PRIORITIES IN GLOBAL MEASLES CONTROL - REPORT OF AN OUTBREAK IN NDJAMENA, CHAD

In N'Djamena, capital of Chad, measles vaccination coverage of 12-23-m onth-old children fell from 61% in 1990 to 15% in 1993. A community su rvey 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 74%. Measles incidence was highest (77/1000/month) in children aged 9-11 months and fell among c hildren > 3 years of age. Incidence rates were high (56/1000/month) am ong 6-8-month-old children, but only 3 deaths occurred in this age gro up. Measles vaccine efficacy, estimated by comparing attack rates in u nvaccinated and vaccinated children, was 71% (95% CI, 59-80%). Extrapo lation of the results to the city population indicated that an estimat ed 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 gl obal commitment to preventive health care.