Disease of interest

So do I hide under the table now?” Delivered with a smile, this was the only answer that I could give in response to an apology coming from an official from the US Centers for Disease Control and Prevention. This was back in 2018, and we were in a Measles and Rubella Initiative meeting. He was giving an overview of the measles situation and happened to mention the Disneyland outbreak in 2014 and how, unfortunately, the strain that was identified was similar to the one circulating in the Philippines.

Did I personally take offense on behalf of our country? The answer is a definite no. What was shared was a hard truth. The objective of the meeting was to strengthen collaboration with global partners to fight against two deadly, disabling diseases that are vaccine-preventable.

How can you not appreciate the fact that people who are not even your own are willing to help?

Why deadly and disabling? To better understand, let us go into a brief description of these two diseases. Measles and rubella are highly contagious and may infect anyone that is unprotected. Both may manifest with fever and rash and, at times, may be clinically indistinguishable from other nonspecific viral exanthems at the onset. Shedding of the virus may occur even before symptoms are manifested and after the infection has occurred.

Rubella is acquired through the inhalation of large aerosols. More commonly known as German measles, it is generally mild in children but is potentially dangerous for pregnant women who contract the infection. Untoward consequences include the possibility of miscarriage, premature delivery, or having a child born with permanent hearing, eye, or heart defect and intellectual disability.

Measles on the other hand is transmitted through person-to-person contact and airborne spread. Droplets from respiratory secretions may remain airborne for one to two hours. This is the reason why outbreaks may easily occur in public spaces, in areas of overcrowding, most especially in undervaccinated populations. Manifestations aside from fever and rash include the three Cs: cough, coryza, and conjunctivitis. Presented with these symptoms, a history of exposure to a child with fever and rash or recent travel to an area where it is highly prevalent makes one suspect measles. Complications may range from diarrhea, otitis media (ear infection), to pneumonia or encephalitis. SSPE or subacute sclerosing panencephalitis is unfortunately a “fatal and progressive degenerative disease that may occur seven to 10 years after a natural infection,” and having measles at an early age is a risk factor. There have also been reports of tuberculosis being reactivated after an infection.

In a consultative and collaborative meeting last January with the Department of Health Epidemiology Bureau, it was shared that measles cases have remarkably risen in 2022 as compared to 2021 with Regions 6 and 7, and the National Capital Region reaching alert and epidemic thresholds in the recent weeks. Of the measles cases reported, around 64 percent involved children less than five years of age. This comes as no surprise, as national immunization coverage rates against vaccine-preventable diseases have remained “measly” even prior to the pandemic, leading to the accumulation of susceptible children. In 2021, we were identified as one of the five top countries contributing to the global count of 18 million zero-dose children, meaning that they have never received any of the routine vaccinations. The Philippines was one of the top seven contributors with the most children remaining unprotected from measles.

Faced with a less-than-rosy picture, we can either choose to sink or swim. Catch-up immunization is continually being espoused and pursued on both a private and national scale, alongside measures to intensify awareness of the role and importance of needed surveillance for vaccine-preventable diseases. Plans for instituting supplemental immunization activities in the coming months have been laid. These are not novel initiatives but targeted strategies that have worked in the past and are very much needed to stop outbreaks from happening.

For now, it is more than clear that we have made a choice. The responsibility lies not in one agency but is a group effort. Being committed, supportive, and courageous will surely keep our heads above water.

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