Resurgence of measles calls for more vigilance in vaccination

“Failure to vaccinate susceptible population led to the resurgence of measles.”

This was repeatedly emphasized by Dr. May Emmeline Montellano, the president of Philippine Foundation for Vaccination and a pediatric infectious disease specialist, during a roundtable discussion organized by the Merck, Sharp and Dohme (MSD) last Tuesday, amid the alarming declaration by Department of Health of a measles outbreak in a number of cities and provinces in the country.

Montellano pointed out that the lack of vaccination is critical in causing the resurgence. “One of the factors that contribute to the spread of measles is the failure to vaccinate susceptible populations, especially the babies and young children,” she said.

Measles, or tigdas in Filipino, is a highly contagious viral infection spread from person to person through air droplets. Infants and persons with chronic diseases are most susceptible. There is no specific treatment for measles and most people recover within two to three weeks. However, it can cause serious complications particularly in malnourished children and people with reduced immunity. Among these complications are blindness, encephalitis, severe diarrhea, ear infection and pneumonia. Measles can be prevented by immunization.

Despite the availability of a safe and effective vaccine, measles remains one of the leading causes of death among young children globally. According to the WHO, in 2011 there were 158,000 measles deaths globally—about 430 deaths every day or 18 deaths every hour. More than 95 percent of deaths occur in low-income countries with weak health infrastructure, formal and enduring structures that support public health.

For eradication

Through global prevention efforts, progress has been made in measles control since 2000. Currently, the WHO had targeted measles, mumps and rubella (MMR) for eradication by 2015. In 1998, the DOH even committed to eliminate measles by 2008.

However, the past five years saw an increasing number of cases being reported in Europe and Asia, particularly among the younger population who were not vaccinated. In 2011 the country had more than 6,500 reported cases, majority of which in children below 10 years. According to recent Inquirer reports, Health Assistant  Secretary Eric Tayag confirmed 1,724 cases nationwide from Jan. 1 to Dec. 14, 2013, notably in populous areas such as the National Capital Region and Regions 4A—with the NCR topping the lists at 744. Twenty-one of these cases led to death.

In this context, vaccination is crucial, according to  Montellano.

In most developing countries such as the Philippines, high attack rates and serious disease among infants necessitate early vaccination—usually at 9 months for a solo measles vaccine. And the combination MMR vaccine can be given as early as 12 months, followed by a second dose at four to six years or at least 28 days aside from the first dose.

71% drop

Measles vaccination resulted in a 71-percent drop in measles deaths between 2000 and 2011 worldwide. In 2011, about 84 percent of the world’s children received one dose of measles vaccine by their first birthday through routine health services—up from 72 percent in 2000.

On the other hand, MMR vaccination is cost-beneficial, as it translates to a lesser cost of treatment. The combined vaccination reduces the number of injections that causes less discomfort for children and a reduced overall number of visits needed for completion of the vaccination schedule, a greater convenience for parents. It can also lead to herd immunity, wherein the presence of enough people who are immune to the disease protect the few non-immune ones.

“Ultimately, a combined vaccination can encourage vaccine compliance, uptake and coverage and thus help achieve herd immunity against disease which is exactly what the country needs now,”  Montellano said. “Our fear against the measles virus should be our call to action to have ourselves and our children protected through immunization.”