So, anticipating, preventing, recognizing and responding to ADRs should be the prime concern of the clinicians so as to minimize the incidence of ADRs. Footnotes Source sellckchem of Support: Nil. Conflict of Interest: None declared.
Measles is the fifth killer disease among children under five years of age in the world.[1,2] Sri Lanka, Latin America,[3] Romania[4], and South Korea[5] experienced outbreaks of measles in spite of sustained high coverage with single-dose vaccination strategy. Thus, the 2001�C2005 WHO/UNICEF strategic plan for measles mortality reduction and regional elimination recommended achieving high routine vaccination coverage (>90%) in every district and ensuring that all children receive a second opportunity for measles immunization.

[6] The three phases of the strategy are measles control, outbreak prevention, and measles elimination.[7] Measles immunization coverage in India ranging from 42.2% to 58.8%[8�C10] suggests that there is gradual rise over the years while it satisfactorily increased from 71.8%[11] to 89. 1%[12] to 86.3%[13] in Himachal Pradesh Generally, measles outbreaks follow a cyclic pattern and occur every 3�C4 years as a result of build up of the susceptible. As the coverage increases, inter epidemic interval increases as well as focus shifts towards older age groups as observed in Thailand and Sri Lanka.[14] This is on account of high measles immunization (>95%) in Himachal Pradesh that the incidence of the measles cases have gone down from 19 to 8/lac[15] from 2001�C2003. Despite high immunization rate, outbreaks of measles were reported in hilly areas of Himachal Pradesh in 2006.

Two reported outbreaks of measles in highly immunized hilly areas were investigated under two sub centers, namely, Sailli and Sarah.[16] In the same year, an outbreak of rubella was also detected and investigated in the Shahpur-Samote blocks of Kangra district. The last reported outbreak of measles in the block was 8-9 years ago. These blocks are situated at an altitude of 2600 feet to 3500 feet above the sea level with over 50% of the population belonging to the poor socio-economic strata. During the same period, no such outbreaks were reported from any other blocks within the district. Hence, a study was undertaken with the following objectives; to identify factors associated with outbreaks of measles in Shahpur block and to recommend appropriate remedial measures to prevent further outbreaks.

MATERIALS AND METHODS Many factors are reported to be associated with measles such as geographically difficult hilly areas, poor socio-economic strata with unemployment, illiteracy, Dacomitinib overcrowding, traditional beliefs of people seeking help from the local Chellla/quacks, irregular cold chain maintenance, lack of training of the health workers etc.