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. 2021 Dec 15:19:100334.
doi: 10.1016/j.lanwpc.2021.100334. eCollection 2022 Feb.

Measles outbreak in the Philippines: epidemiological and clinical characteristics of hospitalized children, 2016-2019

Fleurette M Domai  1 , Kristal An Agrupis  2 , Su Myat Han  1 , Ana Ria Sayo  3 , Janine S Ramirez  3 , Raphael Nepomuceno  1 , Shuichi Suzuki  1   2 , Annavi Marie G Villanueva  1   3 , Eumelia P Salva  3 , Jose Benito Villarama  3 , Koya Ariyoshi  4 , Kim Mulholland  1   5   6   7 , Luigi Palla  1   8 , Kensuke Takahashi  1   4   9 , Chris Smith  1   4   10 , Edna Miranda  3
Affiliations

Measles outbreak in the Philippines: epidemiological and clinical characteristics of hospitalized children, 2016-2019

Fleurette M Domai et al. Lancet Reg Health West Pac. .

Abstract

Background: Measles outbreaks increased worldwide during 2017-19. The largest outbreak in the World Health Organisation Western Pacific region occurred in the Philippines where first-dose measles-containing vaccine (MCV1) coverage had reduced to 75% in 2018. The aim of this study was to summarise paediatric measles admissions to the national infectious diseases referral hospital in Manila during 2016 to 2019.

Methods: A retrospective single-centre observational study including 5,562 children aged under five years admitted with measles from January 2016 to December 2019. We summarised sociodemographic and clinical characteristics, vaccine status, reported exposures, and outcomes. Univariable and multivariable logistic regression analyses were undertaken to assess associations between different characteristics of hospitalised children and death.

Findings: The median age of children hospitalised with measles was 11 months (interquartile range: 7-28). 84·5% of cases were reported not to have received any MCV. The risk of mortality was 3·2%, with 41% of deaths occurring among children aged less than 9 months. No children died who had received two MCV. The following characteristics were significantly associated with mortality in the multivariable analysis: age group, residence outside of the national capital region, not having received any MCV, duration between onset of fever and hospital admission of 7-14 days compared with 0-3 days, not receiving vitamin A supplementation, having pneumonia, and gastroenteritis.

Interpretation: The Philippines remains at risk of future measles epidemics. Routine immunization needs to be strengthened and earlier timing of MCV1 requires further evaluation to reduce measles incidence and mortality.

Keywords: Philippines, Western-Pacific region; immunisation; measles; paediatric infectious diseases; vaccine-preventable disease.

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Conflict of interest statement

KM is a member of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization. The other authors declare no conflicting interests.

Figures

Figure 1:
Figure 1
Trends in measles cases in the Western Pacific Region, San Lazaro Hospital (SLH), Manila, the Philippines, 2016-2019 (a) Distribution of hospitalized measles cases admitted to SLH by location (b) Epidemic curve of the hospitalized measles cases at SLH Manila by week of admission, and (c) Time-series of reported confirmed and compatible measles cases in the Western Pacific Region by month of rash onset, 2016-2019 (adapted from: WHO Measles-Rubella Bulletin 8)
See this image and copyright information in PMC

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