Measles outbreak among children ≤15 years old, Jaintia Hills District, Meghalaya, India, 2017.

BACKGROUND: Of 1115 measles outbreaks during 2015 in India, 61,255 suspected measles cases were reported. In 2016, a measles outbreak was reported at East and West Jaintia Hills districts in Meghalaya State, India. OBJECTIVES: The outbreak was investigated to describe the epidemiology, estimate vaccination coverage and vaccine effectiveness (VE), determine risk factors for the disease, and recommend control and prevention measures. METHODS: A measles case was defined as new-onset fever with maculopapular rash occurring between May 1, 2016, and January 21, 2017, in a resident of East and West Jaintia Hills. Cases were identified by active and passive surveillance. Serum and urine samples were collected from cases with laboratory diagnosis for confirmation. A retrospective cohort study was conducted to estimate vaccination coverage, VE, and risk factors for the disease. RESULTS: We identified 382 cases (51% female). The attack rate was 24% with three deaths. The case fatality rate was <1%. The median age was 4 years (range: 3 months-12 years). Among children 12-60 months, 128 (56%) received measles-containing-vaccine first-dose (MCV1), 85 (37%) received measles-containing-vaccine second-dose (MCV2), and 80 (35%) received Vitamin A. VE for MCV1 was 78% and for MCV2 94%. Being unvaccinated for MCV1 (relative risk [RR] = 9.7, 95% confidence interval [CI] = 4.6-20.5) and MCV2 (RR = 17.4, 95% CI = 4.3-69.4) were both strongly associated with illness. CONCLUSIONS: Poor vaccination coverage led to the measles outbreak in East and West Jaintia Hills districts of Meghalaya. Strengthening the routine immunization systems and improving Vitamin A uptake is essential to prevent further outbreaks.

Measles outbreak investigation at Indo-Myanmar border, Longding District, Arunachal Pradesh, India, 2017.

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.