Full Throttle vs. Measles

DoH teams up with PPS, other groups in a race to immunize children and beat the spread of Tigdas

By MICHELLE CIRIACRUZ

Despite the government’s high-profile claim of fully immunized (FIC) coverage in all cities and municipalities of the National Capital Region, NCR still accounted for 50 to 85 percent of measles cases nationwide from 1997 to 2000.

     Health Secretary Manuel M. Dayrit concedes that the government did fall short of its immunization objectives in the past four years. The incidence of measles in the NCR, particularly in the highly urbanized poor areas, remains largely the same as before the Ligtas Tigdas campaign was launched in 1998. The 2000 surveillance data of the DoH showed that these measles cases congregate in urban slums and that 70 percent of the infected children were unimmunized, contrary to the 97 percent reported FIC coverage.

     In fact, the National Statistics Office confirmed that, based on its survey, full immunization coverage for some two million infants aged 12 to 23 months dropped to 61.3 percent last year compared to 65.2 percent in 2000. Coverage in rural areas fell by six percentage points with 56.5 percent, while in urban areas full immunization rates dropped by 1.1 percentage points to 68 percent.

     The World Health Organization said that sprawling urban slum areas were falling out of the government program, which also suffered from vaccine shortages.

     Only one out of five children were fully immunized last year in the Autonomous Region in Mindanao, an impoverished Muslim self-rule area that has been wracked by three decades of separatist rebellion. Even Manila and suburbs achieved only 74 percent coverage.

     In the first of a series of social mobilization meetings for the NCR-wide Iwas Tigdas 2002 last April 3, Sec. Dayrit acknowledged that the continued high incidence is due to the country’s failure to sustain its routine immunization efforts against the disease in children aged nine to 12 months.

“Just like polio, we also actually allowed our measles vaccination in infants to drop—so routine immunization for measles has actually also dropped. That’s why we’re seeing measles all over the place now,” he admitted.

     The Iwas Tigdas 2002 campaign, spearheaded by the DoH and the Philippine Pediatric Society in cooperation with various government and nongovernment organizations, comes after the intensive Balik Patak polio program, which was implemented last February in response to the recurrence of polio cases in the Philippines. “We failed to keep our polio immunization rates high, allowing the virus to mutate and eventually recover a capability to cause disease in a mutated form, and transmit this disease to others,” Sec. Dayrit explained.

     The health threat from measles, especially to children below five years old, springs from the same neglect. Children as young as six months are already being infected, and the interepidemic period or the period between peaks is getting narrower. Although the first phase of measles immunization campaign in 1998 was chiefly successful—with 26.5 million children in the nine months to 15 years age range vaccinated—coverage afterwards dropped, leaving a substantial number of children unvaccinated and therefore susceptible to the disease. They then became opportune vectors for the infection of younger children.

     “The reason children were getting sick of measles at six months is we have failed to immunize them at the appropriate time. Therefore, this group that escapes immunization actually infects six-months-old children,” Sec. Dayrit explained.

     The anti-measles campaign is the elimination of measles as a public health problem by 2008. The planned nationwide follow-up campaign is supposed to be in 2003, but according to Sec. Dayrit: “We don’t have enough logistics to begin the 2003 campaign [yet], which we had planned earlier in 1998.”

     However, it does not preclude beginning a smaller scale immunization campaign this June and September targeting the depressed urban areas in NCR and some other parts of the country, where the risk of transmission is highest. It was also planned in anticipation of the measles peak season around October or November.

     Iwas Tigdas 2002 will follow up on the lessons learned from the Balik Patak polio campaign that immunized more than 12 million children, higher than the 11.9 million target. DoH personnel and volunteers will again cover the depressed urban areas in NCR by conducting door-to-door vaccination of children nine to 59 months of age.

     Pilot test runs are, in fact, already underway in some areas of Metro Manila, like Taguig and Las Piñas. The team, composed of at least one doctor, midwives or nurses, and barangay health volunteers, will first map their designated areas then visit each home that has an appropriately aged child in a sectoral approach. They will then administer the vaccine to the child, after which they will mark the houses and the children as “reached.”

     It must be made clear, however, that the Iwas Tigdas campaign does not aim to eradicate the measles virus, which provides its one major difference and makes it less ambitious from the polio campaign.

     The campaign’s objective is to strengthen routine immunization and to prevent the excessive cases of mortality and morbidity from measles in high-risk areas. Sec. Dayrit confirmed: “We must make sure that the routine vaccination of infants has to very high—as high as 90 to 95 percent... In order to really attack this problem we have to be consistent and dependable, not just have damage control-type strategies.”

     He also explained that sticking to the specified age group of nine to 59 months instead of lowering it to six months will save the country PhP8 million in resources. Most infants are also still protected by maternal antibodies, and so will not really benefit from a measles vaccination. “The strategy is to vaccinate at a time when the vaccine is most effective,” he said.

     “When we do that, and we do it effectively we will reduce the number of children that infects the six-month [old children], we will reduce the resources that we need to do this on a nationwide scale, and we will actually be more effective in our campaign,” Sec. Dayrit concluded.

The campaign is also in line with President Gloria Arroyo’s platform of helping the urban poor. Dayrit revealed, in a run-up to the Philippine president’s state of the nation address in July, that there will be a 100-day period where a lot of focus will be on the urban poor. Iwas Tigdas 2002, which will target nine to 59 -months-year-old infants in the urban poor areas, actually fits with this strategy quite well.

     Sec. Dayrit envisioned that when they eventually do the nationwide campaign in 2003, the situation would have moved to where more children would be immunized against measles, and routine immunization would be kept up.