title: The 2013 measles outbreak in Sri Lanka: experience from a rural district and implications for measles elimination goals.
abstract: BACKGROUND
  Sri Lanka was the first country in the Southeast Asian region to achieve its measles elimination goal in 2011. In 2012, the measles immunization schedule changed from a measles vaccine at 9 months to a measles, mumps and rubella vaccine at 12 months. However in 2013, Sri Lanka reported its worst recent outbreak of measles. This study investigated a part of this outbreak in order to describe its epidemiology.
  
  
  METHODS
  A prospective study was carried out at the university medical unit of the Teaching Hospital, Anuradhapura (THA), the third largest hospital in Sri Lanka, from October 2013 until March 2014. An epidemiological profile of patients was constructed, case confirmation was done on all suspected cases and the basic demographic details of these suspected cases were obtained from the available records.
  
  
  RESULTS
  From January 2013 to March 2014, 101 measles suspects were admitted to the THA. Until June 2013, all suspected cases were aged below 12 months of age. During the study period (15 months), the total number of patients aged below 9 months, 9 to 12 months, 1 to 11 years, 12-29 years and over 29 years were 10 (9.9 %), 11 (10.9 %), 6 (5.9 %), 37 (36.6 %) and 36 (35.6 %), respectively (data missing-1). Out of the 33 patients clinically suspected, 32 tested positive for measles. Common clinical features included: fever (n = 33, 100 %), maculopapular rash (n = 33), conjunctivitis (n = 31), posterior cervical lymphadenopathy (n = 23) and Koplik's spots (n = 8). Features suggestive of pneumonia were observed among 30 (90.9 %) patients and 26 (78.8 %) had diarrhoea. Two patients (6.1 %) who developed severe pneumonia received care at an intensive care unit due to respiratory difficulties. Out of 33 patients, 15 (45.5 %) had prior immunization for measles, two (6.1 %) reported that they never had a measles immunization and 16 (48.5 %) were unsure about their immunization status. Out of those who reported they were previously immunized, 11 (73.3 %) belonged to the age group of 12-2 years.
  
  
  CONCLUSIONS
  Because the first cases of this outbreak were infants, an increase in susceptible infants due to the change in the vaccine schedule could partly explain the outbreak.
authors.affiliation: Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. niroshanajd@yahoo.com.|Tropical Disease Research Unit, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. niroshanajd@yahoo.com.
authors.forename: Niroshana Jathun
authors.initials: NJ
authors.lastname: Dahanayaka
authors.affiliation: University Medical Unit, Teaching Hospital, Anuradhapura, Sri Lanka. sithu2@yahoo.com.
authors.forename: Sithumini
authors.initials: S
authors.lastname: Pahalagamage
authors.affiliation: Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. ranjanganegama@gmail.com.
authors.forename: Ranjan Madushanka
authors.initials: RM
authors.lastname: Ganegama
authors.affiliation: Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. pweerawansa@yahoo.com.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Weerawansa
authors.affiliation: Tropical Disease Research Unit, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. sunethagampodi@yahoo.com.|Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. sunethagampodi@yahoo.com.
authors.forename: Suneth Buddhika
authors.initials: SB
authors.lastname: Agampodi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D049674:History, 21st Century; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D008457:Measles / Q000175:diagnosis / Q000453:epidemiology* / Q000266:history / Q000517:prevention & control; D008458:Measles Vaccine; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population; D012621:Seasons; D062211:Spatio-Temporal Analysis; D013188:Sri Lanka / Q000453:epidemiology; D014611:Vaccination; D055815:Young Adult
chemical_list: D008458:Measles Vaccine