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Background: According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India., Methods: Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated., Results: Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1)., Conclusion: Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination.

An analysis of data on 45 intravenous drug abusers treated for skeletal infection in 1982-1983 is presented. Eighty percent of patients were younger than 40 years old. None had any serious underlying illnesses. Septic arthritis was noted in 33 patients, osteomyelitis in seven, and both in five. Bone or joint infection involved the extremities in 78% of patients. The knee joint (left, 11 patients; right, four) was most commonly affected, and the left groin was the most frequent site of drug injections, a finding that suggests a relationship between the sites of injection and infection. Fever was absent in 16 (36%) of 45 patients. The predominant pathogens isolated were methicillin-resistant Staphylococcus aureus and groups A and G streptococci. Pseudomonas aeruginosa was much less common (11% of patients). Treatment included bed rest, intravenous antibiotics, and arthrocentesis when needed. Surgery was required in only seven (16%) of 45 patients. The immediate prognosis for intravenous drug abusers with skeletal infection was excellent. Attempts to obtain follow-up information from most patients, however, were unsuccessful.