|Year : 2015 | Volume
| Issue : 1 | Page : 193-194
Dual infection of measles and rubella in chitradurga district, Karnataka, India
NJ Shaikh, CG Raut, DP Sinha, MJ Manjunath
National Institute of Virology, Bangalore Unit (ICMR), Rajiv Gandhi Institute of Chest Diseases Premises, Someshwaranagar, Bangalore, Karnataka, India
|Date of Submission||06-Feb-2014|
|Date of Acceptance||07-Apr-2014|
|Date of Web Publication||5-Jan-2015|
N J Shaikh
National Institute of Virology, Bangalore Unit (ICMR), Rajiv Gandhi Institute of Chest Diseases Premises, Someshwaranagar, Bangalore, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shaikh N J, Raut C G, Sinha D P, Manjunath M J. Dual infection of measles and rubella in chitradurga district, Karnataka, India. Indian J Med Microbiol 2015;33:193-4
|How to cite this URL:|
Shaikh N J, Raut C G, Sinha D P, Manjunath M J. Dual infection of measles and rubella in chitradurga district, Karnataka, India. Indian J Med Microbiol [serial online] 2015 [cited 2019 Oct 18];33:193-4. Available from: http://www.ijmm.org/text.asp?2015/33/1/193/148446
Measles continues to be a major cause of childhood morbidity and mortality in India. Recent studies estimate that 80,000 Indian children die each year due to measles and its complications, amounting to 4% of under 5 years deaths. 
Measles is a highly infectious and potentially fatal viral infection mainly affecting children. Immunisation against measles directly contributes to the reduction of under-five child mortality and hence to the achievement of Millennium Development Goal 4.  The World Health Organisation (WHO), in 2002, established a regional network of national measles laboratories with standardised testing procedures for IgM antibodies to measles in all South East Asian Region (SEAR) countries. Five to ten samples are tested during each outbreak to confirm the diagnosis of measles/rubella. 
In October 2013, an outbreak of suspected- measles, in Chitradurga district, Karnataka, was investigated. Information about occurrence of cases of fever and rash in villages was given by the Primary Health Centre, Chikkagondanahalli Medical Officer. A team from National Institute of Virology Bangalore visited the affected areas to investigate, help and guide the local health authorities in managing the outbreak. A house-to-house survey was carried out to collect information regarding the outbreak, examined the patients, and noted the details about their illness. Laboratory criteria for diagnosis employed were presence of measles-specific IgM antibodies in the sample and isolation of virus.
From 21 children, a total of 53 samples were collected. Distribution of the samples is given in [Table 1]. We sampled those who were willing, while two reluctant/refusing populations were dropped. All the samples were carried on cold chain to the laboratory. The serum samples were first processed for measles and rubella IgM antibodies testing as these were the acute samples. The test was done using IgM enzyme-linked immunosorbent assay (ELISA) kit (SIEMENS) provided by the WHO. Throat swab, urine and vesicular swab samples were taken for virus isolation in tissue culture as per the protocol of the WHO. The samples were inoculated on the Vero h/SLAM cell line and incubated. On 5 th day, full cytopathic effect (CPE) was observed. Serological results showed that out of 21 serum samples 9 (39.1%) were positive for measles IgM antibodies, whereas 7 (30.4%) were positive for rubella IgM antibodies. Interestingly, 5 (23.80%) serum samples showed dual infection with measles and rubella.
Mostly the children were below age group of 10 years. In the age group of 1-5 years children showed IgM positivity to both the viruses and also dual infection was found in this age group. In the age group of 6-10 years, only one child showed dual infection.
The QIAmp viral RNA kit (Qiagen, Germany) according to the manufacturer's protocol was used. The positive measles virus polymerase chain reaction (PCR) products were sequenced and comparison of the nucleotide sequence was performed using the National Center for Biotechnology/Basic Local Alignment Search Tool (NCBI/BLAST) programme with the GenBank database. The WHO reference N-gene sequence and software ClustalW version 2.0.11 was used.  A diagnostic RNA virus based (RT)-PCR to detect virus on clinical sample was used. Sequence identity revealed that the "D8 genotype" matching with the measles virus genotype D8 strain MVs/Gadag. IND/02.13[D8] nucleoprotein (N) gene (Genbank acc. KC862252) with three nucleotide change with Gadag strain. The D8 genotype detected in the present study is demonstrated. 
Sequencing results revealed that the "2B genotype" matching 87% identity with rubella virus strain RVi/Kannur. IND/09.09 glycoprotein E1 gene (GenBank acc. JQ413980).
This is the first report of dual infection of measles and rubella in India. There are few studies, which showed mixed infection of measles and rubella in children.  The children were sparsely distributed, principally belonging to the lower socio-economic strata and were malnourished. This unusual outbreak remained confined to children between 1-10 years is an example for understanding the strategy and implementation of measles control programme. The serology proved IgM positive for measles and rubella in the children where as D8 and 2B strains were genotyped. Though dual infection could not be proven by PCR but serological evidence is presented in the study. There was no measles associated fatality in this outbreak. Our new findings from this outbreak as dual infection of measles/rubella from the children, virus isolation and detection of measles/rubella genotype from different specimens, may help to improve the measles surveillance programme.
| ~ Acknowledgement|| |
We thank Director, National Institute of Virology for providing all the facilities to carry out the research work
| ~ References|| |
Vashishtha VM, Choudhury P, Bansal CP, Gupta SG. Measles control strategies in India: Position paper of Indian Academy of Pediatrics. Indian Pediatr 2013;50:561-4.
Centers for Disease Control and Prevention (CDC). Progress toward sustainable measles mortality reduction: South-East Asia Region, 1999 - 2002. MMWR Morb Mortal Wkly Rep 2004;53:559-62.
Rota PA, Liffick SL, Rota JS, Katz RS, Redd S, Papania M, et al
. Molecular epidemiology of measles viruses in the United States, 1997-2001. Emerg Infect Dis 2002;8:902-8.
Wairagkar N, Chowdhury D, Vaidya S, Sikchi S, Shaikh N, Hungund L, et al
. MeaslesNetIndia collaborators. Molecular epidemiology of measles in India, 2005 - 2010. J Infect Dis 2011;204:S403-13.
Gupta SN, Gupta N, Singh NN, Swain P, Gupta S. Two in one outbreak of rubeola-rubella in tobacco affected maan vajreshwari nagarkot dham-district Kangra of Northern Himanchal. Am J Epidemiol Infect Dis 2013;1:47-52.