Abstract
Background: In an outbreak setting, in co-educational school, we investigated suspected triple outbreak in April, 2009: varicella first and then, with chance detection of measles and german measles to confirm diagnosis and recommend remedial measures to prevent further outbreaks. Methods: We defined a case of varicella with maculopapulovesicular rash without other apparent cause in students/staff of the school and residents of neighbouring nutritionally poor villages of Khalet and Roady since 23 rd March to 14 th October, 2009. We line listed case patients to collect information on age, sex, residence, date of onset, symptoms, signs, traveling, treatment history and vaccination status. The outbreak was described by time, place and person characteristics. Diagnosis was confirmed epidemiologically and serologically; first to chickenpox, measles and german measles viruses. Results: We identified 505 case patients from mixed outbreaks of varicella, measles and german measles (30/505 clinically, 467/505 epidemiologically linked and 8/505 laboratory confirmed case patients from a study population of 3280. We investigated the suspected outbreak with case definition of chickenpox but measles 20/3280 (0.60%) and german measles 34/3280 (1.03%) cases were also observed. The overall all attack rate (AR) was 15% while in school, it was 22% but highest (56%) in Nursery upto 4 th standard with index case in first standard. Sex specific AR was (23%) more in boys. Triple concurrent infection caused 05% complications but no death reported. Severity of the symptoms was more in 5 th standard onwards with 49-249 lesions and severer in poor villages Roady and Khalet (p Conclusions: Triple infection of varicella, measles and rubella was confirmed epidemiologically and serologically. We recommended local authorities for MMRV in the school and near villages with aggressive information, education and communication (IEC) activities in affected areas.
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