MEASLES OUTBREAK INVESTIGATION IN VILLAGE PIPALIYA HASNABAD AND ADJOINING VILLAGES, BERASIA BLOCK, BHOPAL DISTRICT, MADHYA PRADESH, INDIA, JULY- AUGUST 2023

Abstract

Background

India has adopted measles–rubella (MR) elimination goals; however, three laboratory-confirmed measles cases were reported from Berasia block, Bhopal district, in August 2023, in an area known for vaccine hesitancy. No measles outbreaks had been reported in Bhopal during 2020–2022. We investigated this outbreak to describe its epidemiological characteristics and identify root causes.

Methods: We defined a suspected case as fever with maculopapular rash in any resident of Pipaliya Hasnabad or adjoining villages, Berasia block, between 28 April and 28 August 2023. A confirmed case was defined as measles-specific IgM positivity by ELISA. Epidemiologically linked (epi-linked) cases were those occurring from outbreak declaration up to 12 weeks, and within 4 weeks of onset of the last case. Active case search was conducted through house-to-house visits. Cases were interviewed using a semi-structured questionnaire and standard D003 form. Root-cause analysis included review of surveillance performance, routine immunization coverage, immunity gaps, and outbreak response activities.

Results: We detected 36 measles cases (6 laboratory-confirmed, 30 epi-linked); median age was 60 months (IQR 33–90), 44% were female, and 97% belonged to the Muslim community. Most cases occurred in children aged 5–9 years (39%) and 1–4 years (33%). In addition to fever and rash, common symptoms were coryza (42%), cough (39%), and conjunctivitis (19%); complications included acute respiratory illness (42%), diarrhoea (19%), and malnutrition (8%). The overall attack rate was 0.57% with no deaths, and 92% of cases were unvaccinated or partially vaccinated. An immunity gap for MCV2 (coverage <95% at district and block level during 2021–2023) persisted despite reported MCV1 coverage >95%. Awareness gaps (16% at district and 40% at block level) and vaccine hesitancy related to AEFI concerns and refusals (54% and 47%, respectively) were prominent, although timeliness indicators and routine immunization/surveillance performance were largely within recommended standards.

Conclusion: This laboratory-confirmed measles outbreak in Pipaliya Hasnabad primarily affected 1–10-year-old children from a predominantly Muslim community. Despite overall satisfactory routine immunization and surveillance performance, an MCV2 immunity gap, coupled with substantial awareness deficits and vaccine hesitancy, contributed to the accumulation of susceptible children and subsequent outbreak. Strengthening MCV2 coverage and targeted risk communication to address hesitancy are critical to sustaining MR elimination efforts