By Cheng Ordoñez, Editor-in-Chief

THE Philippines has been plagued by measles, a viral disease that can spread rapidly, also known also as rubeola or morbilli, which is considered as an endemic disease — meaning it is continually present in a community and considered a highly contagious infectious disease caused by virus.

The Department of Health (DOH), along with data from the Epidemiology Bureau of the Philippines, showed that there were more than 4,300 cases nationwide with 70 recorded fatalities due to measles.

The DOH on Monday, February 11, said that majority of the fatalities were coming from Calabarzon with 79% of them not vaccinated.

Health Secretary Francisco Duque III said the Epidemiology Bureau recorded 4,302 cases of measles from January 1 to February 9, this year or an increase of 122% from the same period last year, when there were 1,935 cases and 18 deaths due to measles.

Majority of those who died were, at least, one month old to 31 years old.

The DOH reiterates almost 4 out of 5 fatalities were not vaccinated for measles.

According to Duque, one of the main reasons behind the measles outbreak was the hesitation of parents to have their children vaccinated. In the wake of the Dengvaxia controversy, immunization rates plummeted as parents refused to have their children vaccinated, fearing this would harm them.

As this developed, Duque appealed to the public to avail of free vaccination in public health centers. He noted that other vaccines were “long proven to be effective.”

DOH FB Photo

The breakdown of the measles cases and deaths per region, based on the DOH’s latest data, showed the following:

  • Metro Manila – 1,296 cases, 18 deaths
  • Calabarzon – 1,086 cases, 25 deaths
  • Central Luzon – 481 cases, 3 deaths
  • Western Visayas – 212 cases, 4 deaths
  • Northern Mindanao – 189 cases, 2 deaths
  • Eastern Visayas – 166 cases, 7 deaths
  • Mimaropa – 131 cases, 1 death
  • Central Visayas – 109 cases, 2 deaths
  • Bicol – 44 cases, 1 death

The DOH earlier declared an outbreak in Metro Manila and expanded its coverage to other parts of Luzon, as well as Central Visayas and Western Visayas with Rizal, Laguna, Batangas topping measles cases in Calabarzon with a total of 560 cases, 409% higher than 2018’s record of 110.

In a statement, DOH Calabarzon said that the total number of cases in the region has reached 560 from January 1 to February 2, this year, 409% higher than the previous year’s record of 110 with 14 confirmed deaths, with the fatalities ages ranging from nine months to 81 years old.

Of the provinces, Rizal topped the list with 226 cases, followed by Laguna with at 115, closely followed by Batangas at 114 cases. Cavite has 87 reported cases and Quezon has 18.

The DOH-Calabarzon regional office has directed all Provincial Health Offices (PHOs), City Health Offices (CHOs), National Immunization Program (NIP) coordinators and Provincial Health Team Officers in the provinces of Cavite, Laguna, Batangas, Rizal and Quezon to immediately conduct mass immunization against measles following a significant spike in cases of the communicable disease.

Vaccination sites will be set-up in churches, bus stations, fast-food chains and other public areas, the DOH said in an advisory. Medical teams will also be tasked to go on house-to-house visits to administer the vaccine, if necessary.

Increasing trend

Figure from the DOH Epidemilogy Bureau showed that the number of measles cases regions of Ilocos, Cagayan Valley, Central Luzon, CALABARZON, MIMAROPA and Bicol has shown an “increasing trend” as of January 26, with children less than one year old are the usual fatalities.

Measles is a highly contagious respiratory disease caused by a virus. Its complications include diarrhea, middle ear infection, pneumonia, encephalitis, malnutrition, blindness and may lead to death.

It will be recalled that the Dengvaxia controversy tainted the government’s immunization programs, not only discrediting the anti-dengue vaccine but also casting doubt on other vaccines that could protect individuals from life-threatening diseases.

Following the measles outbreak in several parts of the country, lawmakers at the House of Representatives called on the public to renew their trust in government institutions as a whole to contain the spread of the disease and prevent further deaths.

Kabayan party-list Rep. Ron Salo urged parents to have their children vaccinated against measles, saying unfounded fears on the negative effects of vaccination further puts their children’s lives at risk.

“We need to renew our trust to these tried and proven anti-measles vaccines. We cannot afford to risk further our children’s health because of some unfounded fear on the negative effects that may be caused by these vaccines,” he told the Philippine government news agency PNA.

“These vaccines have long been used by health professionals on our people, including ourselves when we were still young,” Salo added.

Since the botched anti-dengue vaccination program of the past administration, the DOH has noted a significant drop of vaccine coverage — from 70 to 80 percent of target in 2016 to 2017 to just 40 percent coverage in 2018.

President Rodrigo Duterte has urged parents to have their children vaccinated against common diseases.

1-Ang Edukasyon party-list Rep. Salvador Belaro Jr. echoed Salo’s call, further saying parents should not resort to homegrown remedies if their children have measles.

He added that parents should not send their children to school if they are displaying measles symptoms to prevent spreading the disease to other children.

“Instead of school, they should go to the nearest barangay health center or government hospital. Schools can be hotspots of the spread of measles and other contagious diseases because of population density and the vulnerability of children and teenagers,” Belaro said.

He also asked the Department of Education and the Commission on Higher Education to direct all school heads to take precautions against measles for the health and safety of their students and faculty.

AFP medical units readied

The Armed Forces of the Philippines (AFP), through its medical units, is more than ready to help the Department of Health DOH in administering measles vaccines to stem the outbreak of the deadly disease.

“The AFP is always ready to provide assistance should the Department of Health seek its help in facilitating the nationwide mandatory measles vaccination,” AFP public affairs office chief, Col. Noel Detoyato told the Philippine News Agency.

“Barangay and municipal health teams have always had close coordination with the AFP’s line units. There is an established mechanism on the ground if ever they will need support from the military,” Detoyato added.

In Pangasinan, three people, including infants, died of measles in the province in a span of one week last January, according to a report from the Provincial Health Office (PHO).

PHO said the victims aged eight and nine months old were residents of Barangay Lanas this town, while the 31-year-old female is from Barangay Tipor Bani.

Provincial health officer Dr. Anna Ma. Teresa de Guzman said her office has recorded 122 suspected measles cases from January 1 to February 11 this year, 5.17 percent higher than the 116 cases in 2018.

De Guzman said of the total number of cases this year, 23 were confirmed to be positive with measles.

“Among the towns and cities in the province, our main focus is on Lingayen, with a 2,000-percent increase, (in suspected cases)” she said.

Lingayen currently has 21 suspected cases, contrary to 2018 with only one case.

Other towns and cities being closely monitored are Dagupan City, also with 21 suspected measles cases; Bugallon, 10; Calasiao, eight; San Carlos and Binmaley with seven each.

“Due to the continuously increasing number of measles-rubella cases we must immediately provide immunization to all children regardless of their vaccination status, whether they have received the vaccine or not, everyone must be immunized,” DOH Regional Director, Dr. Eduardo C. Janairo said.

According to the Regional Epidemiology and Surveillance Unit (RESU), around 560, measles-rubella cases were recorded with 14 confirmed deaths from Jan. 1 to Feb. 2, this year.

Among the symptoms of measles are fever, dry cough, runny nose, red watery eyes (conjunctivitis), tiny white spots (Koplik) which appear inside the mouth and skin rashes.

“There is no cure for measles but it can be prevented through proper immunization of children aged six months to 59 months old. A person can receive the vaccine more than twice after 28 days or after a month after receiving it,” Janairo said.

Despite a low number of measles cases in the Davao Region, the DOH has started intensifying the immunization drive for measles and broaden deployment of nurses to support local government units.

DOH FB Photo

DOH-11 Director Annabelle Yumang said they have recorded 86 measles cases from January 1 to February 10 based on the report of Regional Epidemiology Surveillance Unit, with two recorded deaths in Bunawan District, Davao City, and Pantukan, Compostela Valley.

“This is 75 percent lower compared to the same period last year,” Yumang said during Monday’s press conference here.

Dr. Raquel Montejo, officer-in-charge of the DOH Center for Health Development, said the youngest patient involves an eight-month-old baby, while the oldest was a 75-year old man.

Montejo said Davao City has the highest measles cases with 53, followed by Davao del Sur with 20; Compostela Valley with seven; Davao del Norte with five; and Davao Oriental with one.

In the same period last year, DOH-11 reported a measles outbreak with 347 recorded cases.

In October 2018, the World Health Organization conducted a study in selected areas in Metro Manila to identify reasons why parents are not having their children immunized. It showed that fear of vaccines due to Dengvaxia and the lack of time among households as the main reasons for the decline in vaccination rate.

The DOH noted that the London School of Hygiene and Tropical Medicine vaccine confidence project results in 2015 and 2018 showed a big discrepancy in the respondents’ views. The vaccine confidence and the people’s belief in its importance have dropped from 93 percent to 32 percent while the number of people believing in the safety and productivity of the vaccines dropped from 82 percent to 21 percent.

The DOH EB added Eastern Visayas, Mimaropa (Mindoro, Marinduque, Romblon, and Palawan), Calabarzon, Central Visayas and Bicol Regions are places which have shown increasing trend as to reported cases for last week.

The DOH has been conducting vaccination activities against measles such as Outbreak Immunization Responses in several regions. This was followed by a nationwide Supplemental Immunization Activity (SIA) for six to 59 months old which was conducted in two phases — in April 2018 in the NCR and Mindanao; and in September 2018 in other parts of Luzon and Visayas.

Health Secretary Francisco Duque III said the SIA campaign achieved coverage of 69 percent during Phase 1 of implementation and 29 percent in Phase 2 despite DOH’s efforts.

“I appeal to the public to rebuild your trust and confidence in vaccines that were long proven to be effective, and I am quite sure that all of us sometime in our lives have been recipients of these vaccines which had protected us from various diseases,” he said.

Outbreak in E. Visayas

In Eastern Visayas, it was reported that DOH has already deployed health teams in some areas to help control the spread of measles as the number of cases is expected to rise in the next few weeks.

DOH Regional Director Minerva Molon said the disease has already killed 11 children and downed 268 others as of February 9.

Molon said the outbreak in the region has prompted the main office to include Leyte and Samar provinces among the top 10 areas in the country with high measles cases.

About 107 new cases were added from Feb. 1 to Feb. 11 alone, indicating a rapid spread of the virus.

Most cases were recorded by health workers in Leyte province specifically in Tacloban City (64 cases), Palo (20 cases), Burauen (19 cases), and Dagami town (14 cases).

Deaths have been reported in Tacloban, Palo, Dagami, San Miguel, and Pastrana in Leyte province and Gandara in Samar province. The latest victim was a six-month-old baby from San Miguel town who died last Saturday.

Among measles cases, more than half or 143 or 53 percent of victims were not vaccinated and 67 cases or 25 percent have unknown vaccination status,” Molon said.

Last year’s immunization coverage in Eastern Visayas dropped to 55 percent from 85 percent a few years back as many mothers lost confidence in the government’s immunization program due to Dengvaxia controversy.

Elaine Joy Villarosa, DOH immunization program manager for Eastern Visayas, said the regional office has enough stocks of vaccines to cover the targeted 95 percent of children’s population in the region.

“We urge mothers to come to health centers and avail the free vaccines for their children. We have been coordinating with local government units as we intensify our immunization program,” Villarosa said.

Measles remains one of the top causes of death among young children globally, despite the availability of a safe and effective vaccine, according to the World Health Organization.

The disease is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 10 to 12 days after infection, include high fever, a runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth.

Several days later, rashes will develop, starting on the face and upper neck and gradually spreading downwards.


Red flag up

The DOH already raised the red flag for measles in some regions of Luzon, Central and Eastern Visayas, aside from the National Capital Region.

In its February 5 report, DOH reported that as of January 26, 2019, there were 575 cases with 9 deaths in Calabarzon (Region 4A); NCR — 441 with five deaths; Region 3 — 192 cases with four deaths; Region 6 — 104 cases and three deaths; and Region 7 — 71 cases with one death. Also, Mimaropa (Region 4B) has 70 cases with no deaths; Region 1 — 64 cases with two deaths; Region 10 — 60 cases with no deaths; Region 8 — 54 cases and one death; and Region 12 — 43 cases with no deaths.

These regions, according to DOH, should step-up their response against this highly communicable disease, ensure that preventive measures play a vital role in preventing the spread of the disease, and must be emphasized to mothers and the general public as a whole.

Health Secretary Duque III said: “Supportive measures, like building the nutritional status of the sick person and increasing oral rehydration are important measures to increase body resistance and replace lost body fluids caused by coughing, diarrhea, and perspiration, as well as adding that immunization and vitamin A supplementation of nine-month-old children and unvaccinated individuals are the best defenses against measles.”

Also, a total of 13 cases of measles have been reported by health authorities in North Cotabato since January, the Integrated Provincial Health Office (IPHO) reported.

Dr. Eva Rabaya, provincial health chief, said all 13 patients are safe, although some were still recovering in government hospitals and private infirmaries.

IPHO-North Cotabato will soon start a “house to house” initiative to ensure all children are immunized against the measles virus.

Six measles cases, meanwhile, were reported in South Cotabato.

All the cases were from Polomolok town. From January 1 to February 3 last year, Soccsksargen region had 40 measles cases, data from the DOH measles monitoring center showed.

Soccsksargen consists of the provinces of North Cotabato, South Cotabato, Sultan Kudarat, and Sarangani and the cities of Cotabato, Kidapawan, Tacurong, Koronadal, and General Santos.

DOH FB Photo

Isolation rooms

Officials of the the Department of Health in Western Visayas are urging government-run hospitals to dedicate  a ‘measles room.’

‘Fast lanes’ and vaccination of health personnel who will be handling measles patients are also being proposed during a press briefing held on February 8, 2019.

Marlyn M. Convocar, DOH 6 (Western Visayas) director, said that measles isolation rooms were imposed in DOH-run hospitals in the region, such as the Corazon Locsin Montelibano Memorial Regional Hospital in Bacolod City; the Don Jose Monfort Medical Center Extension Hospital in Barotac Nuevo, Iloilo; the Western Visayas Sanitarium in Santa Barbara, Iloilo; and the Western Visayas Medical Center in Mandurriao, Iloilo City.

“We encourage government hospitals to convert at least one room into a measles isolation room to prevent the spread of the disease in the health facility,” said Dr. Renilyn Reyes, Medical Officer IV, in a press briefing, recently.

The measles isolation rooms are meant to prevent the spread of the highly-contagious disease, which can be transmitted through contact with respiratory secretions or aerosols.

Convocar said they also prioritize the implementation of “measles fast lanes.”

“The ‘measles fast lane’ works in the same manner as the ‘dengue fast lane’. Patients with high-grade fever and maculopapular rash will immediately be given medical attention,” she said.

Aside from isolation rooms, DOH-6 also plans to dedicate a health personnel that would handle measles patients.

Convocar said the department will also assure that health workers are vaccinated to protect them from the virus.

The dedication of isolation rooms for measles cases and the establishment of “measles fast lanes”, immunization of workers, along with the strict implementation of infection control protocol, are among the actions of the health department in interrupting the transmission of disease in the hospitals.

The department also implemented enhanced catch-up immunization for the defaulters through routine, school-based, and supplemental immunization activities.

The DOH-Western Visayas is positive that the region can conquer the measles outbreak.

“We have solved any outbreak of any cause that struck the region. Now, with the help of everybody, we are confident that we can also overcome measles outbreak,” Convocar said.