The Measles Outbreak

CEBU, Philippines — The Department of Health has reported rising measles cases in the country since last year, with 18,407 cases in 2018 compared to 2,428 cases in 2017 – a nearly eight-fold increase. Health Secretary Francisco T. Duque III alerts the public to be more vigilant. He advises parents that children should be brought to the nearest health facility at the first sign of fever, for prompt treatment and proper case management.

Measles is a highly contagious respiratory disease caused by a virus. It is transferred from person-to-person by sneezing, coughing, and close personal contact. Its signs and symptoms include cough, runny nose, red eyes or conjunctivitis, fever, and skin rashes lasting for more than three days. The disease’s complications include diarrhea, middle ear infection, pneumonia (infection of the lungs), encephalitis (swelling of the brain), malnutrition, and blindness, which may lead to death.

Sec. Duque also encourages “supportive measures like building the nutritional status of the [measles patient] and increasing oral rehydration.” He says these are important measures to increase body resistance and replace lost body ?uids caused by coughing, diarrhea, and perspiration. Duque emphasizes that immunization and vitamin A supplementation for nine-month-old children and unvaccinated individuals are the best defenses against measles.

According to the World Health Organization (WHO), when a community has low immunization coverage, the likelihood of measles outbreak increases. An immunization coverage of 95 percent among all children is needed for a community to be fully protected against measles, WHO adds. Protection is highly necessary for the vulnerable members of the population such as infants that are too young to receive vaccination, people who have weakened immune systems, and older adults.

The Philippines has seen a decline in the first dose of measles vaccine in the past decade – from above 80 percent in 2008 to below 70 percent in 2017. Initial figures for 2018 indicate further decrease. As a result, many children have become susceptible to measles infection. WHO estimates that 2.6 million Filipino children under age five are not protected from measles. As long as routine immunization remains low in the country, periodic measles outbreaks will be experienced.

The decreased rate of vaccination against measles is seen as a key contributor to the increasing measles outbreaks. And multiple factors may have contributed to the low immunization coverage in the country. Inadequate service delivery continues to be a concern, including less than optimal number of immunization sessions at the primary care level and accessibility issues especially in hard-to-reach areas.

Many people believe that the biggest blow to the vaccine confidence among the population was the dengue vaccine (Dengvaxia) issue. A recent study has found that Filipinos who believe “that vaccines are important, are safe and are effective” dropped from close to 100 percent in 2015 to between 60 and 80 percent in 2018. This reveals a critical need to improve public understanding of the critical importance and safety of vaccines.

Health authorities say that vaccination is the most cost-effective protection against measles. They point out that measles vaccine has been proven safe and effective and have been used in the routine immunization program of the Philippines since the 1960s. Under the routine immunization program, there are free vaccines available at the health centers for children, with the first dose given when the baby is nine months old and the second dose given when the child is 12 months old.

During a measles outbreak, WHO recommends that children six months old and older should be vaccinated. For those whose children are yet less than six months of age, the parents shall be vigilant of ongoing measles infection in the community and limiting the exposure of the infant to anybody other than primary caregivers. WHO strongly enjoins parents to have their older children vaccinated against measles for the kids’ own protection and to provide some protection to their younger siblings, as vaccinated kids will be unable to pass the virus on to their infant brother or sister.

The typical symptoms of measles are rash and fever, accompanied by any of the following: cough, runny nose, or red eyes. If parents think their child may have measles, they shall seek advice from the local health worker. It is important to bring the child to a health facility quickly if the child is very young, has high fever after more than three days of rash onset, or other signs of severe infection such as breathing difficulties, confusion or convulsion, and diarrhea.

The signs and symptoms of measles are similar to dengue; thus, medical attention shall be sought to determine if the child is showing other symptoms indicative of dengue infection, such as nose bleeding, abdominal pain, and joint pain.

Since April last year, the Department of Health launched the measles immunization campaign called “Ligtas Tigdas” to address the rising measles cases in the country. The department has expanded the campaign to particularly reach unvaccinated children under five years old. Along with the measles vaccination campaign, DOH is also distributing Vitamin A for children aged six to 59 months and administering oral polio vaccine for children aged zero to 59 months.

DOH is closely working with partners such as the Philippine Red Cross, UNICEF and WHO to strengthen its outbreak response activities. These agencies are in a concerted effort to help in the effective implementation of vaccination campaigns to ensure the outbreak is contained, and to help provide the best possible treatment for those affected.