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To identify risk factors for measles death, we conducted a case-control study among infants and children hospitalized for measles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>National surveillance data were used to identify hospitalized cases of laboratory-confirmed or epidemiologically linked measles in infants and children aged<jats:underline>&lt;<\/jats:underline>\u200959\u2009months with rash onset from January 2016 to July 2018. We abstracted medical records of 50 fatal cases (\u201ccases\u201d) and 250 non-fatal cases (\u201ccontrols\u201d) matched by age, sex, district of residence, and urban\/rural place of residence. We calculated univariable and multivariable matched odds ratios (OR) and 95% confidence intervals (CIs) for risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety-three percent of case-patients and controls had not received a valid dose of a measles-containing vaccine; only 5 % received Vitamin A supplementation once diagnosed with measles. In the univariable analysis, cases were more likely than controls to have had a healthcare-related exposure to measles manifesting as inpatient admission for pneumonia during the 7 to 21\u2009day measles incubation period (OR: 3.0; 95% CI [1.2, 7.2]), to have had a history of malnutrition (OR: 3.4; 95% CI [1.1, 9.9]), and to have had pneumonia as a complication of measles (OR:7.1; 95% CI [2.0\u201324.8]). In the multivariable analysis, pneumonia as a measles complication remained a risk for death (OR: 7.1; 95% CI [1.4\u201335.3]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Implementing infection prevention and control practices, ensuring immunization of healthcare workers, and hospitalizing only severe measles cases may minimize the risk of nosocomial measles transmission. Implementing World Health Organization (WHO) recommendations for Vitamin A supplementation, improving immunization of children to prevent influenza, pneumococcal, and other bacterial respiratory diseases may decrease complications and deaths due to measles in Romania.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-021-05966-3","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T14:04:10Z","timestamp":1616162650000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Risk factors for measles deaths among children during a Nationwide measles outbreak \u2013 Romania, 2016\u20132018"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6448-9587","authenticated-orcid":false,"given":"Morgane","family":"Donadel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Stanescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Pistol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brock","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Butu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragan","family":"Jankovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan","family":"Paunescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Zimmerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,19]]},"reference":[{"issue":"10111","key":"5966_CR1","doi-asserted-by":"publisher","first-page":"2490","DOI":"10.1016\/S0140-6736(17)31463-0","volume":"390","author":"WJ Moss","year":"2017","unstructured":"Moss WJ. 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Both Institutional Review Boards determined that the study was not human subjects\u2019 research since the primary intent was epidemic disease control activity. Romanian public health policy and practice applied to this disease control activity. The Romania MOH contacted all hospital and family doctors to request participation in the study. Before family doctors were interviewed, they were asked for their verbal consent; their consent was documented in the study databases. Verbal consent of physicians was determined to be appropriate and sufficient based on Romanian public health policy and practice with regard to public health investigation. We received administrative permission to access and use the hospital and family doctor medical records. Data used in the study were anonymized.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"279"}}