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This is an important discussion of a country whose recent setbacks have compromised prospects for early elimination of measles in the Western Pacific Region.
PROGRESS TOWARDS MEASLES ELIMINATION, PHILIPPINES, 1998-2014
Excerpt below; full text is at http://www.who.int/wer/2015/wer9015.pdf?ua=1
Discussion
The nationwide measles resurgence in the Philippines during 2013–2014 reflected insufficient implementation of measles elimination strategies. Persistent low vaccination coverage since 1998 combined with the relatively low level of circulation of measles virus after SIAs resulted in the accumulation of measles-susceptible cohorts of older age children and young adults and a change in the epidemiology of measles in the Philippines. The resurgence highlighted key programme challenges: (i) persistent suboptimal MCV1 coverage,
(ii) low MCV2 coverage since introduction during 2009–2010; (iii) suboptimal SIA coverage with large variation in coverage by region; (iv) recent SIA target age groups too narrow to interrupt measles virus transmission among older children, evidenced by the proportion of
cases occurring outside the SIA target age group, and (v) inadequate outbreak response activities before widespread measles virus transmission started. The failure to achieve high population immunity among the targeted age groups before 2013 contributed to the observed increase in the proportion of measles cases among older children and young adults that indicated a shift in the age of the measles-susceptible population from young children to a wider age group during the nationwide measles resurgence in 2013–2014. This shift will require special strategies for vaccination activities.
In June 2014, the WPR Immunization and Vaccine-Preventable Diseases Technical Advisory Group (TAG) recommended that countries achieve and maintain ≥95% 2-dose MCV coverage through routine services and periodic SIAs, and, in addition, that endemic countries and countries experiencing nation-wide resurgence (1) update national plans and develop subnational plans with focus on high-risk and measles-susceptible groups; (2) enhance surveillance activities, including rapid case detection and outbreak investigation; (3) annually review and identify districts and age groups with suboptimal population immunity; and (4) increase population immunity by taking corrective actions such as periodic selective immunization activities and more frequent subnational or national SIAs.
The TAG also recommended maintaining a national outbreak response plan for implementation of timely and prompt response activities.
Based on these recommendations, the Philippines Department of Health (DOH) proposed the draft NIP Strategic Plan for 2015–2019, with plans to conduct (1) selective immunization activities for children aged 12–35 months in all regions in 2015 and (2) non-selective SIAs for a wide target age group during 2015–2017 in regions with sustained measles virus transmission or identified measles-susceptibility among older children and adults. In October 2014, the DOH issued an administrative order to strengthen local government capacity to identify measles outbreaks, plan outbreak response activities, and provide health workers with guidance on how to respond appropriately to new outbreaks and sustained measles virus transmission.
In August 2015, the government will implement a nationwide public school-based measles-rubella-tetanus-diphtheria vaccination of 7th grade students and establish a school entry immunization check in all public and private schools. Children with incomplete vaccination records at the time of the school entry immunization check will be referred to either the school clinic or the nearest health centre to receive missed vaccinations.