Progress toward measles elimination—Philippines, 1998-2014

Abstract

In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR) established a goal to eliminate measles by 2012.The recommended elimination strategies in WPR include 1) ≥95% 2-dose coverage with measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs); 2) high-quality case-based measles surveillance; 3) laboratory surveillance with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus genotypes; and 4) measles outbreak preparedness, rapid response, and appropriate case management. In the WPR, the Philippines set a national goal in 1998 to eliminate measles by 2008. This report describes progress toward measles elimination in the Philippines during 1998-2014 and challenges remaining to achieve the goal. WHO-United Nations Children's Fund (UNICEF)-estimated coverage with the routine first dose of MCV (MCV1) increased from 80% in 1998 to 90% in 2013, and coverage with the routine second dose of MCV (MCV2) increased from 10% after nationwide introduction in 2010 to 53% in 2013. After nationwide SIAs in 1998 and 2004, historic lows in the numbers and incidence of reported measles cases occurred in 2006. Despite nationwide SIAs in 2007 and 2011, the number of reported cases and incidence generally increased during 2007-2012, and large measles outbreaks occurred during 2013-2014 that affected infants, young children, older children, and young adults and that were prolonged by delayed and geographically limited outbreak response immunization activities during 2013-2014. For the goal of measles elimination in WPR to be achieved, sustained investments are required in the Philippines to strengthen health systems, implement the recommended elimination strategies, and develop additional strategies to identify and reduce measles susceptibility in specific geographic areas and older age groups.

FIGURE 1

Number of reported measles cases and estimated percentage of MCV1 and MCV2 coverage, by year — Philippines, 1998–2014 Abbreviation: MCV = measles-containing vaccine. Source: World Health Organization (WHO)–UNICEF estimates of national immunization coverage are available at http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index4.htm. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) was among children aged 1 year; estimated coverage with the routine second dose of measles-containing vaccine (MCV2) was among children at the recommended age of administration of MCV2, as per the national immunization schedule. Introduction of MCV2 started in 2009 in Regions 4A, 5, 6, 7, and 12. In 2010, MCV2 was introduced into the routine immunization nationwide; however, reporting was incomplete until the recording/reporting tool was updated in 2012 to accommodate the addition of MCV2. The number of reported measles cases during 1998–2013 is as reported to the World Health Organization (WHO) and UNICEF through the Joint Reporting Form and during 2014 as reported in monthly reports to the WHO Western Pacific Regional Office by December 20, 2014. * Supplementary immunization activities using measles-containing vaccine were implemented in 1998 (nationwide) for children aged 9 months–14 years, 2004 (nationwide) for children aged 9 months–7 years, 2007 (nationwide) for children aged 9–48 months, and using measles-rubella vaccine in 2011 (nationwide) for children aged 9–95 months. ^† Outbreak response immunization activities using measles vaccine during January–February 2014 targeting children aged 6–59 months in Calabarzon, Central Luzon, and the National Capital Region. ^§ Nationwide supplementary immunization activity using measles-rubella vaccine implemented during September 2014 for children aged 9–59 months.

FIGURE 2

Number* of reported confirmed measles cases, by month of rash onset — Philippines, 2013–2014 Source: As reported in monthly reports to the World Health Organization Western Pacific Regional Office by December 20, 2014. * N = 58,389. ^† Outbreak response immunization activities using measles vaccine during January–February 2014 targeting children aged 6–59 months in Calabarzon, Central Luzon, and the National Capital Region. ^§ Nationwide supplementary immunization activity using measles-rubella vaccine implemented during September 2014 for children aged 9–59 months.