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Title

Measles Outbreak Investigation in Village Bara, Khyber Agency, Pakistan-February 2017: A case Control Study.

Background

Measles is highly contagious and remains a leading cause of childhood mortality. Outbreaks of Measles were reported from various parts of Pakistan, particularly tribal areas. In February 2017 Measles outbreak was reported from Bara, Khyber Agency.

Purpose

To confirm the outbreak, assess its magnitude, identify risk factors and to implement prevention and control activities to stop spread of the outbreak.

Methods

A case was defined as “Rash with fever and cough, coryza or conjunctivitis in a child younger than 14 years of age, resident of Bara, during 3rd February to 15th March, 2017.” Active search of cases done. Data was collected using a pretested structured questionnaire and analyzed using Epi Info version 7.1. Descriptive analysis was done followed by age & sex matched case control study. Case fatality rate, attack rate, vaccine efficacy, and secondary infectivity rates were calculated.

Results

Total 42 cases were identified. The Epi curve ranges from 3rd February to 15th March with a bi-modal peak on 23rd Feb and 5th March. Mean age of the cases was 37 months (range 1-120 months). Males were 52.38% (n=22). Socioeconomic status of parents was poor (28.57%laborers, 38.10% earn below 10000 PKR/month, 59%fathers were literate while all mothers were illiterate). Case Fatality rate was 7.14% (n=3). Vaccination showed protective effect [OR 0.12 (95% CI: 0.03-0.40; P<0.05)]. Vaccination coverage survey showed 46.3% coverage for Measles-1. Secondary infectivity was high in houses where children were more than 7 in number [OR 8.67 (95% CI: 1.76-42.6, P<0.05). Distance from health facility (>3kms) showed higher odds of getting the illness [OR 2.89 (95%CI: 1.22-6.84); P<0.05].

Conclusions

This study in a post-conflict repatriated population showed relationship of low socioeconomic status, low vaccination coverage, distance from health facility and overcrowding with the disease. Awareness sessions and mop-up vaccination in the area contributed to controlling the outbreak.