Nationwide campaign to fight measles outbreak continues
Since the Department of Health declared a measles outbreak in five regions on 7 February, a massive immunization and public information campaign has been underway, implemented by the Government and assisted by the Red Cross, the United Nations, and humanitarian partners. Children are the most at risk by the nationwide outbreak, which is currently affecting all 17 regions of the country. The highly contagious disease has already claimed the lives of close to 400 people, mostly unvaccinated children under the age of five.
According to the Department of Health’s (DOH) Epidemiology Bureau, 28,362 cases were officially reported from 1 January to 4 April, an increase of nearly 380 per cent compared to the same period in 2018. According to WHO, the case fatality rate is now decreasing but still high at 1.37 per cent, with reports from health facilities showing many children die of measles complications such as pneumonia. Other underlying causes for the high mortality are late referral and malnutrition. While some reports suggest that the trend of 500 measles cases per day seems to be decreasing slightly, and the death rate has also slowed down from 8 to 5 deaths a day, it is too early to tell if this is a sign that the current outbreak has reached its peak. WHO continues to assess the overall risk of the outbreak as high at the national level due to the large number of cases still being reported, chronic low routine immunization coverage, and persistent vaccination hesitancy.
Stepping up the country’s vaccination programme
The DOH is leading the nationwide immunization campaign, assisted by the Philippine Red Cross, UNICEF, WHO, IOM and a number of other non-governmental humanitarian partners such as Americares, International Medical Corps, and the Family Planning Organization of the Philippines. The DOH aims to track and vaccinate 3.7 million children aged six to 59 months, 7 million children aged five to 12 years, and 2.6 million adults, with the school-aged children targeted to be immunized before the end of the current school year in early April. As of 3 April, over 4.7 million children had been vaccinated.
Although measles cases seem to be decreasing due to coordinated efforts being made, there is still a need to push for the 95 per cent coverage considered necessary to stamp out the disease. WHO is seeing an increase in other diseases related to poor immunization, such as polio and diphtheria. Measles is an indicator disease for low vaccination coverage, and one of the other concerns is the lack of polio vaccination, as the Philippines is one of the top countries considered at risk to a polio outbreak. UNICEF and WHO continue to provide technical, financial and logistics support to DOH in the planning, implementation and monitoring of response activities, including the effective implementation of the catch-up measles vaccination campaign. The USAID-funded ReachHealth project hired 50 nurses who vaccinated over 5,600 children in Metro Manila and Calabarzon region. The Philippine Red Cross has mobilized volunteers to support the immunization campaign, vaccinating over 16,800 children to date, and is operating measles care units in hospitals to help with the clinical management and medical care of highly contagious patients. In the northern highlands of Luzon, IOM, in an initiative funded by the European Civil Protection and Humanitarian Aid Operations, hired nurses to conduct house-to-house visits to support with measles, polio and Japanese Encephalitis vaccinations in 45 schools, 16 health centres and a teacher’s camp police school.
A coordinated plan of response
Rapid coverage assessments conducted by UNICEF and WHO in 9 regions found that while 91 per cent of children targeted were vaccinated, there was a still a challenge in reaching remote, indigenous populations and seasonal workers, a lack of documented proof of children’s vaccinations, and no waste management plan for used needles. During their monitoring visits, cold chain equipment was found to be old and needing replacement, as temperature control is crucial to the effectiveness of the vaccine. There are reports of previously immunized children contracting measles, suggesting inadequate handling of vaccines. Other concerns reported are a chronic shortage of medical staff to vaccinate the large number of children targeted, the need to strengthen the case management system at the health facility level, and the need for a monitoring mechanism to track the effectiveness of the expanded programme of immunization.
There is also a concern regarding vaccine stocks. So far, six million doses have been procured with the assistance of UNICEF, however, over 12 million doses are needed in the coming months for the expanded campaign. UNICEF is working to mobilize more vaccines but there is a global production bottleneck at this point. There are outbreaks worldwide, including in Madagascar, Brazil, Ukraine and Venezuela.
In support of Government efforts, the United Nations and humanitarian partners are advocating for continued routine immunization, including screening all children under five years to identify missed doses, and continued school-based immunization once schools reopen. World Immunization Week on 24-31 April will be used to promote community-based immunization and champion health workers and community leaders as immunization heroes.