Measles outbreak among military students in a military camp, Bangkok, Thailand, February–March 2019

Abstract

Background: On February 20 th, 2019 Communicable disease control division had received reports of 5 suspected measles cases and many viral exanthema cases from Rotsukon Manochayakorn Public Health Center 60 (PHC 60). The surveillance and rapid response team of communicable disease control division and PHC 60, Health department worked together to investigate an outbreak of measles between February 21st to April 2nd, 2019. The objectives of this study were to confirm the diagnosis and outbreak, to assess situation and distribution of disease, to investigate risk factors of disease and to implement prevention and control measures.
Methods: Descriptive and analytic (unmatched case-control) studies were conducted. A total of 215 samples were enrolled (43 cases and 172 controls). Data were collected by modified questionnaire forms. Laboratory confirmation was done by measles IgM and measles PCR techniques. Data analysis was performed using descriptive statistics, odds ratio (OR), 95% confidence interval (CI) and multiple logistic regression.
Results: Measles outbreak among military students in a military camp during February 9th to March 19th, 2019 was propagated source outbreak. There were 43 cases. Morbidity rate was 61.43/1,000 population. There were 32 confirmed cases (74.42%) and 11 probable cases (25.58%). Median age was 19 years, (range: 18-25 years). There was one diarrhea complication case and no fatal case. Sharing bathroom facilities with measles cases (ORAdj = 4.67, 95% CI 1.51-14.45) and sharing bedroom facilities with measles cases (ORAdj 3.03, 95% CI 1.31-7.06) were significant risk factors. Cleaning hand before meal (ORAdj 0.26, 95% CI 0.12-0.54) was significant protective factor.
Conclusions and discussions: The outbreak investigation was confirmed by laboratory testing; the virus strain was genotype D8. Sharing bathroom facilities with measles cases and sharing bedroom facilities with measles cases were significant risk factors. Prevention and control measures for measles outbreak termination included the following: health education for disease prevention, measles cases isolation, MMR vaccination for students and officers and measles surveillance. Additionally, the environmental modification should be recommended such as renovating bathroom facilities, checking amount of chlorine in water within the appropriate level, and cleaning dormitories.