On Tuesday 9/1/2018, the Preventive Medicine Department of the General Health Directorate of the Riyadh Region reported an unusual increase in the number of Measles cases reported from Wade alDawasir city. The total number of cases reached 65 cases. The Field Epidemiology Training Program (FETP) was assigned to verify and investigate this outbreak and recommend control measures.
Methodology
To examine Measles outbreak, we conducted a case-control study among the cases recorded and control in Wade alDawasir city using Health Service Record.
Results
The index case was a female aged 20 years, who transmitted the infection to two of her daughter then transmitted to three of her relative then transmitted to four kids and one old female because of visits. We interviewed 130 respondents: 65cases and 65controls. All 65 cases, were from Wade alDawasir. All the cases were Saudi. Among cases, 40 (62%) were male compared to control 31(48%). This was not statistically significant (OR= 1.75, 95% CI= 0.87-3.52, P value= 0.113). The mean of all cases was 1.75 year and Standard Deviation (± 1.97). The mean of all control was 5.83 year and Standard Deviation (±8.17). (range 1-34years). Regarding age groups of cases, 48 (74%) were 1 years or less and 17(26%) were more than 1 years. compared to 27 (42%) of controls were 1 year or less and 38(58%) of control for more than 1 years. Age has a statistically significant association with Measles occurrence (P value=0.001) OR 0.252(95 %CI .120-.528).
Vaccination status was different between cases and controls, among cases 23 (35%) were vaccinated and 42 (65%) were unvaccinated. Compared to 18(28%) of control were vaccinated and 47 (72%) unvaccinated. Vaccination did not have a statistically significant association with Measles occurrence (P value=.345) OR 1.430(95 %CI .679-3.009). (table 5).All cases and control developed Fever and Rash. Among all cases, 51(78%) have a cough, compared to control 29(45%). The cough has a statistically significant association with Measles occurrence (P value=0.001) OR 4.52(95 %CI 2.099-9.741). Among all cases, 25(38%) have conjunctivitis compared to control 8 (12%). Conjunctivitis has a statistically significant association with Measles occurrence (P value=0.001) OR 4.52(95 %CI 1.82-10.87). Among all cases, 52 (80%) have coryza compared to control 39 (60%). Coryza has a statistically significant association with Measles occurrence (P value=0.013) OR 2.66(95 %CI 1.2-5.84).
Conclusion
The immunization program in Saudi Arabia required a review of measles vaccination. In order to control a measles outbreak, suspected cases must be reported immediately, an accurate diagnosis must be made, and outbreak response measures must be implemented promptly. Evaluation of the situation showed that it may be a result of decreased awareness of measles vaccination among citizen in Wade alDawasir. We need a national initiative to conduct a campaign of measles awareness and a vaccination targeting all children from 9 months to 15 years.