Measles outbreak in the Philippines: epidemiological and clinical characteristics of hospitalized children, 2016-2019

Background Measles outbreaks increased worldwide during 2017-19. The largest outbreak in the World Health Organisation Western Pacific region occurred in the Philippines where first-dose measles-containing vaccine (MCV1) coverage had reduced to 75% in 2018. The aim of this study was to summarise paediatric measles admissions to the national infectious diseases referral hospital in Manila during 2016 to 2019. Methods A retrospective single-centre observational study including 5,562 children aged under five years admitted with measles from January 2016 to December 2019. We summarised sociodemographic and clinical characteristics, vaccine status, reported exposures, and outcomes. Univariable and multivariable logistic regression analyses were undertaken to assess associations between different characteristics of hospitalised children and death. Findings The median age of children hospitalised with measles was 11 months (interquartile range: 7-28). 84.5% of cases were reported not to have received any MCV. The risk of mortality was 3.2%, with 41% of deaths occurring among children aged less than 9 months. No children died who had received two MCV. The following characteristics were significantly associated with mortality in the multivariable analysis: age group, residence outside of the national capital region, not having received any MCV, duration between onset of fever and hospital admission of 7-14 days compared with 0-3 days, not receiving vitamin A supplementation, having pneumonia, and gastroenteritis. Interpretation The Philippines remains at risk of future measles epidemics. Routine immunization needs to be strengthened and earlier timing of MCV1 requires further evaluation to reduce measles incidence and mortality. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

During 2016-2019, 84.5% of children hospitalized with measles in Manila, Philippines had not received any measles vaccine. Factors significantly associated with mortality in the multivariable analysis included age group, residence, lack of vaccination, duration between fever onset and hospital admission, lack of vitamin A supplementation, pneumonia, and gastroenteritis.