Measles outbreak investigation at Indo-Myanmar border, Longding District, Arunachal Pradesh, India, 2017
Kevisetuo Anthony Dzeyie1, Dipu Lowang1, Tanzin Dikid2
1India Epidemic Intelligence Service Officer, National Centre for Disease Control, Delhi, India.
Background:
On May 23, 2017, the health authorities in Longding district, Arunachal Pradesh, India, reported four suspected measles-related deaths in Konsa village, a remote village on the Indo-Myanmar border.
Objective:
We investigated to describe the epidemiology of the outbreak and identify associated risk factors.
Methods:
We defined a measles case as fever and maculopapular rash with cough, coryza, or conjunctivitis in a village of Longding district resident from March 1 to June 18, 2017. In Konsa village, we conducted a retrospective cohort study of children ≤5 years. We calculated attack rate (AR), case fatality rate (CFR), measles-containing vaccine first dose (MCV1) and Vitamin A coverage, risk ratio (RR), and vaccine efficacy. We collected samples for laboratory confirmation. We conducted a routine immunization system evaluation at multiple levels of Longding district.
Results:
We identified 75 suspected cases (56% females) for a Konsa village-specific AR of 86% (75/87) among children ≤5 years; the median age was 36 months; CFR was 7% (5/75); all deaths unvaccinated; none received Vitamin A. Coverage for MCV1 was 9.2% (6/65) and Vitamin A 4.6% (3/65). No MCV1 (RR = 7.3, 95% confidence interval [CI] = 1.3-53) and participation in a recent local festival (RR = 5.3, 95% CI = 1.5-18.5) were associated with illness. MCV vaccine efficacy was 100%. Of 17 cases, 13 tested positive for measles. The local health facility had neither staff nor immunization microplans.
Conclusions:
This outbreak was likely due to low MCV1 and Vitamin A coverage due to poor health-care access. The investigation led to a district measles catch-up campaign and resumption of regular immunization.
Insights
Low measles vaccination coverage in a remote Indian village led to a deadly outbreak. This investigation highlighted poor healthcare access and resulted in a successful catch-up vaccination campaign.
Area of Science:
- Epidemiology
- Public Health
- Vaccinology
Background:
- A measles outbreak with four suspected deaths occurred in Konsa village, Arunachal Pradesh, India, near the Indo-Myanmar border.
- The remote location and limited healthcare access likely contributed to the severity of the outbreak.
Purpose of the Study:
- To investigate the measles outbreak in Konsa village.
- To describe the outbreak's epidemiology and identify associated risk factors.
- To evaluate the routine immunization system in Longding district.
Main Methods:
- A retrospective cohort study was conducted among children aged ≤5 years in Konsa village.
- Case definitions included fever and maculopapular rash with cough, coryza, or conjunctivitis.
- Attack rate, case fatality rate, vaccine coverage, and risk ratios were calculated. Laboratory confirmation and immunization system evaluation were performed.
Main Results:
- An 86% attack rate was observed in children ≤5 years, with 75 suspected cases.
- Case fatality rate was 7%, with all deaths occurring in unvaccinated children who did not receive Vitamin A.
- Low measles-containing vaccine first dose (MCV1) coverage (9.2%) and Vitamin A coverage (4.6%) were identified. Lack of MCV1 and festival participation were significant risk factors.
Conclusions:
- The outbreak was attributed to insufficient MCV1 and Vitamin A coverage, stemming from inadequate healthcare access.
- The investigation prompted a district-wide measles catch-up campaign and the restoration of routine immunization services.
