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Philippines measles outbreak is deadliest yet as vaccine scepticism spurs disease comeback

27 Feb, 2019
Owen Dyer, Source: BMJ

Montreal, Canada
Seventy people, most of them children, have died of measles
in the Philippines since the start of 2019,1
the country’s health
ministry has said, as many as were killed by the virus in the
entire World Health Organization European region in all of
2018.2
There were over 18 000 cases of measles in the Philippines in
2018, compared with about 2400 in 2017. Measles vaccination
rates fell from a 2014 high of 88% to 73% in 2017, then
plummeted to about 55% last year.
The sharp drop came in the wake of a political battle over
Sanofi’s dengue vaccine Dengvaxia, which was discontinued
in the Philippines last year over safety concerns despite the
company’s protests, as politicians traded blame.3
Lotta Sylwander, Unicef representative in the Philippines, said
the agency was “deeply concerned” about the outbreak, adding
that about 2.5 million children under five are not vaccinated
against measles. “There has been a notable unwillingness on
the part of parents to vaccinate their children on time,” she said.
The country’s Epidemiology Bureau said that 79% of those
killed by measles this year were not vaccinated.
Measles has now gained a firm foothold in the densely populated
capital Manila, as well as four other regions, and risks spreading
further, said the government, urging parents to take up free
vaccinations.
The Philippines is an exception in WHO’s Western Pacific
region, where vaccination rates have been climbing faster than
elsewhere in the world.
But measles has also been on the rise in regions such as Europe
where overall immunisations are up, because of uneven coverage
that leaves pockets of increased susceptibility. The deadliest
recent outbreak before the Philippines was in Thailand, which
has generally good coverage, but where 22 people died of
measles last year in the predominantly Muslim southern region.
The number of cases worldwide rose 30% from 2016 to 2017,
according to WHO. Globally, first dose vaccine coverage has
stalled at 85% for several years, while second dose coverage is
67%. The coverage needed for herd immunity is 95%. Last
month, WHO named vaccine hesitancy as one of its top 10
threats to global health for 2019.4
Discussing the European data for 2018, WHO epidemiologist
Zsuzsanna Jakab said: “The picture for 2018 makes it clear that
the current pace of progress in raising immunisation rates will
be insufficient to stop measles circulation. While data indicate
exceptionally high immunisation coverage at regional level,
they also reflect a record number affected and killed by the
disease. This means that gaps at local level still offer an open
door to the virus.”
The biggest gap in Europe has been in Ukraine, where the
outbreak of war in 2014 severely disrupted immunisation
programmes. Ukraine leads the world in measles cases, with 53
218 cases in 2018, or 121 per 100 000 people. Some 3142 cases
were registered in Ukraine in the past week. But the average
patient is older than in the Philippines, and there have been
fewer deaths, 16 since 2019 began.
In the US, a measles outbreak in Washington state appears to
have stabilised, with 53 cases found, but new cases continue to
crop up in other states, and there are 101 cases in 10 states
overall. Washington state has a 90% measles immunisation rate
and 90% of those infected were unvaccinated. New York state
also faces a concentrated outbreak, in a non-vaccinated religious
community.
American media this week carried several stories about teenagers
seeking out their own vaccines against the wishes of anti-vaccine
parents, after one 18 year-old’s Reddit post on the subject went
viral.5 6
Ethan Lindenberger, of Norwalk, Ohio, wrote of his parents:
“Because of their beliefs I’ve never been vaccinated for anything,
God knows how I’m still alive.”
He sought out his own vaccinations on turning 18, but told the
Washington Post that his 16 year old brother is being prevented
from getting shots by their mother against his wishes. Of his 2
year old sister, also not vaccinated, he said: “It breaks my heart
that she could get measles and she’d be done.”
The American Academy of Paediatrics has called on Facebook
to do more to remove misleading anti-vaccine information from
its website. Facebook has accepted advertising revenue from
groups like Vax Truther, Anti-Vaxxer, and Vaccines Revealed.
Britain’s Guardian newspaper gained access to closed groups
on Facebook where pre-approved members are fed false
anti-vaccine information, often by people with a clear financial
interest in discrediting vaccines.7
One such group, called Vitamin C and Orthomolecular Medicine
for Optimal Health, tells its 49 000 members it is “not an
anti-vax group” but its administrator wrote in one message:
“Until they become safe and not driven by money I would avoid
all vaccines.”
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BMJ 2019;364:l739 doi: 10.1136/bmj.l739 (Published 14 February 2019) Page 1 of 2
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That administrator, Katie Gironda, also runs another Facebook
group called Vitamin C Against Vaccine Damage. She is listed
on LinkedIn as chief executive of an online business called
Revitalize Wellness, which sells high dose vitamin C. Warnings
about vaccines are interspersed with injunctions to “shop now”
for vitamin C.
The Guardian related a December post to one of the groups
from a mother in Canada, describing herself as a “first time
mom with a 6 month old daughter who is completely vax free.
My daughter is sick, I’m so upset and worried. I have always
felt confident in my decision to not vax but I’m worried about
what she may have contacted [sic].”
A fellow member wrote back: “Baby needs a vitamin C IV.”

This entry was posted on Wednesday, February 27th, 2019 at 10:40 am and is filed under Literature.

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Evans DR, et at. 2019 VACCINE Vol 37(40):6008-6015
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