Sunday, March 7, 2021

Measles rising

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Measles has staged a comeback as a major public health threat.  As early as 2014, the country was already battling against the disease, with the final tally at 58,010 cases, according to the World Health Organization (WHO).  The figure didn’t include the 110 people, mostly children, who lost their lives to the contagious virus.

A Department of Health (DoH) surveillance report showed that in 2018, some 167 cases (with five deaths) were reported in the Davao Region, which just a year ago (January to March 2017) registered only one case of the measles.

The same figure held in the Autonomous Region of Muslim Mindanao (ARMM). From only one case in 2017, the number increased to 157 cases (with no reported casualties) in 2018.

Other regions with increasing number of measles cases were Region 9 (114 cases from 6 cases), Region 12 (87 cases with one death from no reported case the previous year), National Capital Region (86 cases and 5 deaths from two cases in 2017), and Region 10 (59 cases with one death from one case).

 According to the surveillance report, the top provinces with confirmed cases from 2015 to 2017 were Davao del Sur (107 cases), Metro Manila (87), Zamboanga del sur (76), and Maguindanao (61).

“Areas with declared epidemics included Davao City, Zamboanga City, Isabela City in Basilan, Alicia in Zamboanga Sibugay, Taguig City in Metro Manila, and some municipalities in Antique,” the surveillance report indicated.

But it is not only in the Philippines where cases of measles are surging.  There are reports that measles has struck back in Europe and Africa.  In the United States, where measles has already been eliminated, some measles cases have been confirmed but no deaths were reported.

DENGVAXIA

Some people believe that the recent spike of measles cases in the country was due to “the low trust in the government’s mass immunization program” as a result of the controversial anti-dengue vaccine which, according to the Public Attorney’s Office (PAO), has resulted in the deaths of several children who were vaccinated.

“Since I assumed office in November 2017, I found myself faced with the Dengvaxia crisis,” Health Secretary Francisco Duque III, said in a television interview in January 31.  “In an attempt to collaboratively resolve this issue, we also reached out to various government agencies, including the Public Attorney’s Office.  Unfortunately, my fellow public servants refused to cooperate.  As a consequence, we saw a decline in vaccine confidence and a rise in cases of measles and other vaccine preventable diseases.”

PAO’s Atty. Persida Acosta was blamed for the decline in vaccine confidence. Acosta had provided legal counsel to parents who claimed that the Dengvaxia vaccine resulted in the death of their children.

In a television report aired on February 6, Acosta fired back at her critics, particularly the DoH. She said PAO should not be blamed for the health department’s inability to convince people to undergo vaccination against measles.

NON-VACCINATION

Was the low number of Filipinos taking the measles vaccine the result of a public perception that vaccines were unsafe?

From January to March 2018, the health department’s Public Health Surveillance Division tried to figure out if those with confirmed measles cases were vaccinated against the disease.  The findings showed that majority (80%) were not.
“Top reasons for non-vaccination of measles-containing vaccine among confirmed cases were: not eligible for vaccination (28%), mother was busy (20%), and child was sick (16%),” the report stated.
Other reasons cited in the surveillance report were forgotten schedules, difficulty in accessing health services, fear of side effects, and the fact that vaccination was against their beliefs.

Still others cited transfer of residence, war conflict, refusal of parents, lack of knowledge, and child abandonment as reasons for not having themselves vaccinated against measles.

SIGNS & SYMPTOMS

The DoH estimates that about 2.4 million Filipino children are at risk of getting infected with measles.

Dr. Ruby Constantino, director of the DOH Disease Prevention and Control Bureau told CNN Philippines in a television interview that they expect another measles outbreak this year.

Signs and symptoms of measles appear around 10 to 14 days after exposure to the virus.

According to the Mayo Clinic, those who have measles will experience the following: fever, dry cough, runny nose, sore throat, and inflamed eyes.  Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek may also be present.  The most apparent: a skin rash made up of large, flat blotches that often flow into one another.

 “A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days,” the Mayo Clinic explains.

 The CDC says complications of measles may include ear infection, bronchitis, laryngitis, and diarrhea (reported in less than one out of 10 people with measles).

 Severe complications include pneumonia and encephalitis.  The CDC says that as many as one out of every 20 children with measles get pneumonia, the most common cause of death from measles in young children.

“The Philippines is one of the 15 countries that together account for 75% of childhood pneumonia cases worldwide,” the WHO reported. “In children under 5 years, pneumonia is the leading cause of mortality.”

ANTI-VIRAL TREATMENT 

“Not vaccinating children can lead to outbreaks of measles, mumps, and rubella—all of which are potentially serious diseases of childhood,” reminded Dr. Neil K. Kaneshiro, Clinical Assistant Professor of Pediatrics at the University of Washington School of Medicine.

Vaccines are not perfect, but they are highly effective.  “Normally, vaccines are at least 80% effective—that is, eight out of 10 children vaccinated will develop antibodies against the infection and be protected,” Dr. C. John Clemens, former medical officer with the Geneva-based World Health Organization, told this author.

Although no medical intervention is 100% safe, the risk of serious side effects from vaccines, such as severe allergic reactions, is low.

Until now, no specific antiviral treatment exists for measles virus.  Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhea or vomiting. Antibiotics are prescribed to treat eye and ear infections, and pneumonia.

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