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Southeast Asia scrambles to contain measles outbreak

Disease strains Philippine health budgets, while measles-free nations face threats

MANILA -- Authorities in Southeast Asia are beefing up measles vaccinations to help curb a resurgence of the disease in the region and prevent further spreading across Asia amid a global outbreak.

The World Health Organization has declared an outbreak in 11 countries around the world, including three in Southeast Asia: the Philippines, Thailand and Myanmar. Globally, measles cases have soared 300% in the first three months of 2019 compared with the same period last year, following consecutive increases in the past two years.

The outbreak has sent governments scrambling to contain the spread of measles, a highly contagious viral disease. Several countries in Asia that had previously eliminated measles are seeing the sometimes deadly disease return, amid complacent attitudes and public skepticism over vaccines. The outbreak also is straining funds earmarked for other health care needs.

Dr. Takeshi Kasai, WHO regional director for Western Pacific, said the outbreak is a stark reminder of how measles could trigger serious complications, such as blindness and pneumonia. At the same time, gains on eradicating measles could be reversed if immunization levels are low.

In the Western Pacific, measles cases rose to 30,388 in 2018, up 250% from 2017, two-thirds of which were in the Philippines. This past February, the country's Department of Health declared an outbreak.

"The current outbreak in the Philippines is a reminder of how swiftly and easily measles can make a comeback in communities where too few people are immunized," Kasai told the Nikkei Asian Review.

The WHO's Western Pacific region covers parts of Southeast Asia, including the Philippines, as well as Japan, China and South Korea, but excludes Thailand and Myanmar, both of which belong to the WHO's Southeast Asia region.

Given the highly contagious nature of measles, countries where measles had previously been eliminated remain at risk. Just last week, officials in Japan said at least two workers at Narita Airport in Tokyo acquired measles from infected travelers.

Across the Pacific Ocean, the U.S. also has seen an increase in the number of measles cases amid a debate pitting parents opposed to vaccinations for their children and health officials encouraging their use.

"In 2018 and 2019, multiple outbreaks have occurred in several countries where measles had previously been eliminated where there is low incidence after importation of measles virus through international travel. This has tested population immunity and outbreak response preparedness," Kasai said.

"Until the virus is completely eliminated from every part of the world, there will continue to be a risk of outbreaks," he said.

Kasai said the outbreak highlights the threat of complications from the disease, especially among children. Most measles-related deaths are caused by complications such as brain swelling, diarrhea and pneumonia. Malnourished children and those with weak immune systems are most vulnerable to complications.

The outbreak also is having an economic impact, although it currently does not appear to be significant.

Nicholas Antonio Mapa, senior economist at ING Bank N.V. Manila, said the outbreak in the Philippines is straining the country's health budget.

"This will undoubtedly take its toll on the government's health care system with previous immunity acquired maybe muted and leading to increased funding for treatment of the sick," Mapa said.

From January to mid-April this year, measles cases in the Philippines soared to 31,056, up 368% from 6,641 in the same period last year, including 415 deaths. That compares with 199 deaths for all of 2018.

While reported cases have declined recently, the Philippine government is reluctant to declare the outbreak over.

"We see now a significant, not substantial, reduction in the number of measles cases. So far, it's under control, but I still don't like to say that the outbreaks are over," Health Secretary Francisco Duque told reporters on April 29 at the sidelines of a vaccination campaign.

At the height of the current outbreak, which began in 2017, public hospitals were stretched thin as they accommodated the surge in patients. San Lazaro Hospital in Manila, a government health facility specializing in infectious and tropical diseases, allotted most of its wards for measles cases. Up to three patients shared a single bed to manage the influx. Other infectious diseases, such as dengue, had to be referred to nearby hospitals.

From as many as 300 new measles cases reported daily, the number is now down markedly, but the hospital remains cautious.

"We can only say this is over if there are no more admissions, and yet there are days when we have seven cases of measles admitted," said Dr. Ferdinand de Guzman, the hospital's spokesperson. "It's still one of the diseases we need to look out for."

In Thailand, a measles outbreak in the country is being treated as a pandemic, particularly in the deep southern provinces, where there are remote areas with a number of poor who suffer from malnutrition, said Dr. Suwanachai Wattanayingcharoenchai, director-general of the Ministry of Public Health's Department of Disease Control.

According to Thai government data, 3,590 people were affected by measles in 2018, with 23 deaths. From Jan. 1 to April 25 this year, there have been 301 cases of measles with four resulting in deaths, authorities said.

Most of those infected by the disease have been preschool children who had not been vaccinated, and many have come from poor and sometimes uneducated families, while others were migrant workers who did not have knowledge of the pandemic.

However, Suwanachai said the disease is under control and the Ministry of Public Health has been raising awareness among and dispersing more vaccines, particularly in remote areas to allow everyone to have proper access to prevention.

"We are trying to cut the number of measles patients to less than one person per one million people within the next year. That equates to around 65 people across the country compared to the country's total population of 65 million people," Suwanachai said.

In Myanmar, several townships in Yangon and other parts of the country saw a surge in measles cases this year, and health workers have increased their efforts to vaccinate children. In 2017 and 2018, nearly 2,500 cases of measles were reported in the country, with roughly 75% of that number children under the age of 15.

Amid gains to eradicate measles globally, Kasai said successes in vaccinations could also prompt complacency among individuals, who become less convinced of their effectiveness. Communication gaps could also threaten parents' confidence in vaccinations for their children.

Public confidence in vaccines in the Philippines was undermined a couple of years ago, when French company Sanofi Pasteur said its dengue vaccine, Dengvaxia, could pose higher risks for people who were not previously afflicted by the mosquito-borne disease.

"Countries need strong systems for recording and responding to any adverse events following immunization, and ensuring parents receive information for informed decision-making," Kasai said. "This will help increase trust, understanding of risks and benefits, and acceptance of new vaccines."

Nikkei staff writer Apornrath Phoonphongphiphat in Bangkok contributed to this article.

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