© 1989 Oxford University Press
research-article |
Epidemic Measles in an Isolated Unvaccinated Population, India
*Division of Epidemiology Delhi 110054-India.
**Division of Microbiology National Institute of Communicable Diseases Delhi 110054-India.
Directorate of Health Services Uttar Pradesh, India.
Narain J P (Division of Epidemiology, National Institute of Communicable Diseases, Delhi—110054, India), Khare S, Rana S R S and Banerjee K B. Epidemic measles in an isolated unvaccinated population, India. International Journal of Epidemiology 1989, 18: 952–958.
Between June and September, 1986, an outbreak of measles occurred in Pilkhi Primary Health Centre area (population 56 000) in Tehri Garhwal district, Uttar Pradesh, India. Overall, 1092 cases were identified and 62 died; case-fatality ratio was 5.7%. Illness was restricted primarily to children below 15 years of age; 38% cases were in children under 5 and 58% between 5–14 years of age. To better characterize the outbreak, a survey was conducted in 13 affected villages. The age of the cases ranged from 5 months to 19 years (median = 7.0 years). The age-specific attack rates were 22.4%, 54.5%, 46.2% and 35.3% for children under 1, 1–4, 5–9, 10–14 years of age respectively. In as many as four villages, the attack rate in children below ten was 80% or more. Secondary attack rate among family members was 70%. Overall, 82% of children with measles developed complications which consisted mainly of pneumonia, diarrhoea and dysentery. The age-specific case-fatality ratios in infants and children 1–4 years of age were 23.1% and 11.5% respectively; thereafter the rates tended to decline with increasing age and was higher in females than in males (<0.05). Pneumonia which was a complication in 39% of measles cases contributed to 56% of deaths. Traditional beliefs and customs in the area were strong and did not encourage treatment of measles cases. Although a measles vaccination programme has been launched in India since 1985, only 30 districts could be covered during the first year and another 90 during 1986. The programme is being implemented in a phased manner such that by 1990, all 550 districts (average population 1.8 million) are expected to be brought into the programme. At the time of the epidemic, measles vaccination was not available in the outbreak area.
Revised 1 February 1989