Investigation of Mixed Outbreak (measles-rubella) in Rural Community Temanggung, Central Java

Abstract

Pada tanggal 31 Agustus 2016 terjadi peningkatan kasus dengan gejala demam dan ruam di masyarakat pedesaan Temanggung. Investigasi untuk memastikan kejadian luar biasa dan mengidentifikasi orang, tempat, waktu, faktor risiko, dan tindakan pengendalian. Penelitian ini menggunakan desain studi kasus-kontrol dengan rasio 1:1. Informasi mengenai karakteristik pasien dengan mewawancarai ibu. Mixed outbreak dimulai dari 28 Mei hingga 1 Oktober 2016. Kami menemukan 59 kasus di 3 dusun, gejala yang paling umum adalah demam (94,63%), ruam (88,14%), dan flu (47,46%). Tiga orang terkonfirmasi positif IgM rubella dan dua orang positif IgM campak. Attack rate tertinggi terjadi pada laki-laki (12,65%), usia ≥4 tahun (25%) dan tinggal di Kalitengah (74,57%). Sebanyak 38 kasus (64,41%) belum divaksin dan efektivitas vaksin sebesar 52,17%. Faktor risiko yang berhubungan dengan mixed-outbreak adalah tidak divaksinasi (OR=4.47, 95% CI =1.92-10.47). Mixed outbreak telah dikonfirmasi secara klinis, epidemiologis, dan serologis. Kami melakukan beberapa pengendalian seperti promosi kesehatan dan distribusi vitamin A. Kami juga telah bekerja sama dengan para pemangku kepentingan untuk meningkatkan cakupan vaksinasi campak.

On August 31,2016 there were more cases with symptoms of fever and rash in rural community Temanggung. An investigation to confirm the outbreak and identify the person, places, times, risk factors and control measures. It was a case-control study design 1:1 ratio. Information on characteristic patients was obtained by interviewing the mother. A mixed outbreak started from May 28 to October1,2016. We found 59 cases in 3 sub-villages, most common symptoms are fever (94.63%), rash (88.14%), and flu (47.46%). Three were confirmed positive rubella IgM and two were positive measles IgM. The highest attack rates were male (12.65%), ≥4 years old (25%), and in Kalitengah (74.57%). A total of 38 cases (64.41%) had not been vaccinated, and the effectiveness of the vaccine is 52.17%. The risk factors associated with mixed outbreak were unvaccinated (OR=4.47, 95% CI =1.92-10.47). A mixed outbreak has been confirmed clinically, epidemiologically, and serologically. We did some control such as health promotion and vitamin A distribution. We have also worked with stakeholders to increase measles vaccination coverage.