measles outbreak. what is this picture? case definition clinical case definition – any person in...
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Measles Outbreak
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WHAT IS THIS PICTURE?
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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
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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
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Outbreak Timeline (Metro Manila)
25 cases2012
179 casesDec 10 2013
760casesJan 11 2014
DOH DeclaredOutbreakJan 4, 2014
21 barangaysIn 9 cities
716% increase
416 % increase
DOH statistics
Only 6% of the reported Cases are confirmed
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Philippines
Year Confirmed measles cases
Incidence (per 1 million)
Deaths due to measles
2008 874 9.8 8
2009 1490 16.6 10
2010 6388 68.2 34
2011 6555 69.1 28
2012 1499 15.5 5
2013 1724 17.97 21
Source: WHO. Country Profile-Measles Elimination.
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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
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Source: WHO. Country Profile-Measles Elimination.
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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
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MCV2 routine coverage: the level of coverage by the seconddose of the measles-containing vaccine, as reported in the annualWHO/UNICEF Joint Reporting Form on Immunization.
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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
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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
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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
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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
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Government Response
• Checking for new strain– DOH declared no new strain for this measles
outbreak
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What can we expect?
• A further rise in measles cases in the coming months peaking during the summer where virus replication is faster
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TMC Statistics
October November December January0
10
20
30
40
50
60
Number of Measles Cases (Admissions) from October 2013 to January 15, 2014
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<1 year old 1-4 years 5-9 years 10-14 years 15-18 years0
5
10
15
20
25
30
35
40
Number of Measles Cases (Admissions) per Age Group
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50%50%
Vaccination Status
VaccinatedNon-vaccinated
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29%
17%
13%2%
38%
Number of Doses
1 dose2 doses3 doses5 dosesUnknown
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8%
35%
19%
12%
6%
21%
Reasons for Non-vaccination
Mother was busyIneligible to receive vaccineForgot scheduleBaby was sickOthersUnknown
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12%
88%
Development of Complications
Yes No
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3%
28%
4%66%
Exposure History
SchoolCommunityHomeUnknown