eng Science and Education Publishing American Journal of Epidemiology and Infectious Disease 2333-1275 2014-08-13 2 4 93 96 10.12691/ajeid-2-4-2 AJEID2014242 article Gupta SN drsurendernikhil@yahoo.com 1 Gupta Naveen 2 Gupta Shivani 3 District AIDS Project Officer, Chief Medical Officer office, Kangra at Dharamshala, Himachal Pradesh, India cum Epidemiologist in Charge, District Chamba Freelance researcher in Epidemiology and Ayurveda, Kangra, Himachal Pradesh, India Free lance researcher in infectious diseases and food technology, Shoolini University, Solan, Himachal Pradesh Background and aims: It is commonly observed that in many of the outbreak settings, more than one virus may be infecting the given population. In twin or triple outbreak of measles, german measles (rubella) and varicella in highly immunized hilly areas, maximal number of the case patients in all the hilly villages belonged to the older age group. It suggested an obvious shift to the higher age group, warranting second dose opportunity in such case scenario. The clinical presentations of viral diseases are too similar to differentiate. The aim is to categorize clearly the case patients of modified measles, rubella and atypical measles in outbreak settings. Discussion: Several solitary as well as mixed outbreaks of measles, german measles, chickenpox/herpes zoster have been investigated and documented. In many a time outbreak setting in the hilly areas of Himachal Pradesh, it is a matter of common observation that more than one virus are simultaneously infecting the population. On the basis of outbreak investigation and analytical inference, it has been observed that the symtomatology of modified measles and laboratory confirmed rubella case patients/epidemiologically linked cases are so similar placed that many a time, it becomes much difficult to line list the cases in one section of modified measles or rubella or atypical cases. Conclusion: Similarities of morphological symptoms between modified measles and rubella is the point of challenge and it causes debate between pediatrician and field epidemiologist to differentiate and classify them, thereby causing misleading of the meaning in the outbreak setttings. http://pubs.sciepub.com/ajeid/2/4/2/ajeid-2-4-2.pdf modified measles rubella twin outbreak triple infection Kangra Northern Himachal