By Evangeline T. Capuno
After years of declining measles vaccination coverage, measles cases in 2022 have increased by 18 percent, according to the World Health Organization (WHO). Compared to 2021 data, deaths have increased by 43% globally. This takes the estimated number of measles cases to 9 million, and measles-related deaths to 136,000 (mostly children), according to a new report released by the WHO and the U.S. Centers for Disease Control and Prevention (CDC).
Measles continues to pose a relentlessly increasing threat to children. In 2022, 37 countries experienced large or disruptive measles outbreaks, compared with 22 countries in 2021.
“The increase in measles outbreaks and deaths is staggering, but unfortunately, not unexpected, given the declining vaccination rates we’ve seen in the past few years,”said Dr. John Vertefeuille, director of CDC’s Global Immunization Division.
Undervaccination
“Measles cases anywhere pose a risk to all countries and communities where people are under-vaccinated. Urgent, targeted efforts are critical to prevent measles disease and deaths,” Dr. Vertefeuille added.
Measles is preventable with two doses of measles vaccine. The WHO said that while a modest increase in global vaccination coverage occurred in 2022 from 2021, there were still 33 million children who missed a measles vaccine dose: nearly 22 million missed their first dose, and an additional 11 million missed their second dose.
“The global vaccine coverage rate of the first dose, at 83%, and second dose, at 74%, were still well under the 95% coverage with two doses that is necessary to protect communities from outbreaks,” the WHO pointed out.
Of the 22 million children who missed their first measles vaccine dose in 2022, over half live in just 10 countries. The Philippines was one of the four countries in Asia listed; the three others were India, Indonesia, and Pakistan.
“The lack of recovery in measles vaccine coverage in low-income countries following the pandemic is an alarm bell for action. Measles is called the inequity virus for good reason. It is the disease that will find and attack those who aren’t protected,” said Dr. Kate O’Brien, WHO Director for Immunization, Vaccine and Biologicals. “Children everywhere have the right to be protected by the lifesaving measles vaccine, no matter where they live.”
The recent low measles vaccination was due to the pandemic that took place from 2020 to 2022. In the Philippines, many parents were afraid to have their children vaccinated, due to the fear of being infected with the coronavirus, as going to the health centers entailed overcrowding.
To encourage parents to bring their children to health centers during the national vaccination program, then President Rodrigo R. Duterte urged them. “I, therefore, call on parents [of children] under five years old, as well as the local government leaders and other community stakeholders, to support the immunization activity,” he said in a video message posted over the health department’s Facebook page.
Tigdas
Measles – locally known as “tigdas” or “tipdas” – is a very contagious illness caused by a virus in the paramyxovirus family (which also causes mumps, German measles, and chickenpox). “The measles virus normally grows in the cells that line the back of the throat and lungs,” the WHO said. “Measles is a human disease and is not known to occur in animals.
Measles is easily spread by contact with droplets from the nose, mouth, or throat of an infected person. Sneezing and coughing can put contaminated droplets into the air. “The virus remains active and contagious in the air or on infected surfaces for up to two hours,” the WHO said.
Those who have had an active measles infection or who have been vaccinated against the measles have immunity to the disease. Before widespread vaccination, measles was so common during childhood that most people became sick with the disease before the age of 20.
“Not vaccinating children can lead to outbreaks of measles, mumps, and rubella – all of which are potentially serious diseases of childhood,” reminded Dr. Neil K. Kaneshiro, Clinical Assistant Professor of Pediatrics at the University of Washington School of Medicine.
Signs and symptoms
Infectious disease specialist Dr. Eric Tayag said that a person infected with measles can infect up to 12-13 more people.
“The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days,” the WHO informed. “A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage.
“After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).”
Complications of measles
Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.
“As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care,” the WHO said. “Women infected while pregnant are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery.”
Until now, no specific antiviral treatment exists for the measles virus.
Severe complications from measles can be managed through supportive care, that ensures good nutrition, adequate fluid intake, and treatment of dehydration with WHO-recommended oral rehydration solution (ORS). This ORS replaces fluids and other essential electrolytes that are lost through diarrhea or vomiting. Antibiotics are prescribed to treat eye and ear infections, and pneumonia, if they develop.
Risk factors for developing measles, and immunity to the disease
One good thing: People who recover from measles are immune for the rest of their lives.
Among those who are at risk of being infected with measles are unvaccinated young children; they are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated, or was vaccinated but did not develop immunity) can become infected.
Although measles is a highly contagious disease, it can be prevented through vaccination, Dr. Tayag pointed out. According to the WHO, routine measles vaccination programs for children together with mass immunization campaigns are the key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective, and inexpensive. Dr. Tayag admitted, however, that the recent measles outbreak affecting the country was caused by the failure of some local government units to implement the state-sponsored immunization program in their respective areas.
“The fact that measles outbreaks are occurring at the highest levels we’ve seen in a generation is unthinkable, when we have a safe, cost-effective, and proven vaccine. No child should die from a vaccine-preventable disease,” said Dr. Elizabeth Cousens, the president and chief executive officer of the United Nations Foundation.
Meanwhile, the CDC and WHO urge countries to find and vaccinate all children against measles and other vaccine-preventable diseases, and encourage global stakeholders to aid countries in vaccinating their most vulnerable communities. In addition, to help prevent outbreaks, all global health partners at the global, regional, national, and local levels must invest in robust surveillance systems and outbreak response capacity, to rapidly detect and respond to outbreaks. – ###
