Step on the breaks

For any clinician, arriving at a definitive diagnosis in a child presenting with fever and nonspecific rash is never easy. There are a lot of diseases that can manifest as exanthems, mostly viral in nature, are benign, and self-limiting. However, there are others that are extremely contagious and may result in complications or even death. Three weeks ago, a patient came in with the above symptoms. Fortunate to have a quick-thinking resident and fellow who could not totally rule out measles, the patient was immediately isolated pending confirmatory laboratory results. This led to a string of discussions in the pediatric community and on Feb. 18, the Philippine Pediatric Society (PPS) together with the Pediatric Infectious Disease Society (PIDSP) issued an advisory on the increasing cases of measles in the country.

“Based on the Philippines Integrated Disease Surveillance Report MW No. 5, there were 181 cases reported in the last three to four weeks, an 87 percent increase from 97 cases reported two weeks ago. There was also a 32 percent increase in measles cases at this time of the year compared to the same period (Jan. 1 to Feb. 1) last year. In view of the situation, the PPS and PIDSP enjoin all eligible individuals, especially guardians of children less than 5 years of age, to complete measles immunization of those unvaccinated or partially vaccinated. Furthermore, healthcare providers were encouraged to collaborate with local public officials and the Department of Health to sustain vaccination efforts and report any suspected case. Measles is classified as a notifiable disease and it is mandatory to report it within 24 hours to the local epidemiological surveillance unit, or if there is none, to the local health office.

One young colleague dared to ask if the increasing trend is a reflection of ineffective national campaigns and supplemental immunization activities. This is a difficult question to answer for there are multiple reasons that contribute to the problem. It would be completely unfair to say it is, for it would discount the efforts that have been made by policymakers and the army of people who have selflessly carried out their duties to ensure that every child gets vaccinated.

So why are we constantly missing out? In the last two immunization summits, most of the challenges mentioned were the same as what has been known for years. We have been persistently riddled with logistical problems such as funding, lack of human resources, an unstable supply of vaccines in part by the inability to forecast or due to delays in bidding issues, cold chain concerns, lack of governance, an accurate database where one can go after defaulters, and resistance to digitalization, which can improve monitoring and surveillance activities. According to the most recent partial unofficial report submitted on Dec. 31, 2024 to the FSHIS, the national coverage rate for fully immunized children is at 61 percent. Granting that the private sector may contribute around 10 percent to this number, we are still way beyond what needs to be achieved to prevent outbreaks. While we may have managed to dislodge ourselves from being on the list of the top 20 countries with zero-dose children, we need to work harder. With that less than favorable statistic it was really just a matter of time before we would be seeing cases.

So how can we help? One need not wait for an announcement of an outbreak before we do something concrete. One missed case is one too many. As ordinary citizens, we can contribute by ensuring that our household members and workplace receive timely vaccination for all other vaccine-preventable diseases aside from measles, and as required by Republic Act No. 11332 actively participate in disease surveillance and response.

Aside from measles, what we are currently seeing is a rising number of dengue cases. Dengue, like measles, is a notifiable disease. Reporting goes a long way to document clustering of cases for prompt intervention. In the news lately were unconventional measures being taken for vector control for barangays that were severely affected. While these may have garnered unfavorable remarks and are not evidence-based, at least they succeeded in making people think and move. Their actions might help fuel more decisive measures to help control dengue. Though hospitalization and outpatient package benefits may be of assistance for those who are admitted or seek consultation, prevention is the primary goal. Losing a life has no price tag.

As friendly reminders, keep your hands and your surroundings clean. Put on a mask if needed. If ill, stay away from crowds and pay a visit to your healthcare provider at the soonest possible time. Review your immunization records. Be an agent of correct information.