2nd Edition of Public Health World Conference (PHWC) 2026

Abstract

Background: On September 9, 2024, Semanu II Public Health Center received a report from Kwangen Elementary School regarding 16 students exhibiting symptoms of red vesicles. The outbreak, with an attack rate of 10%, spread after a school camping event. Initially diagnosed as varicella, specimens were tested for measles as part of the health center’s measles discarded rate target. This study analyzes the outbreak’s chronology, clinical characteristics, and public health response.

Methods: A special case investigation was conducted involving 24 cases. Ten specimens were collected for laboratory examination. A survey of 40 households with children under five years old was performed to assess their immunization status. The completeness of immunization was also verified by reviewing student health report books.

Results: The investigation identified the index case of measles, who developed red vesicle on July 29, no additional cases were reported until August 22 when another child developed vesicles and was confirmed as a measles case. On August 23, a school camping event took place. Shortly after this gathering, the number of measles cases began to rise, reaching 24 by October 1. The most common symptoms among affected individuals included red vesicles in 21 cases (87.5%), fever in 17 cases (70.8%), and sore throat in 6 cases (25%). Laboratory testing was conducted on 10 specimens, with 5 testing positive for measles-specific IgM. Although the lesions in some cases resembled vesicles rather than typical macules, laboratory confirmation for varicella was not performed Due to the unavailability of reagents in laboratories in Yogyakarta and the absence of a specialized program for Varicella control and prevention. A survey of 40 households revealed that no children under five had incomplete measles immunization. However, one symptomatic case was found to have incomplete immunization, highlighting a potential vulnerability within the affected population.

Conclusion: A unique case of measles infection with varicella-like clinical manifestations occurred in Kwangen, Semanu, Gunungkidul. Laboratory testing confirmed measles but not varicella. Enhanced vigilance is needed to monitor measles occurring concurrently with other infections. Strengthening laboratory capacity for comprehensive testing and intensifying efforts to achieve universal immunization coverage are essential to prevent future outbreaks.