Measles Outbreak in a Highly Urbanized City, Davao City, Philippines, 2018

  • Vaccine preventable diseases
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Background:
On December 27, 2017, the Epidemiology Bureau received report of measles cases with two deaths in Davao City. An FETP team was sent to profile cases, determine existence of outbreak, source, and risk factors, and recommend control and preventive measures.

Methods:
We conducted a matched for age and sex 1:1 case-control study. A suspect case is a previously well individual in Davao City with fever and rash and any of the following: cough, coryza, and conjunctivitis from November 2, 2017-January 12, 2018. A confirmed case is a suspect case positive for Measles IgM antibody on enzyme linked immunosorbent assay or viral isolation by Polymerase Chain Reaction. Key informant interview and environmental survey were conducted.

Results:
We identified 223 cases. One hundred eighteen (53%) were males. Age ranged from one month to 40 years (Median=1). Four died (CFR=1.8%). National Immunization Program provides measles vaccination for children aged 9 and 12 months. Of 185 (83%) without measles vaccination, 38% were aged <9 months. 2017 Measles vaccination coverage (MCV) was 78.5% and 63.7% for 1st and 2nd doses, respectively. Vaccination was challenging due to high population mobility, religious beliefs, and misconceptions.
High number of evacuees from recent Mindanao siege seen in one village. Houses are one-room dwellings and clustered. Twenty-eight (70%) of 40 specimens were Measles IgM positive. Risk factor was having a sick household member (OR=13.37, 95%CI=2.89-61.75). Having measles vaccine (OR=0.08, 95%CI=0.02-0.37) was protective.

Conclusion:
There was an outbreak of measles in Davao City from November 2017 to January 2018. Influx of displaced persons in a community with low MCV and continuous household exposure increased risk for disease. Outbreak response immunization was conducted among 6-59 months. We intensified master-listing and defaulter tracing among targeted age groups. We collaborated with schools and private sector to increase awareness of importance of vaccination and immediate, proper case management.

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