Root-Cause Analytical Survey for Measles Outbreak: Vaccination or Vaccine?- A Study From Madhepura District, Bihar, India.
BACKGROUND
Though measles is a vaccine preventable disease, outbreaks still continue to occur because of poor immunization coverage rate at the national level.


OBJECTIVE
To report the survey results of an outbreak of measles in Puraini village of Madhepura district in Bihar, India.


METHODS
This cross-sectional survey was conducted among children aged 6 months to 12 years during an outbreak of measles in December 2008. WHO case definition criteria was used to define active measles cases. Demographic data, immunization status, and disease outcome among the cases was obtained by pre-structured questionnaires. Blood samples from 5 cases were sent for laboratory confirmation.


RESULTS
A total of 52 cases and 8 deaths were reported with an attack rate of 28% and case fatality rate of 15.4%. Out of 35% cases of post-measles complications, dysentery with pneumonia was the most common. Anti-measles IgM antibody tested positive in all the 5 serum samples sent for confirmation. No child had received measles vaccination in the past, and the reasons were lack of awareness, lack of faith on vaccination, and unavailability of health workers.


CONCLUSIONS
This survey calls for strengthening of disease surveillance and routine immunization coverage to achieve measles control in these communities. This has important public health implication for the whole country regarding measles elimination in near-future.
Consultant (National Health Mission), MoHFW, Nirman Bhawan , New Delhi, India .
Sudipta
S
Basa
Assistant Professor, Department of pediatrics, All India Institute of Medical Sciences (AIIMS) , Bhubaneswar, India .
Rashmi Ranjan
RR
Das
Ex Deputy Director, NCDC , New Delhi, India .
Javed Akhtar
JA
Khan
Case fatality rate; Immunization; Morbillivirus; Secondary attack rate; Vitamin A