Measles outbreak in a migrant laborer population in the wake of COVID-19 pandemic: Kathmandu, Nepal, 2020
Abstract We describe a measles outbreak in migrant laborers working in a carpet factory in Kathmandu, the capital of Nepal. The outbreak occurred during the nationwide lockdown enforced to contain the COVID-19 pandemic and 2 weeks after the Supplmentary Immunization Activities done for measles elimination. We included all the patients from the factory presenting to Mulpani Primary Health Centre, Kathmandu, Nepal with acute febrile rash illness. Recovered patients with history of fever and rash within the defined outbreak period with a clear epidemiological linkage were also included. Laboratory confirmation was done by detection of immunoglobulin M (IgM) in serum samples against the measles virus via enzyme-linked immunosorbent assay (ELISA). We compared attack rates (ARs) between those less than 5 years and 5 years or older. We identified 11 case patients ranging from 7 months to 27 years of age (3 below 5years of age); rash onsets were from 28 March-20 April 2020. All case-patients were laborers who had immigrated to Kathmandu from rural parts of the country. We sent serum samples of 7 patients for laboratory confirmation; 5 patients tested positive. The remaining four patients had a clear epidemiological linkage. The average attack rate was 30.5% with no significant difference between attack rates among the <5 years and the ≥5 years reported as 37.5 and 28.5 respectively. Migrant population from rural regions with poor outreach of essential health services like vaccination can act as pockets of measles susceptible individuals if not measles reservoirs. The squalid conditions in which the migrant laborers live-in can also compound the risk of outbreak in such populations. It is prudent to address the vaccination status of such population and timely correct their vaccine status if unvaccinated in order to meet the goal of measles elimination by 2023.