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. 2019 Mar 18;19(1):267.
doi: 10.1186/s12879-019-3873-y.

Rubella outbreak in the school children, Addis Ababa, Ethiopia: February-April 2018

Getachew Dinede  1 , Abigiya Wondimagegnehu  2 , Fikre Enquselassie  3
Affiliations

Rubella outbreak in the school children, Addis Ababa, Ethiopia: February-April 2018

Getachew Dinede et al. BMC Infect Dis. .

Abstract

Background: Rubella is a vaccine-preventable contagious disease causing an estimated 100,000 children to be born with congenital rubella syndrome each year globally. Studies documented that 18 rubella outbreaks were occurred each year in Ethiopia. Yeka sub-city woreda 13 public health emergency management office reported two measles suspected cases on 8 February, 2018. We investigated this outbreak to identify its etiology, describe the outbreak and implement control measures.

Methods: We described the outbreak using descriptive epidemiology. The study population was defined as students learning in the school where the outbreak occurred. Suspected rubella case was defined as student with generalized rash whereas confirmed case was suspected case tested positive for rubella IgM. Questionnaires, checklists and students record review were used to collect data. We searched for new cases in classes daily and excluded them from classes. The school environment was assessed and the outbreak was described in person and time.

Results: We identified 58 cases (median age: 4.6 years; IQR: 4-5 years) with six of them rubella IgM positive and 52 epidemiologically linked. The outbreak began on 8 February 2018 having multiple intermittent peaks during its course reaching its highest peak at 2 April, 2018 and ended on 20 April, 2018. Index cases were reported from two classes; however, cases were occurred in 13/15(86.67%) of the classes during the entire outbreak. Fifty five percent (32/58) and 45/58(77.59%) of the cases were females and 3-5 years children, respectively. Overall attack rate was 58/531(4.05%). Attack rate was higher in females 32/252 (12.7%) than in males 26/279 (9.32%), and higher 45/275(16.36%) in 3-5 years than those in 5-8 years 13/256(5.08%) children. Case fatality ratio was zero. All cases were vaccinated against measles but unvaccinated against rubella.

Conclusions: Attack rate was higher in females than in males and higher in 3-5 years than 5-8 years children. We recommended establishing rubella surveillance system, conducting sero-prevalence of rubella among child bearing age females and establishing CRS surveillance among young infants to provide evidence-based information for RCV introduction. It was also recommended to develop a national rubella surveillance guideline which aid to exclude rubella cases from schools during outbreak.

Keywords: Descriptive epidemiology; Disease outbreaks; Rubella; School.

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Conflict of interest statement

Ethics approval and consent to participate

Research Ethical Review Committee of Addis Ababa Health Bureau approved the study. Permission to conduct the study was also obtained from Yeka sub-city health office. The national public health authority is empowered to conduct outbreak investigation as stated in Ethiopian Public Health Institute Establishment Council of Ministers Regulation No.301/2013 [28] to protect the community from outbreak impacts which compel communities to participate in the process as they are direct beneficiaries. The investigation was also exempted from ethical committee clearance based on this regulation. Confidential codes were used to protect individual privacy of our research participants.

Consent for publication

Not applicable because data which could affect individual privacy was not indicated in the manuscript.

Competing interests

The authors declared that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Rubella cases by date of rash onset, Yeka sub-city, Addis Ababa, Ethiopia: 8 February − 20 April, 2018
See this image and copyright information in PMC

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References

    1. Fauci S, Kasper L, Hauser L, Harrison R. Principles of Internal Medicine: Rubella. 18th ed. USA: The McGraw-Hill Companies, Inc; 2012.
    1. Lanzieri T, Redd S, Abernathy E, Icenogle J. Surveillance Manual. Rubella: Chapter. 2017;14:1.
    1. Kancherla V, Oakley GP, Brent RL. Urgent global opportunities to prevent birth defects. Semin Fetal Neonatal Med. 2014;19(3):153–160. doi: 10.1016/j.siny.2013.11.008. - DOI - PubMed
    1. Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet. 1982;2:781–784. doi: 10.1016/S0140-6736(82)92677-0. - DOI - PubMed
    1. Enders G, Miller E, Nickerl-Pacher U, Cradock-Watson JE. Outcome of confirmed periconceptual maternal rubella. Lancet. 1988;1:1445–1447. doi: 10.1016/S0140-6736(88)92249-0. - DOI - PubMed