UNDER THE MICROSCOPE
Measles is making a comeback in the United States of America. A total of 295 cases were diagnosed in 2024 and so far, there are 164 cases this year, and one death.
Before the measles vaccine was introduced in 1993, an estimated three to four million were infected, 48,000 people were hospitalized and 400-500 died in the USA each year. Measles was officially eliminated from the USA in 2000.
But due to vaccine hesitancy fueled by a now-debunked small study published in 1998, measles is making a comeback not only in the USA, but around the world. In the Philippines, the Dengvaxia controversy caused a massive drop in vaccine acceptance from 93 percent to 32 percent, with measles epidemics and outbreaks occurring since 2019 when there were 31,056 cases and 415 deaths. Since then, almost 900 children had died of measles.
Measles is not just a childhood disease. The age distribution of measles cases in the 2024 outbreak shows that 48 percent were in ages five to 19 years and 18 percent were 20 years and over.
It isn’t just a rash either, as some people claim. Aside from high fever, cough, runny nose, and conjunctivitis, there are severe complications that can occur, some requiring hospitalization. Pneumonia in measles cases is often the cause of death in children.
One out of a thousand children with measles develop encephalitis (brain inflammation), which can lead to convulsions, and if not dying, can leave the child deaf or with intellectual disability.
Subacute sclerosing encephalitis (SSPE) is a very rare but fatal disease that can activate in later life. There is no cure for SSPE.
In pregnant women, measles may cause premature birth or a low-birth-weight baby.
Another grave complication of measles is the phenomenon of immune amnesia, which occurs because the measles virus infects immune system cells called memory B-cells and T-cells which remember previous infections and helps protect against future infections. As a consequence, those who had measles may, in the next five years, experience the same infections they had before for which immunity is usually attained, and cause additional deaths not directly attributable to measles alone.
Measles vaccination, through the MMR (Measles, Mumps, Rubella) vaccine has been found to reduce the risk of death from all causes after vaccination by 30-86 percent. That is powerful evidence of the additional protection offered by the MMR vaccine. Preventing immune amnesia with the MMR vaccine really works.
To prevent further outbreaks, we must have 95 percent coverage for the vaccine with two doses, which protect 97 percent of children vaccinated. That coverage enables herd immunity to take effect. But in 2017, the Philippine coverage for MMR was a measly 46.8 percent for the second dose. We have a long way to go before achieving full coverage for measles. In the meantime, we will continue to have outbreaks year after year.
There has been a call to bring back the “Let’s DOH It” campaign initiated by the Doctor to the Barrios, Dr. Juan Flavier, DOH Secretary in 1992. This led to a wider vaccine coverage, especially for polio vaccine.
But, no disrespect intended, Dr. Flavier did not have to deal with vaccine hesitancy, anti-vaccine activism and anti-vaxxers like Robert F. Kennedy Jr., who was recently confirmed as Secretary of the US Health Department. Responding to the question of the recent death of a child in Texas due to measles, RFK Jr. said “measles outbreaks are not unusual.” But he ignored the fact that measles was eliminated in the USA in 2000. Let’s just hope measles doesn’t become endemic in the USA if his anti-vaxxer sentiments get the better of him in the next four years.
For the Philippines, it is the consensus that the Dengvaxia controversy has done a lot of damage against vaccine acceptance. Filipinos tend to generalize and apply brand names to other similar products. Example: Toothpaste is commonly referred to as Colgate, a brand name. Thus, Dengvaxia became the poster child for all vaccines, and families are now refusing to have their children vaccinated against any and all vaccines. Hence, the measles and pertussis outbreaks happened. Even polio, declared eliminated in the Philippines, is making a comeback.
There still is a lot of vaccine disinformation going on in the Philippines, not only on social media but in the press, radio and TV as well. Apparently, some newsmen are enticed with awards, monetary and otherwise, to publish articles claiming that Dengvaxia caused the deaths of the children in the cases, even though this claim was debunked by the judge who dismissed the first eight cases, as well as the Department of Justice, which junked another 98 cases of the same nature.
Unless, we finally lay the Dengvaxia issue to rest, it is highly doubtful that we will ever have the chance to eliminate measles, among other vaccine-preventable diseases.