Measles epidemic in Davao City: 2017-2018
SPMC J Health Care Serv. 2018;4(1):3 ARK: http://n2t.net/ark:/76951/jhcs5bc39n
1Regional Epidemiology Surveillance Unit, Department of Health Region XI, JP Laurel Ave, Davao City, Philippines
2Hospital Research and Publication Office, Southern Philippines Medical Center, JP Laurel Ave, Davao City, Philippines
Correspondence Cleo Fe Tabada, firstname.lastname@example.org
Article editor May Kathryn Lazaro
Received 21 May 2018
Accepted 3 July 2018
Cite as Tabada CF, Ladrero CX. Measles epidemic in Davao City: 2017-2018. SPMC J Health Care Serv. 2017;4(1):3. http://n2t.net/ark:/76951/jhcs5bc39n
Diseases of epidemic potential are on surveillance using the Philippine Integrated Disease Surveillance and Response (PIDSR) system maintained by the Department of Health (DOH) regional offices. Southern Philippines Medical Center (SPMC) contributes data to this system through the Regional Epidemiology Surveillance Unit of Region XI (RESU XI), which releases summary surveillance reports on a weekly basis. The report itself is a count of patients with disease signs or symptoms, suspected disease conditions, specific clinical diagnoses, or laboratory-confirmed diagnoses. Per DOH policy, a single notification of a measles diagnosis needs confirmation and investigation. An increasing number of cases warrants the initiation of outbreak response immunizations (ORI) by the local government, even before an epidemic is formally declared. Serologic confirmation of measles is performed at the Research Institute for Tropical Medicine (RITM) in Muntinlupa, Alabang.
By the end of 2016, Davao City had a 67% immunization coverage for all prescribed antigens—including measles—among children aged 12 months and younger. The number of patients with measles diagnosis reported to the RESU XI had been low from January to October of 2017. From 2 to 14 November 2017, SPMC reported 7 patients clinically diagnosed to have measles. All seven patients came from one barangay in Davao City. The number of reported cases and involved areas in Davao City increased during the succeeding weeks and peaked on 3 February 2018.
From 2 November 2017 to 25 June 2018, a total of 882 patients were reported to have measles in Davao City. Only 79/882 (8%) patients had laboratory confirmation of measles. The patients’ ages ranged from 17 days to 87 years. There were 237/882 (27%) patients aged less than 9 months who were not eligible for measles vaccination but were diagnosed to have the infection. Thirty-six (4%) of the reported patients died. Of the patients who died, 16 were not eligible for measles immunization.
Right after the report from SPMC in early November 2017, RESU XI met with the local health unit personnel of the affected barangay to alert them of the alarming number of measles cases from the area. A team, composed of barangay health workers and personnel from Davao City Epidemiological Surveillance Unit (Davao CESU) and RESU XI, went to different puroks within the affected barangay to conduct investigation and monitoring for additional cases. The local health unit has already been performing catch-up immunizations with measles containing vaccines (MCV) for 9 to 24-month-old children as part of its regular immunization program. In response to the increasing number of reported cases of measles, the District Health Officer of the affected barangay ordered the immediate expansion of the catch-up MCV immunization coverage to include infants aged 6 to 8 months.
On 21 December 2017, due to the increasing reports of cases and deaths, now involving other areas in the city, DOH Region XI deployed nurses to conduct ORI in Davao City for four days.1
The City Health Office of Davao City formally declared a measles outbreak within the city on 22 January 2018.2
Two more batches of nurses were deployed to more areas in the city from 15 January to 16 February 2018 to intensify the ORI initiated in December 2017.3 4
By this time, increasing number of cases were also reported in provinces surrounding Davao City. This prompted the respective areas to also initiate ORI for measles and intensify their catch-up immunizations for all other antigens.5
The number of cases started to drastically decline on 18 February 2018.
On 9 May 2018, the DOH started a Mindanao-wide supplemental immunization activity (SIA) for all antigens to include children aged 6 to 59 months, regardless of immunization status.6 7
By 30 June 2018, after the SIA, Davao City had 83% immunization coverage among children aged 5 years and younger.
This epidemic of a preventable disease is ongoing. An appropriate response at the level of the first affected area in Davao City was immediately initiated, and subsequent support from the national and local governments led to a full-swing epidemic response in the succeeding weeks. From 18 February 2018 up to the last recorded weekly count as of this writing, there has been a fluctuating trend in measles incidence, generally leading towards a decrease in number of reported cases. The coordinated efforts of the DOH personnel and local health units—to enhance the coverage and widen the scope of measles immunization—are expected to put this epidemic under control.
We extend our deepest gratitude to the Department of Health Region XI Regional Epidemiology Surveillance Unit (DOH XI RESU) and Davao City Health Office for the information on immunization status and intervention they provided. We also give our special thanks to Alvin John Labrador and Roselle Princess Rosas of DOH XI RESU for generating the data on measles epidemiology.
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1. Department of Health. Authority of the following HRH personnel to conduct outbreak response immunization on December 22, 27-29, 2017 at Davao City, Department of Health Region XI Personnel Order 4133-2017 (21 December 2017).
2. Canedo KV. Measles cases 'rising' in Davao City. 2018 February 13. [cited 2018 July 6]. In: SunStar Philippines [Internet]. Davao: SunStar Publishing, Inc. c2018. Available from: https://www.sunstar.com.ph/article/418649/Measles-cases-rising-in-Davao-City.
3. Department of Health. Authority of the following HRH personnel to conduct outbreak response immunization on January 15-31, 2018 at Davao City, Department of Health Region XI Personnel Order 0086-2018 (12 January 2018).
4. Department of Health. Authority of the following Health personnel, job orders and NDP/RHMPP to conduct outbreak response immunization(ORI) in Davao City, Department of Health Region XI Personnel Order 0218-2018 (26 January 2018).
5. Department of Health. Conduct of Outbreak Response Immunizations and Catch-up Immunizations for MCV1 and MCV2, Department of Health Region XI Memorandum 0020-2018 (8 February 2018).
6. Department of Health. Conduct of Mop-Up Operations of Measles, Oral Polio Vaccine immunization and All Other Antigens on May 9 to July 31, 2018 and Strengthening Regular Immunization Activities thru Reaching Every Purok Strategy in All Health Facilities thereafter, Department of Health Region XI Memorandum Circular 0016-2018 (27 April 2018).
7. Tejano IC. DOH launches 'Ligtas Tigdas'. 2018 May 11. [cited 2018 July 6]. In: SunStar Philippines [Internet]. Davao: SunStar Publishing, Inc. c2018. Available from: http://my.sunstar.com.ph/davao/local-news/2018/05/11/doh-launches-ligtas-tigdas-600550.
Copyright © 2018 CF Tabada, et al.