MANILA, Philippines – Just how widespread are measles cases in the Philippines?
Data obtained by Rappler from the Department of Health (DOH) epidemiology bureau showed there were now measles cases in every province of the country – save for Batanes, Tawi-Tawi, and the chartered city of General Santos – as of 9 am Friday, February 22.
Three weeks since the DOH declared a measles outbreak in several regions on February 7, there have been at least 12,736 cases and 203 deaths recorded from January 1 to February 22.
Those numbers show a steep climb from the number of cases and deaths recorded in the same period in 2018. The increase showed there are now 357% more cases of measles compared to the same time last year when there were 2,789 cases.
With more cases comes the bigger possibility of more fatalities. Compared to when there were 25 deaths due to measles from January 1 to February 22, 2018, there was now a 712% increase in fatalities with at least 203 deaths recorded so far.
Of the number of cases recorded as of February 22, 2019, this translated to a roughly 2% fatality rate.
While that may seem like a small number, this is already considered high by the World Health Organization (WHO) and Unicef as measles is supposed to be a vaccine-preventable disease. The Philippines also aimed to eradicate the disease by 2025.
According to the WHO and Unicef, the outbreak's overall risk "remains high" as there were large number of unprotected children and adults.
Days after announcing an outbreak, the DOH said it recorded 4,302 measles cases across the country as of February 9 this year. This means that since then, some 648 new cases were recorded per day, in a just little over two weeks' time.
Why are there so many cases? To understand how cases were able to increase rapidly over a short period of time, it’s worth looking at how contagious measles is as a disease.
According to the United States Center for Disease Control (CDC), measles is so contagious that if an unvaccinated person walks into a room where someone has measles, there is a 90% chance that the unvaccinated person will get the disease.
Measles is also highly virulent that for every person with the disease, about 12 to 18 people may be infected. (FAST FACTS: What is measles and how can it be prevented?)
The maps below show where these cases and deaths are, as well as which regions are most affected, based on the latest data of cases and deaths recorded by the DOH epidemiology bureau:
Apart from how contagious the disease is, health officials earlier pointed to the hesitation of some parents to have their children vaccinated as among the top reasons behind the huge increase in measles cases. Among the over 12,000 cases recorded, the epidemiology bureau said 6 out of 10 or about 63% had not been vaccinated against the disease.
In the wake of the Dengvaxia controversy, immunization rates plummeted as parents refused to have their children vaccinated, fearing this would harm them.
Apart from this, however, factors for an outbreak had already been brewing.
In an interview with Rappler, National Immunization Program Manager Wilda Silva said a 3-year trend from immunization programs weren’t keeping up with the pace of population growth, thus leading to a growing number of unvaccinated children.
In response, the DOH conducted supplemental immunization programs – an acitivity that Silva said showed favorable results in the past.
"Data in the DOH will tell you we are strong in conducting supplemental immunization and we do it every 3 years of 4 years based on analysis of data because once defaulters accumulate to almost the same as 1 year target, then an outbreak is bound to happen," Silva said.
Silva said these were the same measures health officials took in 2014 – the last time the Philippines saw an outbreak in Metro Manila – and upon seeing a growing number of unvaccinated kids from 2011.
With the Dengvaxia scare, however, the health department’s effort to mitigate risks of unvaccinated children fell short of targets.
"Vaccine hesitancy was really identified. [It] may not be the sole reason why measles started to show up again in 2018 but it was blown out of proportion because the intervention was not successful enough," Silva said.
She added: "What is very peculiar in 2018 is the vaccine hesitancy issue brought about by Dengvaxia. That's why we did not get the expected outcome from the immunization, which could have stopped the transmission of measles and it wouldn’t have blown out of proportion in 2018 and 2019."
The regular supplemental immunization program for measles called “Ligtas Tigdas” saw its vaccination coverage rates take a nosedive with 69% in Phase 1 and 29% in Phase 2 in 2018. The DOH usually aims for a target coverage of 85% for immunization programs.
The effects were not lost on communities, which had first hand experience with the Dengvaxia vaccine.
Data showed that Dengvaxia implementing regions had the highest number of individuals infected with measles as 3,116 cases were recorded in Calabarzon and 3,002 in Metro Manila.
Among the top 3 areas with the highest number of cases were the province of Rizal with 1,672 cases, followed by Quezon City with 733 cases, and Manila with 663 cases.
Are the number of cases still growing? The rising number of measles cases in the country have yet to slow down.
Health Secretary Francisco Duque III earlier told Rappler the increase in measles cases has not yet waned as the government has yet to achieve its target of 95% vaccination coverage.
During an outbreak, Duque added cases were expected to increase every 2 to 3 days of monitoring.
Data obtained by Rappler from the DOH epidemiology bureau showed this. From reporting that there were 4,302 cases as of February 9 this year, the number of measles cases has grown considerably every 2 to 3 days to count over 12,000 now infected with the highly contagious disease.
Hover over the dots in the chart below to see the exact number of cases and deaths.
The health chief said that numbers would only start to wane when the government's 95% vaccination coverage rate is achieved. This target coverage rate would also ensure "herd immunity" wherein people who already have measles will be "walled off" from the rest of the population.
What comes next? The government is in the middle of conduciting a mass immunization campaign to reach the target 95% coverage rate, which translated to some 12 million people.
Aside from this, the DOH also partnered with non-governmental agencies, doctors groups, and businesses to treat and protect many people as possible. (LOOK: Measles vaccination in tents, fast-food chains)
All in all, their goal is to vaccinate some 12 million people by March, according to 3 subgroups:
Health officials have repeatedly urged the public to get vaccinated against measles as this remains the best defense against the disease. (READ: EXPLAINER: When should one get vaccinated against measles?) – Rappler.com