RESUMO
Objectives: [I] To estimate the magnitude, compare the results of two wards [Shivpuri and Achhimohal] and [ii] to formulate recommendations for prevention and control. STUDY DESIGN: Experimental study
Place And Duration: 1st October to 16th November 2006 in residents of Shivpuri and Achhimohal ward
Methodology: We selected and compared two wards; Shivpuri ward with high attack rate and the other Achhimohal one-low attack rate. We defined a case as the occurrence of fever with joint pain with or without skin rashes during the period of 1st October to 16th November 2006 in residents of Shivpuri and Achhimohal ward. We collected information on age, sex, residence, date of onset, symptomatology, history of treatment, deaths in the family. We described outbreak in time, place and person characteristics. We collected 14 random blood samples from shivpuri and 7 blood samples from Achhimohal ward for serological investigation. We conducted entomological survey for species identification
Results: We identified total 384 case-patients among 2,202 residents [overall attack rate [AR: 384/2202 [17%]; Median age: 31 year] in both the wards. [343/1173 [29%] in Shivpuri ward vs 41/1029 [4%]]; sex specific AR was 52% for females. The major symptoms were fever 384/384 [100%], arthralgia 380//384 [99%]. Severity of disease and oedema were less prevalent in children of age group 1-15 year as compared to older age group 31-45 years [109/239 [46%], 13/183 [7%]]. The attack rate was highest 88/239 [37%] and statistically significant [P<0.03] in Shivpuri ward adjacent to pond. Both wards, Shivpuri-141 of 343 [41%] and Achhimohal-23 of 41 [56%] reported consulting with unqualified private practitioners. 19/21 were positive for anti Chikungunya IgM antibodies. 38/43 households [88%] in Shivpuri ward and 6/43 households [13%] in Achhimohal ward identified three species of Aedes mosquitoes
Conclusion: Chikungunya is mosquito born and laboratory confirmed; severely debilitating disease. Recommended for aggressive Information, Education and Communication [IEC] for emptying the storage of water once in a week and rational use of drugs
RESUMO
Objective. We investigated the outbreak as a suspected outbreak of measles with the objectives of confirming diagnosis, estimating the magnitude of outbreak and formulating recommendations for control and prevention. Methods. We defined a case of the rubella as occurrence of fever with rash in any resident of these three villages between 20th October to 9th December, 2006. We line listed the cases and collected information on age, sex, residence, date of onset, symptoms, signs, treatment history, traveling history, vaccination status and pregnancy status. We described the outbreak by time, place and person characteristics. Sera of a sample of case patients were tested for IgM antibodies to measles and later rubella viruses. Results. We identified 61 cases in three villages - 39 cases in Hattli, 17 in Thulel and 5 in Dramman. The overall attack rate (AR) was 8.7%. Sex specific AR for males was 10% and females 7.4%. All case patients were less than 20 years of age and the attack rate was highest in the age group 11-20 years (median age 12 years). The index case was traced in Hattli Bengali slum and occurred on 20th October 2006 where majorities (41%) of the cases were reported. No pregnant woman was found to be affected. The number of cases peaked on 19th November and the last case was reported on 9th December 2006. Of 61 case-patients, 50 (82%) were immunized against measles while proportions of children vaccinated for measles were 96% (672/700) and none of them were immunized against rubella (including two (3%) who had MMR immunization privately). Out of six blood samples tested, all tested negative for measles IgM antibodies but four were positive for IgM antibodies to rubella. Only 36% (22/61) of the cases took the treatment from modern system of medicine. Conclusion. An outbreak of rubella was confirmed and was possibly due to the frequent traveling of Bengali colony patients to other areas for selling the food items. We advised the local health authorities to provide MMR vaccination to the unexposed and energetic IEC in three affected and neighboring villages.