|LETTER TO THE EDITOR
|Year : 2012 | Volume
| Issue : 2 | Page : 168-169
Outbreak of "Modified measles" in an urban resettlement colony of North India
Binod Kumar Patro1, Heamant D Shewade1, S Kathirvel1, Suraj S Senjam1, Mini P Singh2, RK Ratho2
1 School of Public Health, PGIMER, Chandigarh, India
2 Department of Virology, PGIMER, Chandigarh, India
|Date of Web Publication||21-Aug-2012|
Binod Kumar Patro
School of Public Health, PGIMER, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patro BK, Shewade HD, Kathirvel S, Senjam SS, Singh MP, Ratho R K. Outbreak of "Modified measles" in an urban resettlement colony of North India. Indian J Public Health 2012;56:168-9
|How to cite this URL:|
Patro BK, Shewade HD, Kathirvel S, Senjam SS, Singh MP, Ratho R K. Outbreak of "Modified measles" in an urban resettlement colony of North India. Indian J Public Health [serial online] 2012 [cited 2020 Jan 21];56:168-9. Available from: http://www.ijph.in/text.asp?2012/56/2/168/99921
Measles continues to be a significant contributor to under-five morbidity and mortality in spite of the availability of a safe and cost-effective vaccine over four decades. In 2008, globally there were a total of 164,000 measles deaths, which translates to nearly 450 deaths every day or 18 deaths every hour due to measles infection. More than 95% of measles deaths occur in low-income countries with weak health infrastructure. Recent estimates put the figure at 80,000 per year for India, which contributes to 4% of under-five mortality.  We report an outbreak of modified measles in an urban resettlement colony of Chandigarh with high immunization coverage.
Based on the initial report of two cases with fever and rash meeting the clinical description of measles from the catchment area of the resettlement colony of a neighboring health center on 22 November 2010, a house-to-house survey was undertaken in the urban resettlement colony. A total of 14 cases were detected by house-to-house survey. The survey explored the origin of primary case in the community on 8 November 2010. The last case was traced on 31 December 2010. Blood samples were collected from the first six cases. Five out of six cases were tested positive for measles-specific antibody by IgM enzyme-linked immunosorbent assay (ELISA). A focal outbreak of measles was confirmed at Indira Colony of Chandigarh in December 2010.
The youngest case was 2 months old and the eldest child was 19 years old. Five were males and the rest all were females. Eight out of 14 cases were above the age of 5 years. Nine cases were clustered around three adjoining households. Epidemic curve showing the distribution of cases over time is presented in [Figure 1]. There was no history of travel outside the colony in the preceding month by all the affected children. All 14 cases were age appropriately immunized with measles vaccine as per national immunization schedule. The clinical presentation was milder in all cases. Outbreak response immunization (ORI) was carried out in the whole population. The outbreak was declared over after 4 weeks following the onset of the last clinical case. There was no mortality and no complications in the 2-month follow-up period. The clinical presentation was nonclassical in regard to progression, duration, and severity.
Modified measles is a distinct clinical entity characterized by less intense symptoms and a milder rash which may occur in individuals with preexisting partial immunity induced by active or passive vaccination. Patients of modified measles include infants under 1 year of age who retain some passively acquired maternal antibodies and older individuals with a history of active immunization.  A report of modified measles among health care professionals has been documented in the literature. 
The present outbreak reiterates the importance of close suspicion and active case finding of measles cases among older children and infants. Swift response in the form of ORI and outbreak investigation can interrupt the outbreak. The present outbreak validates the need for second dose of measles immunization which has been initiated by the Government of India. 
| Acknowledgment|| |
Directorate of Health Services and District Immunization Officer, Chandigarh UT is acknowledged.
| References|| |
|1.||Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al.; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet 2010;375:1969-87. |
|2.||Gershon A. Measles (Rubeola). In: Harrison's principles of internal medicine. 17 th ed. New Delhi: McGraw Hill Medical; 2008. p. 1215. |
|3.||Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ. Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: High risk of infection but low risk of transmission. J Infect Dis 2011;204 Suppl 1:S559-63. |
|4.||Guidelines for Planning and Implementation of Measles Catch-up Immunization Campaign. MoHFW GoI; 2010. p. 6. |