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Aug 4, 2013

Measles like illness outbreak in Upper Mustang, Nepal

Science and Technology Conference 2009, Huachiew Chalermprakiet University, Thailand; 10/2009

Background: Since 2004, there have been increasing reports of rubella outbreaks in Nepal, through the Vaccine Preventable Diseases (VPDs) surveillance network. This report details an investigation of a suspected “measles-like illness” outbreak in Mustang, a remote and hard to reach Himalayan district in the Western part of Nepal.

Methods: The Mustang District Rapid Response Team (RRT) investigated the outbreak in Chhonup and Lomanthang villages in Mustang, beginning on the 17th of June 2008, following the standard measles outbreak investigation guidelines. Blood samples were collected from seven children within 4 to 28 days of rash onset. All the samples were tested for both measles and rubella IgM antibodies in the National Public Health Laboratory (NPHL) in Kathmandu, Nepal

Results: Forty-eight cases were detected at the time of the investigation. There were two waves in the outbreak. The first occurred at the beginning of April, and the second from mid-May to mid-June. The primary attack rates were 1% and 4% in Lomanthang and Chhonup respectively. The primary attack rates were highest in the 1 – 9 year old population. No deaths in children with measles-like illness were reported from either village during this investigation. All children found with measles-like illness had been immunized against measles. All 7 serum samples were confirmed to be IgM positive for anti-rubella. The remaining 41 cases with measles like illness were considered epidemiologically linked to these laboratory-confirmed cases, and classified as rubella.

Conclusion: Since there is no vaccination against rubella in Nepal, the number of rubella susceptible individuals in the population has increased. Once the virus was introduced into the community, it spread very quickly and affected many susceptible individuals. It is highly recommended that rubella vaccinations be included in the National Immunization Programme (NIP) of Nepal.

Chhonup Village

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