Controlling the measles outbreak

MANILA, Philippines - The year started with alarming news as the Department of Health declared a measles outbreak in a number of cities and provinces in the Philippines. Known in Filipino as tigdas, measles is a viral infection spread from person to person through the air by infectious droplets and is highly contagious, especially for infants and persons with chronic diseases. After an incubation period of 10 to 14 days, measles begins typically with fever, coryza (common cold), hacking cough, photophobia (sensitivity to light), and conjunctivitis (typical map-like rashes that develop on the person’s face and head initially, then the limbs and trunk). Common complications brought about by the disease are diarrhea, otitis media (middle ear infection), pneumonia, and encephalitis. In infants who die of measles, pneumonia accounts for about 60% of deaths, whereas in children 10 to 14 years of age, death is more often observed to be from complications of acute encephalitis.

 â€œOne of the factors that contributes to the spread of measles is the failure to vaccinate susceptible populations, especially babies and young children,” notes Dr. May Montellano, president of the Philippine Foundation for Vaccination and a pediatric infectious disease specialist. “Of course, there are other contributing reasons for suboptimal vaccination coverage, such as limited healthcare access, and also delayed supplementary immunization activities.”

Alongside primary prevention with vaccination, a key factor to help control the spread of many airborne diseases such as measles, mumps, and rubella (MMR), is herd immunity. Herd immunity is the presence of enough people who are immune to the disease such that the few people who are non-immune will be unlikely to encounter an infectious case.

Dr. Montellano says, “For this disease, more than 90% of the population need to be vaccinated in order to achieve herd immunity. And it is important to note that one dose is not enough for protection. It is highly recommended to follow the routine two-dose schedule and use of combined MMR vaccines.”

The recommended age for measles vaccination depends on the local measles epidemiology.  In most developing countries such as the Philippines, high attack rates and serious disease among infants necessitate early vaccination, usually at nine months of age for a solo measles vaccine, according to local medical society recommendation. The combination MMR vaccine is given as early as 12 months of age, followed by a second dose at four to six years old or at least 28 days apart from the first dose.

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