BMJ 2019;364:l739 doi: 10.1136/bmj.l739 (Published 14 February 2019) Page 1 of 2 BMJ: first published as 10.1136/bmj.l739 on 14 February 2019. Downloaded from
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Philippines measles outbreak is deadliest yet as vaccine scepticism spurs disease comeback
Owen Dyer
Montreal, Canada
Seventy people, most of them children, have died of measles exceptionally high immunisation coverage at regional level, in the Philippines since the start of 2019,1 the country’s health they also reflect a record number affected and killed by the ministry has said, as many as were killed by the virus in the disease. This means that gaps at local level still offer an open entire World Health Organization European region in all of door to the virus.” 2 2018. The biggest gap in Europe has been in Ukraine, where the There were over 18 000 cases of measles in the Philippines in outbreak of war in 2014 severely disrupted immunisation 2018, compared with about 2400 in 2017. Measles vaccination programmes. Ukraine leads the world in measles cases, with 53 rates fell from a 2014 high of 88% to 73% in 2017, then 218 cases in 2018, or 121 per 100 000 people. Some 3142 cases plummeted to about 55% last year. were registered in Ukraine in the past week. But the average The sharp drop came in the wake of a political battle over patient is older than in the Philippines, and there have been http://www.bmj.com/ Sanofi’s dengue vaccine Dengvaxia, which was discontinued fewer deaths, 16 since 2019 began. in the Philippines last year over safety concerns despite the In the US, a measles outbreak in Washington state appears to company’s protests, as politicians traded blame.3 have stabilised, with 53 cases found, but new cases continue to Lotta Sylwander, Unicef representative in the Philippines, said crop up in other states, and there are 101 cases in 10 states the agency was “deeply concerned” about the outbreak, adding overall. Washington state has a 90% measles immunisation rate that about 2.5 million children under five are not vaccinated and 90% of those infected were unvaccinated. New York state against measles. “There has been a notable unwillingness on also faces a concentrated outbreak, in a non-vaccinated religious on 5 March 2019 by Giuseppe Giocoli. Protected copyright. the part of parents to vaccinate their children on time,” she said. community. The country’s Epidemiology Bureau said that 79% of those American media this week carried several stories about teenagers killed by measles this year were not vaccinated. seeking out their own vaccines against the wishes of anti-vaccine parents, after one 18 year-old’s Reddit post on the subject went Measles has now gained a firm foothold in the densely populated viral.5 6 capital Manila, as well as four other regions, and risks spreading further, said the government, urging parents to take up free Ethan Lindenberger, of Norwalk, Ohio, wrote of his parents: vaccinations. “Because of their beliefs I’ve never been vaccinated for anything, God knows how I’m still alive.” The Philippines is an exception in WHO’s Western Pacific region, where vaccination rates have been climbing faster than He sought out his own vaccinations on turning 18, but told the elsewhere in the world. Washington Post that his 16 year old brother is being prevented from getting shots by their mother against his wishes. Of his 2 But measles has also been on the rise in regions such as Europe year old sister, also not vaccinated, he said: “It breaks my heart where overall immunisations are up, because of uneven coverage that she could get measles and she’d be done.” that leaves pockets of increased susceptibility. The deadliest recent outbreak before the Philippines was in Thailand, which The American Academy of Paediatrics has called on Facebook has generally good coverage, but where 22 people died of to do more to remove misleading anti-vaccine information from measles last year in the predominantly Muslim southern region. its website. Facebook has accepted advertising revenue from groups like Vax Truther, Anti-Vaxxer, and Vaccines Revealed. The number of cases worldwide rose 30% from 2016 to 2017, according to WHO. Globally, first dose vaccine coverage has Britain’s Guardian newspaper gained access to closed groups stalled at 85% for several years, while second dose coverage is on Facebook where pre-approved members are fed false 67%. The coverage needed for herd immunity is 95%. Last anti-vaccine information, often by people with a clear financial 7 month, WHO named vaccine hesitancy as one of its top 10 interest in discrediting vaccines. threats to global health for 2019.4 One such group, called Vitamin C and Orthomolecular Medicine Discussing the European data for 2018, WHO epidemiologist for Optimal Health, tells its 49 000 members it is “not an Zsuzsanna Jakab said: “The picture for 2018 makes it clear that anti-vax group” but its administrator wrote in one message: the current pace of progress in raising immunisation rates will “Until they become safe and not driven by money I would avoid be insufficient to stop measles circulation. While data indicate all vaccines.”
For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2019;364:l739 doi: 10.1136/bmj.l739 (Published 14 February 2019) Page 2 of 2
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2 Thornton J. Measles cases in Europe tripled from 2017 to 2018. BMJ 2019;364:l634. That administrator, Katie Gironda, also runs another Facebook BMJ: first published as 10.1136/bmj.l739 on 14 February 2019. Downloaded from 10.1136/bmj.l634 30733215 group called Vitamin C Against Vaccine Damage. She is listed 3 Dyer O. Philippines halts dengue immunisation campaign owing to safety risk. BMJ on LinkedIn as chief executive of an online business called 2017;359:j5759. 4 World Health Organization. Ten threats to global health in 2019. www.who.int/emergencies/ Revitalize Wellness, which sells high dose vitamin C. Warnings ten-threats-to-global-health-in-2019. about vaccines are interspersed with injunctions to “shop now” 5 Charles S, Radnofsky C. Amid measles outbreak, some unvaccinated teens are seeking ways to get their shots. NBC News, 11 February 2019. www.nbcnews.com/storyline/ for vitamin C. measles-outbreak/teens-defying-their-parents-get-vaccinated-amid-measles-outbreak- The Guardian related a December post to one of the groups n970341. 6 Horton A. Unvaccinated teens are fact-checking their parents—and trying to get shots on from a mother in Canada, describing herself as a “first time their own. Washington Post, 11 February 2019. www.washingtonpost.com/health/2019/ mom with a 6 month old daughter who is completely vax free. 02/10/unvaccinated-teens-are-fact-checking-their-parents-trying-get-shots-their-own/? utm_term=.c7ffab9fa5ad. My daughter is sick, I’m so upset and worried. I have always 7 Pilkington E, Glenza J. Facebook under pressure to halt rise of anti-vaccination groups. felt confident in my decision to not vax but I’m worried about Guardian. 12 February 2019. www.theguardian.com/technology/2019/feb/12/facebook- what she may have contacted [sic].” anti-vaxxer-vaccination-groups-pressure-misinformation. Published by the BMJ Publishing Group Limited. For permission to use (where not already A fellow member wrote back: “Baby needs a vitamin C IV.” granted under a licence) please go to http://group.bmj.com/group/rights-licensing/ permissions 1 Department of Health. Philippines. DOH identifies vaccine hesitancy as one of the reasons for measles outbreak. 11 February 2019. www.doh.gov.ph/node/16721. http://www.bmj.com/ on 5 March 2019 by Giuseppe Giocoli. Protected copyright.
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