German measles outbreak bursts in two unvaccinated border hilly districts of Northern Himachal Pradesh, India

Background: We investigated German measles outbreak as a suspected one of measles to confirm diagnosis and recommend for control and prevention. Materials and Methods: We defined a case of German measles as the occurrence of febrile rash in any resident of the eight villages from 20th October to 16th January, 2007. Case patients were line listed and information on age, sex, residence, date of onset, symptoms, signs, traveling, treatment history, vaccination status, and pregnancy status were collected. The outbreak was described by time, place, and person characteristics. Diagnosis was confirmed clinically, epidemiologically, and serologically; first to measles, scrub typhus and later to German measles viruses. Results: We identified 116 cases in eight villages (112/116 clinically and 04/116 laboratory confirmed). The overall attack rate (AR) was 11%; highest in the age group of 11-20 years (range 13% to 44%). Sex specific AR for male was 12%. All case patients were <20 years of age with a median age of 12 years. Complication rate was 05%, but no death reported on account of German measles. No pregnant woman was found to be affected. None of them were immunized against rubella. Four tested positive for immunoglobulin M (IgM) antibodies to rubella out of eight samples. Thirty three percent (38/116) had their treatment of choice to the modern medicine. Conclusion: German measles outbreak was confirmed in unvaccinated populations, which was possibly due to the frequent traveling of Bengali colony vendors’ case patients to other areas. We advised the local health authorities to provide MR vaccination to the unexposed in eight affected and neighboring villages.
Key words: German measles, MR vaccination, northern himachal, outbreak

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