titled "Measles Outbreak 2026 in Southern Bangladesh: Epidemiological Profile, Clinical Characteristics, Genetic Analysis with Maternal & Child Antibody Status", examined 170 children. 

Conducted by Asperia Health Research and Development Foundation (ARF), Chattogram City Corporation and Chattogram Medical College's child research team, with funding from Beximco Pharmaceuticals, the study showed that 59.4% of the children had a hospital or healthcare-facility link and 86.7% developed at least one complication.

Pneumonia was the most common complication, affecting 56.1%, while 19% had diarrhoea. Seven children died, all of them unvaccinated, under one year old and suffering from severe pneumonia and malnutrition.

About 46% of the infected children were under nine months old, including 23 under six months – an age group largely below the routine measles vaccination threshold.

Among children who missed vaccination, 52% of parents said they did not know or forgot the scheduled time, 30% said the child was ill on the vaccination day, 8% said the mother was ill, 8% feared the vaccine, and 4% had lost the vaccination card.

The study found that 75.5% of the children came from rural or remote areas and 64.8% from low-income households. Of the 170 children, 51 were severely malnourished, and 37 had not been exclusively breastfed for the first six months.

Genetic analysis of 17 samples found the B3 measles virus in all cases. Researchers said B3 is not a new or unknown strain and has previously been detected in Bangladesh and elsewhere. They found no evidence of a new or vaccine-resistant strain.

Principal investigator Dr Kamrun Nahar said immediate isolation, adequate ventilation and infection-control measures are essential because measles is highly contagious. 

Dr Mohammad Musa Mia, head of paediatrics at Chattogram Medical College, said general wards pose an infection risk and proposed a separate measles hospital or at least a 100-bed dedicated unit.

The study also found that 60% of children who had not received vitamin A developed severe measles, although researchers cautioned that this does not establish a direct causal link. No deaths occurred among vaccinated children, but some vaccination histories were based on mothers' reports.

Researchers also assessed maternal and child measles-rubella antibodies, but the tests could not quantify antibody levels. They recommended further research on protection among children under six months, mothers' vaccination history and maternal antibodies. 

Some children also returned weeks after initial recovery with infection or pneumonia, warranting further study of measles' longer-term effects.

Chattogram Divisional Health Director Dr Sheikh Fazle Rabbi said door-to-door vaccination would be conducted and stressed that vaccination must be accompanied by isolation and infection control. 

Authorities have decided to vaccinate children aged six months to five years, while inclusion of six-month-olds in routine vaccination remains under consideration.

The researchers recommended achieving more than 95% routine vaccination coverage, targeted campaigns for missed children, door-to-door vaccination in underserved areas and regular training for vaccinators. They also advised against unnecessarily delaying vaccination for children with a mild cold or cough unless medically contraindicated.

The study was hospital-based and observational, limiting its ability to represent milder cases or establish direct causal relationships.