Philippines: Measles Outbreak - Operation Update - Re-emergence of vaccine preventable diseases – Measles outbreak - DREF n° MDRPH032 (12 March 2020)

Situation Report
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Description of the disaster

The number of measles cases has increased in the Philippines in recent years, with a dramatic increase in cases across the country in late 2018. On 7 February 2019, the Philippines’ Department of Health (DOH) reported outbreaks of measles in five Regions, namely the National Capital Region, Central Luzon (III), CALABARZON (IV-A), Western Visayas (VI) and Central Visayas (VII). In the following weeks, the outbreaks reached 17 Regions. See maps.

Based on the DOH’s Measles and Rubella Surveillance report and WHO Epidemiological Overview 2020, between 1 January and 31 December 2019, a total of 47,871 cases of measles, including 632 deaths, were recorded, with a case fatality rate (CFR) of 2.6 per cent.

Most cases were recorded in the first three months of 2019. For the year 2018, there had been 20,827 cases reported with 199 deaths. So far, for 2020, between 1 January and 1 February, 1,189 cases and 10 deaths have been reported.
The reported cases in January 2020 were approximately 82 per cent lower compared to the same period in 2019; the median age of people dying is two-years old and the case fatality rate at an average of 0.8 per cent.

Between January 2018 and December 2019, measles outbreaks developed differently between affected regions, according to the incidence rates and case fatality rates shown in the following two charts provided by WHO (24 Feb 2020).

Poor immunization coverage is widely recognized by health specialists as the root cause of the measles outbreaks. Prior to the outbreaks, children fully immunized against the measles vaccine have reportedly gone from 91 per cent to less than 40 per cent in the past five years. It was estimated in 2018 that 3.7 million children under the age of five were susceptible to measles infection. The highly contagious nature of the disease and the low vaccination rate by international standards resulted in multiple outbreaks. Dense, urban, poor environments and the refusal to vaccination exacerbated the situation favoring the rapid spread of the disease.

To cope with the outbreaks, the DOH implemented an immunization program, targeting 3.7 million children aged 6 to 59 months. DOH has published guidelines and led a national measles vaccination campaign, including oral polio vaccine (OPV) and vitamin A distribution, prioritizing unvaccinated children aged 6 to 59 months; schoolchildren from kindergarten to grade 6; and adults who voluntarily wish to be vaccinated against measles.

As the graph above shows, the peak of the outbreaks occurred in January-February 2019, with the highest number of weekly cases recorded in the first four months of the year. The latest DOH Measles and Rubella Surveillance report, released on 14 February 2020, shows that the number of cases per week is now lower than that for the same period in 2019. This indicates that the epidemic has stabilized since its deadliest phase. The main priority for the government initiatives to prevent preventable diseases is now to ensure that at least 95 per cent of the population is provided with measles containing vaccine (MCV), be it Measles, Mumps and Rubella (MMR) or Measles and Rubella (MR), OPV and Vitamin A (as proposed by the DOH).

The high number of measles cases has strained the existing public health system. As an auxiliary to the public authorities, PRC was invited to support the DOH in its response to the epidemics. Supported by the IFRC Emergency Appeal, the PRC has given priority to three response mechanisms: (i) support to the hospitals that are overcrowded, (ii)
Source: WHO, Philippines Epidemiological Overview 2020, 24 February 2020 Source: WHO, Philippines Epidemiological Overview 2020, 24 February 2020 support to the DOH’s Outbreak Response Immunization campaign to vaccinate the 3.7 million children who have never been vaccinated with Measles Containing Vaccine, and (iii) ensure social mobilization and awareness.

Summary of current response

The PRC response is divided into three phases on this operation. From 10 February to September 2019, PRC mainly conducted the following response activities:

• Measles Care Units (MCUs): PRC set up seven MCUs in six hospitals, treated 3,735 patients and cared for their immediate family members.

• Vaccination: PRC teams with more than 2,000 volunteers vaccinated a total number of 16,956 children, supported by 20 chapters in 21 cities and municipalities. These were undertaken in coordination with the DOH who provided vaccinations and cold chain management as well as one roving field doctor to support senior health personnel from PRC and oversee the administration of the vaccines, in accordance with DOH protocols for vaccine management.

• Training: Training of Trainers (ToT) on epidemic control for volunteers (ECV) and the immunization compliance module.

• Accountability: Throughout the response, the PRC’s Operations Centre (OpCen) has been collecting and collating all data on measles cases and the current response, and published regular updates.

• Section C and the PRC platform present more details on activities carried out, the places of vaccinations and MCUs.

Phase 1, which focused on setting up measles care units (MCUs), conducting direct vaccination, and WASH activities, ended in September 2019. Phases 2 and 3 aim to support government routine immunization activities, ensuring continuity of measles prevention. The Phase 2 of the project was planned to start during third quarter of the year.

However, measles related activities were overtaken with polio activities, following the government’s declaration of national polio outbreak on 19 September 2019. Based on the current response to polio activities, Phase 2 activities for the measles operation is expected to start from mid-March 2020. At the same time, the PRC is also responding to multiple operations both health emergencies (Dengue, Polio and COVID-19) and health in emergencies (Batanes Earthquake, Mindanao Earthquake, Typhoon Kammuri, Typhoon Phanfone, Taal Volcano). This resulted in a prioritization of activities with resulting delays. Phase 2 activities for measles operation are expected to start from midMarch 2020.