1. Measles Outbreak

2. WHAT IS THIS PICTURE?

4. Case Definition Clinical case definition – Any person in whom a clinician suspects measles infection – Any person with fever, maculopapular rash, cough, coryza, conjunctivitis Laboratory criteria for diagnosis – 4x increase in antibody titer, isolation of measles virus, or presence of IgM antibodies

5. What is considered an outbreak? DOH: – 1 case, suspected or confirmed, in a community where there was no case in the past – 1 case per 2 weeks for 2 consecutive weeks WHO – Number of cases observed is greater than the number normally expected in the same geographic area for the same period of time

6. Outbreak Timeline (Metro Manila) 25 cases 2012 179 cases Dec 10 2013 760cases Jan 11 2014 DOH Declared Outbreak Jan 4, 2014 21 barangays In 9 cities 716% increase 416 % increase DOH statistics Only 6% of the reported Cases are confirmed

7. Philippines YearConfirmed measles cases Incidence (per 1 million) Deaths due to measles 20088749.88 2009149016.610 2010638868.234 2011655569.128 2012149915.55 2013172417.9721 Source: WHO. Country Profile-Measles Elimination.

8. DOH National Epidemiology Center Jan 1 – Dec 14, 2014 1,724 cases and 21 deaths Majority came from Metro Manila (744 cases) 13/17 regions of the Philippines have measles case increase 2013 (NCR)  416 confirmed cases – 1568 % increase! 2012 (NCR)  25 confirmed cases Las Pinas (78), Manila (72), Muntinlupa (65), Caloocan (45), Paranaque (32), Malabon (31) – Urbanized, congested area – High mobility of the residents – Supposedly good EPI coverage

9. Source: WHO. Country Profile-Measles Elimination.

10. Population at Risk Children under age 5 years old – Higher percentage of death due to measles complication – 158,000 people died from measles in 2011 Pregnant women Immunocompromised

12. MCV2 routine coverage: the level of coverage by the second dose of the measles-containing vaccine, as reported in the annual WHO/UNICEF Joint Reporting Form on Immunization.

13. Goals Herd Immunity – Vaccination coverage of no less than 95% – The “Iligtas sa Tigdas ang Pinas” program in 2011 only covered 84% of the population (15,649,907) – MR vaccine 16% (~3million) were unvaccinated or in 2 years since at 84% coverage, 6 million were unvaccinated Measles Free by 2017 (WHO) – 1 case per 1 million population

14. Vaccination Measles – At 9 months – At 6 months during outbreaks Maternal antibodies may have dwindled already MMR – 2 doses – 1 dose  90% immunity Booster at 12-18 (15) months – 2 doses  almost 100% immunity At 4-6 years of age Some children who have been vaccinated still got infected 2-3% may not develop antibodies Some parents refuse vaccination – Religious belief – Transfer of residence

15. Government Response Vaccination – It will take a couple of weeks before they develop immunity Mass Immunization Campaign that aims to cover children <5 years old (11.7 million) – Door to Door approach – All (6mo-59 mo) will be vaccinated regardless of prior vaccination (unless does is <1 month ago) or if recently had measles DepEd and DOH advise voluntary quarantine

16. Government Response Mandatory Nutrition Program – FNRI: underweight children 0-5 years (3.35 million) – Significant increase in prevalence among 6-10 years old from 22.8% in 2005 to 25.6% in 2008 Those who are malnourished are at increased risk of dying from measles complication – Vit A supplementation can reduce mortality risk by 50% Tayag: “infants and children with measles should be hospitalized” – Panic among parents

17. Government Response Checking for new strain – DOH declared no new strain for this measles outbreak

19. What can we expect? A further rise in measles cases in the coming months peaking during the summer where virus replication is faster

20. TMC Statistics