title: Widespread outbreaks of measles in rural Uttar Pradesh, India, 1996: high risk areas and groups.
abstract: OBJECTIVE
  To describe outbreaks of measles which affected many districts in Uttar Pradesh (UP) during 1996.
  
  
  METHODS
  Outbreak investigations.
  
  
  METHODS
  The state of Uttar Pradesh, India.
  
  
  METHODS
  The reported data on measles morbidity, mortality and vaccine coverage from 1991 through 1996 were reviewed. Reported vaccine coverage levels were compared with the results of coverage surveys carried out in UP from 1992 through 1996. Line lists on measles cases were analyzed to ascertain the age, immunization status, geographical distribution, and age and sex-specific fatality ratios during the outbreaks. A community survey was organized in 7 affected villages to estimate vaccine effectiveness.
  
  
  RESULTS
  Fifty one of 68 districts in UP reported 6922 measles cases and 281 deaths in 1996. The majority of cases and deaths occurred in June and July which are usually low transmission months. Overall cases fatality ratio (CFR) was 4.1%. CFRs were significantly higher in females and young children. The median age of cases was found to be below 5 years. There was heavy clustering of cases and deaths in rural areas. About 85% of the cases and virtually all the measles associated deaths occurred in unvaccinated children. Published documents on statewide coverage surveys revealed that the measles vaccine coverage levels ranged between 26% and 36% during 1992-96. Large gaps were found between reported coverage and survey results. Nevertheless, epidemiological studies indicated a vaccine effectiveness of more than 90%.
  
  
  CONCLUSIONS
  The outbreaks occurred due to poor vaccine coverage levels and an inefficient surveillance system which failed to generate early warning signals. The study highlights the urgent need to raise the vaccine coverage levels rapidly in all districts to achieve measles control and prevent future outbreaks in UP.
authors.affiliation: National Institute of Communicable Diseases, Delhi, India.
authors.forename: J
authors.initials: J
authors.lastname: Singh
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: R N
authors.initials: RN
authors.lastname: Rai
authors.forename: S
authors.initials: S
authors.lastname: Khare
authors.forename: D C
authors.initials: DC
authors.lastname: Jain
authors.forename: R
authors.initials: R
authors.lastname: Bhatia
authors.forename: K K
authors.initials: KK
authors.lastname: Datta
mesh_terms: D017677:Age Distribution; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage*; D011159:Population Surveillance; D011336:Probability; D012307:Risk Factors; D012424:Rural Population; D017678:Sex Distribution; D015996:Survival Rate; D014611:Vaccination / Q000592:standards* / Q000639:trends
chemical_list: D008458:Measles Vaccine