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  • Title: Influence of cross-sex transmission on measles mortality in rural Senegal.
    Author: Aaby P.
    Journal: Lancet; 1992 Aug 15; 340(8816):388-91. PubMed ID: 1353555.
    Abstract:
    Previous studies of measles mortality in West Africa have shown a significantly higher case-fatality rate (CFR) among girls than among boys. This study aimed to find out whether the male/female difference in CFR is related to different risks for boys and girls of being infected as secondary rather than index cases and of transmission from someone of the same or the opposite sex. The study was conducted in Niakhar, a rural area of Senegal (population 24,000). All cases of measles reported between March, 1983, and December, 1986, were investigated to determine source of infection and pattern of transmission. For each case, the closest source of infection was judged the most likely. Death was attributed to measles if it occurred within 6 weeks of the onset of rash. Girls had a higher measles CFR than boys (53 deaths/722 cases [7.3%] vs 45/778 [5.8%]); the relative risk of death was 1.30 (95% confidence interval [CI] 0.89-1.90). Secondary cases infected by a child of the opposite sex had a 2.44 (1.48-4.02) times higher risk of death than did secondary cases infected by a child of the same sex. The risk of cross-sex transmission of infection was significantly greater for female than for male secondary cases (1.26 [1.09-1.47]). When this difference in risk of exposure to infection from the opposite sex was taken into account, the difference in risk of death between girls and boys disappeared (1.06 [0.66-1.69]). Within families, the CFR was higher in huts with 1 boy and 1 girl affected than in huts of either 2 boys or 2 girls affected (relative risk 2.16 [0.99-4.70]). Measles infection contracted from a person of the opposite sex is more severe. Variation in exposure may be an important determinant of sex differences in case fatality. 1500 measles cases occurring between March 1983-December 1986 in rural Niakhar, Senegal were studied to determine whether the excess case fatality rate (CFR) for girls was associated with different risks for boys and girls of being infected by a child of the opposite sex. Case studies uncovered the closest source of infection and the pattern of transmission within the compound. A death within 6 weeks of the emergence of the rash was considered to be measles related. Girls had a higher CFR and relative risk (RR) than did males (7.3% vs. 5.8%; RR=1.3), but the difference was not significant. The CFR among secondary cases of measles infected by a child of the opposite sex was higher than it was for those infected by a child of the same sex (RR=2.44). Girls were at greater risk than boys of being infected as secondary cases by a child of the opposite sex than were boys (RR=1.26). When the difference in risk of being infected by the opposite sex was controlled, the difference no longer existed (RR=2.16). The CFR for girls stood 3.15 times higher in families with a boy and a girl affected than in families with 2 girls affected compared with 1.47 for boys in a similar situation. These results suggested that measles infection acquired from a child of the opposite sex is more dangerous than if it were acquired from a child of the same sex. Perhaps differences in exposure determines sex differences in case fatality. Cross-sex transmission research is needed to determine whether a hitherto biological or behavioral unnoticed mechanism may aggravate infections.
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