Measles Outbreak among Nomadic Population with Low Herd Immunity in an Eastern District of Bhutan, 2016
DOI:
https://doi.org/10.59096/osir.v11i1.263072Keywords:
measles, outbreak, nomad, vaccine, coverage, BhutanAbstract
During September-November 2016, a number of measles cases were reported from Trashigang District, Bhutan. The outbreak was investigated to determine epidemiological characteristics and risk factors, and recommend control measures. Hospital records of measles cases were reviewed. An active case finding was conducted in the affected communities and schools. Vaccination records were also reviewed. A case-control study was conducted to determine risk factors for measles infection. Tests for measles and rubella immunoglobulin M (IgM) antibodies, viral identification in throat swabs by polymerase chain reaction, and viral genotyping were performed. Total 62 suspected cases were identified, with no reported deaths. The first case developed symptoms on 15 Sep 2016 and 72.2% of the cases occurred in October 2016. The majority (85.0%) were 14 years old and younger (median 8.2 years, interquartile range 6.5-12.0). Cases were from Sakteng (87.1%) and Merak (12.9%) Subdistricts, the latter being a common place where nomads lived. Among 40 cases tested for measles IgM and viral identification, 33 (82.5%) were found to have measles IgM antibodies. All positive samples were genotyped and 11 (33%) were identified as D8 strains which circulated in India during 2016. The measles vaccine efficacy was 82.0%. Significant risk factors were having previous contact with a measles case (OR = 8.46, 95% CI = 2.08-34.41) and not receiving measles vaccination (OR = 6.61, 95% CI = 2.60-16.82). Immunization for outbreak response, case-based investigation and supplementary immunization activities were recommended.
References
World Health Organization South-East Asia Regional Office. Measles elimination and rubella control. 2013 [cited 2016 Oct 28]. <http://www.searo.who.int/mediacentre/events/governance/rc/66/9.pdf>
World Health Organization South-East Asia Regional Office. Strategic plan for measles elimination and rubella and congenital rubella syndrome control in the South-East Asia Region, 2014-2020. New Delhi: World Health Organization; 2015 [cited 2016 Oct 28]. <http://www.searo.who.int/entity/immunization/documents/sear_mr_strategic_plan_2014_2020.pdf>
Bhutan. Ministry of Health. National strategic plan for measles elimination and rubella/CRS control. 1st ed. Thimphu: Ministry of Health, Bhutan; 2015. p. 1-38.
O'Connor PM, Liyanage JB, Mach O, Anand A, Ramamurty N, Balakrishnan MR, et al. South-East Asia regional update on measles mortality reduction and elimination, 2003-2008. J Infect Dis. 2011 Jul;204 Suppl 1:S396-402.
Rota PA, Brown K, Mankertz A, Santibanez S, Shulga S, Muller CP, et al. Global distribution of measles genotypes and measles molecular epidemiology. J Infect Dis. 2011 Jul;204 Suppl 1:S514-23.
Centers for Disease Control and Prevention. Epi Info [cited 2016 Oct 28]. <https://www.cdc.gov/epiinfo/pc.html>
Singh K, Garg R. Outbreaks of measles in Rajasthan in 2014 : a cross sectional epidemiological investigation. 2017 May;4(5):1751-7.
Nujum ZT, Varghese S. Investigation of an outbreak of measles: failure to vaccinate or vaccine failure in a community of predominantly fishermen in Kerala. J Infect Public Health. 2015 Jan-Feb;8(1):11-9. Epub 2014 Aug 23.
Nepal Health Research Council. Measles outbreak in Kapilvastu, Nepal: an outbreak investigation 2016. Kathmandu: Nepal Health Research Council; 2016.
Wiesen E, Wannemuehler K, Goodson JL, Anand A, Mach O, Thapa A, et al. Stability of the age distribution of measles cases over time during outbreaks in Bangladesh, 2004-2006. J Infect Dis. 2011 Jul;204 Suppl 1:S414-20.
Akramuzzaman SM, Cutts FT, Hossain MJ, Wahedi OK, Nahar N, Islam D, et al. Measles vaccine effectiveness and risk factors for measles in Dhaka, Bangladesh. Bull World Health Organ. 2002;80(10):776-82. Epub 2002 Nov 28.
Puvimanasinghe JP, Arambepola CK, Abeysinghe NM, Rajapaksa LC, Kulatilaka TA. Measles outbreak in Sri Lanka, 1999-2000. J Infect Dis. 2003 May 15;187 Suppl 1:S241-5.
Dahanayaka NJ, Pahalagamage S, Ganegama RM, Weerawansa P, Agampodi SB. The 2013 measles outbreak in Sri Lanka: experience from a rural district and implications for measles elimination goals. Infect Dis Poverty. 2015 Nov 30;4:51.
Long VN, Niramitsantipon A, Jiraphongsa C, Attawong B, Khuankaw W, Tipsriraj S, et al. Investigation on measles outbreak among university students in Phrae Province, Thailand: risk factors and seroprevalence of antibodies to measles. OSIR. 2011;4(1):6-12.
Wairagkar N, Chowdhury D, Vaidya S, Sikchi S, Shaikh N, Hungund L, et al. Molecular epidemiology of measles in India, 2005-2010. J Infect Dis. 2011 Jul;204 Suppl 1:S403-13.
Hartoyo E, Wiyatno A, Jaya UA, Ma'roef CN, Monagin C, Myint KS, et al. Occurrence of measles genotype D8 during a 2014 outbreak in Banjarmasin, South Kalimantan, Indonesia. Int J Infect Dis. 2017 Jan;54:1-3. Epub 2016 Nov 4.
NJ Shaikh, CG Raut, DP Sinha, MJ Manjunath. Dual infection of measles and rubella in chitradurga district, Karnataka, India. Indian J Med Microbiol. 2015 Jan-Mar;33(1):193-4.
Weston KM, Dwyer DE, Ratnamohan M, McPhie K, Chan SW, Branley JM, et al. Nosocomial and community transmission of measles virus genotype D8 imported by a returning traveller from Nepal. Commun Dis Intell Q Rep. 2006;30(3):358-65.
Slade TA, Klekamp B, Rico E, Mejia-Echeverry A. Measles outbreak in an unvaccinated family and a possibly associated international traveler - orange county, Florida, december 2012-january 2013. MMWR. 2014;63(36):781-4.
Black CL, Yankey D, Kolasa M. National, state, and local area vaccination coverage among children aged 19-35 months - United States, 2012. MMWR. 2013 Sep 13; 62(36);733-40.
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