Introduction: Vietnam experienced several outbreaks of measles between 2017 and 2019, with various pediatric patients presenting severe complications.

Aims and objectives: This study aims to identify factors associated with death among children with severe measles admitted to Vietnam National Children's Hospital.

Method: This single-center retrospective cohort study included 849 patients with severe measles (defined as patients requiring any form of respiratory support) admitted from 1/1/2017 to 31/12/2019. Data on epidemiological, clinical characteristics, and outcomes were collected. The correlation was examined using Firth's Bias-Reduced logistic regression.

Results: The median age was 8 months (interquartile range 5-12), with 759 (89.3%) children having at least 1 comorbidity. 30 (3.5%) patients died, with 40% aged less than 9 months. Also, among patients aged ? 9 months, 354 (88.7%) were unvaccinated. Only 1 among 33 (3.3%) children having received at least 2 doses of MCV deceased. Admission year of 2018 (adjusted odds ratio (aOR) 0.05, 95%CI 0.01-0.44); age ? 5 years (aOR 10.35, 95%CI 2.77-38.21); residence of Hanoi (aOR 0.21, 95%CI 0.04-0.88); co-infection with adenovirus (aOR 9.83, 95%CI 3.56-28.46); presenting with sepsis/septic shock (aOR 32.52, 95%CI 1.52-734.1) were identified as independent factors significantly associated with mortality.

Conclusion: Future measles epidemics remain a major concern in Vietnam. Immunization programs should be reinforced to enhance coverage among children ? 9 months old, and hospitals should implement intensive strategies to identify and manage high risk patients to reduce mortality.