The 2013 measles outbreak in Sri Lanka: experience from a rural district and implications for measles elimination goals.

Monday, 7th of December 2015

The 2013 measles outbreak in Sri Lanka: experience from a rural district and implications for measles elimination goals.

Dahanayaka NJ¹² Pahalagamage S³ Ganegama RM⁴ Weerawansa P⁵ Agampodi SB⁶⁷.

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 ameasles 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 Kopliks 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 12-29 years.

CONCLUSION:

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.

Access to url link for graPhical presentation http://www.ncbi.nlm.nih.gov/pubmed/26627462
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