Practical observations from an epidemiological investigation of a measles outbreak in a district of India
Ashok Mishra1, Subodh Mishra, Chandrakant Lahariya
1Department of Community Medicine, Gajara Raja Medical College, Gwalior, MP - 474 009, India.
Background:
Measles is a major cause of childhood morbidity and mortality, accounting for nearly half of the morbidity associated with global vaccine preventable diseases. Regular outbreaks of Measles are reported in India, of which only a few are investigated. This study was conducted in the Shivpuri District of Madhya Pradesh (India) to investigate and asses various epidemiological factors associated with measles outbreak.
Materials And Methods:
A cross-sectional study was carried out in 30 randomly selected sub-centers in 8 blocks of the Shivpuri District of Madhya Pradesh, covering 212 villages, selected by cluster sampling. The villages, which had reported measles cases, were extensively investigated by the field teams through extensive house-to-house surveys during 12-19 May 2004.
Results:
A total of 1204 cases with 14 deaths were reported with an attack rate of 6.2% and a case fatality rate of 1.2%. In this study, 17.7% of the cases reported post-measles complications with diarrhea as the most common post measles complication. The routine measles vaccine and Vitamin A supplementation in the area was also less than 30%.
Conclusions:
The majority of the cases had occurred in the unvaccinated children and in under 5 year old population. There are repeated outbreaks and a long delay in reporting of the cases. The occurrence of cases, in a reasonable proportion of the vaccinated population, points toward the fact that there is a possibility of a vaccine failure in older children. This study calls for an improved surveillance system, an improvement in the cold chain, and enhancements for measles vaccination if India is to achieve the goal of measles elimination.
Insights
Measles outbreaks in India disproportionately affect unvaccinated children under five. Low vaccination rates and potential vaccine failure necessitate improved surveillance and vaccination strategies for measles elimination.
Area of Science:
- Epidemiology
- Public Health
- Vaccinology
Background:
- Measles significantly contributes to childhood morbidity and mortality globally, representing nearly half of vaccine-preventable disease burden.
- India experiences frequent measles outbreaks, yet investigations remain limited, highlighting a critical public health surveillance gap.
Purpose of the Study:
- To investigate and assess epidemiological factors contributing to a measles outbreak in Shivpuri District, Madhya Pradesh, India.
- To understand the impact of vaccination status and identify potential challenges in measles control.
Main Methods:
- A cross-sectional study employing cluster sampling surveyed 212 villages in Shivpuri District, Madhya Pradesh.
- House-to-house surveys were conducted from May 12-19, 2004, in villages reporting measles cases.
Main Results:
- The outbreak involved 1204 cases and 14 deaths, with an attack rate of 6.2% and case fatality rate of 1.2%.
- Diarrhea was the most common post-measles complication, affecting 17.7% of cases.
- Routine measles vaccination and Vitamin A supplementation coverage were below 30% in the studied area.
Conclusions:
- The majority of measles cases occurred in unvaccinated children, particularly those under five years old.
- Repeated outbreaks and delayed reporting indicate systemic issues.
- A notable proportion of vaccinated individuals contracting measles suggests possible vaccine failure, especially in older children, underscoring the need for enhanced surveillance, improved cold chain, and increased vaccination coverage to achieve measles elimination goals.
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