Startling rise in measles cases


PETALING JAYA: Malaysia saw an increase in measles cases last year to 206 from 128 cases in 2021, says Health director-general Tan Sri Dr Noor Hisham Abdullah.

“Around 84% of measles cases reported were among children younger than seven years old, with most of the cases reported in Negri Sembilan, Selangor, Terengganu, and Kuala Lumpur,” he told The Star.

Melaka had 22 cases in 2022, compared with eight in 2021.

In Sabah, four cases were reported in its east coast district of Tawau on Feb 16, with the cases involving siblings aged 10, eight, two and one.

Measles is one of the 13 diseases covered by the National Immunisation Programme (NIP) meant to protect children from major diseases.

One possible reason for this increase in measles, which is nearly exclusively passed from human to human (the only known natural reservoir of the virus), could be the spill-over effect of the Covid-19 pandemic, which hit Malaysia in a big way in 2020.

Dr Noor Hisham said at the height of the pandemic, particularly when the movement control order was in effect, there was a significant decrease in the number of parents who brought their children in for vaccination under the NIP.

Other than measles, the NIP protects children from diphtheria, haemophilus influenzae type B (Hib), hepatitis B, human papillomavirus (given to girls only), Japanese encephalitis, mumps, pertussis (whooping cough), poliomyelitis (polio), rubella (for girls only), tetanus, tuberculosis (TB), and pneumococcal.

He said the reduction in childhood vaccination could have been caused by the fear of parents in bringing their children to clinics due to Covid-19, even though government immunisation services was never stopped during the pandemic, not even when the MCO was enforced.

“Those children who missed their immunisation schedule are being followed up either through calls or home visits,” he added.

Under the NIP schedule, the measles vaccine, which is given together in a single injection with mumps and rubella (hence known as the MMR shot), targets children aged from nine months (first dose) to 12 months (second dose).

The Health Ministry is now handling the backlog of those who missed their vaccination shots including the MMR.

Dr Noor Hisham said all children in the target group who were previously vaccinated will be given another shot to ensure they have adequate immunity to fight measles.

“This is one of the strategies in an outbreak response, to ensure the transmission can be halted. For those who have not received the dose, this shot will ensure they have protection against measles,” he said, adding that the people are also potentially more exposed to the virus following the resumption of social and economic activities.

He said the accumulation of a susceptible population such as the unvaccinated, along with those who have not been fully vaccinated over the years, was another factor for the increase.

“Although measles vaccination reached 95% each year, 5% (about 20,000 to 25,000) of the eligible children remained unvaccinated every year. Over the years, this number snowballs, and they remain susceptible to measles,” he added.

On whether there is a concern that cases may increase, Dr Noor Hisham said one single sick person can infect 12 to 18 susceptible persons.

“As long as there are still susceptible people in the community, measles can continue to spread.

“Therefore, it is important to keep the susceptible population low enough to prevent measles from spreading. To do this, 95% of the most susceptible population (children) should be vaccinated against measles,” he added.

Dr Noor Hisham also advised parents to ensure that their children have been completely vaccinated against measles.

“Under the NIP, two doses of MMR vaccine are given at nine months and 12 months old. Children who have missed vaccination should get their MMR vaccine without delay.

“Bring the child for treatment and for doctor’s advice if the child is showing any symptoms of measles, and do not bring the child to any social gathering or send them to school,” he added.

The World Health Organisation (WHO) and US Centers for Disease Control and Prevention (CDC) said in a report last November that a record high of nearly 40 million children missed their measles vaccine doses in 2021 because of the Covid-19 pandemic.

On Feb 10, WHO said in a statement that after a “period of very low detection of measles in the WHO European Region in 2021, cases have been increasing since early 2022.”

It added that persistent immunity gaps and missed doses of vaccines due to the pandemic have left many people, among them an increased number of children, susceptible.

“To prevent a resurgence of measles and other serious vaccine-preventable diseases, WHO calls for urgent action in all countries to identify all those, especially children, who have missed vaccine doses, and to devise targeted strategies relevant to local settings to enable them to catch up,” it said.

Following large outbreaks of measles in 2018 and 2019, with nearly 200,000 reported cases, the number of reported cases in the region fell in 2020 to just over 12,000.

For 2021, only 159 cases were reported in 22 countries; however, this increased in 2022, with 904 cases reported to date in 27 countries, WHO added.

Indonesia saw 32 times more measles cases in 2022 than the year prior.

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