In April 1997, immediately preceding the annual pilgrimage to Makkah, the Makkah Health Directorate was notified of four cases of measles among police cadets who were on pilgrimage duty. We began an investigation to determine the extent of the outbreak and prevent occurrence of new cases.
Methodology
A case of measles was defined as a febrile illness with generalized maculopapular rash of three or more days' duration with cough, coryza, or conjunctivitis occurring between 27 March and 9 April 1997 in a police cadet. A rubella case was defined as a febrile illness with a diffuse maculopapular rash with post-auricular, occipital or posterior cervical lymphadenopathy during the same time period in police cadets. We searched medical records of the hospital serving the police cadets for cases of rash illness and obtained exposure histories and determined contacts for these cases.
Results
Five measles cases and four rubella cases were identified among thousands of police cadets on Hajj duty. All rubella cases and one measles case were serologically confirmed (by IgM) and four other measles cases had Koplik's spots. Affected cadets ranged in age from 20 to 31 years. No case had been vaccinated against measles or MMR. Measles first appeared in one cadet from the Eastern Province before arrival in Arafat. From eight to 13 days later, measles appeared in four other cadets from the Eastern Province after they arrived in Arafat. Rubella appeared in cadets over a six-day period after they had arrived from the Eastern Province (one case) and the Southern Region (three cases). Measles and rubella cases lived in two 2,400-square-meter buildings during the Hajj duty; each building accommodated 500 cadets. All cadets ate all meals together in a common mess hall and shared recreational facilities. Cases ceased to appear after vaccination of 600 cadets with MMR vaccine.
Conclusion
Currently, there is no policy for vaccination of police or military cadets in Saudi Arabia, yet these diseases produced similar outbreaks during 1995 and 1996. To prevent similar occurrences, measles and rubella vaccination is needed among these groups.