Measles, Misinformation, and Misguided Caution

Filipino parents have numerous reasons for not wanting to have their children vaccinated. Some believe that vaccines make children sick while others believe vaccines aren’t necessary since they had measles themselves and survived. Like in the US, some parents here believe vaccines cause autism. And further galvanizing a similar idea is the recent Dengvaxia scare, which eroded the public’s trust in vaccines and government vaccination programs.

These beliefs and other factors may have contributed to the rise in measles cases in the Philippines. As of Feb. 16, DOH officially reported 8,443 measles cases with 136 deaths. The first quarter isn’t over, but 2019’s measles cases are more than double the number of the total measles cases in 2017 (2,428).

Clearly, we need to have a better understanding of measles and vaccinations to stop these numbers from rising and the situation from escalating.

A Disease that Preys on the Most Vulnerable

Tigdas or measles is a highly contagious disease caused by a virus that is passed through direct contact and through the air. Its first sign is usually a high fever that starts 10 to 12 days after exposure to the virus. Runny nose, cough, and red and watery eyes as well as small white spots in the cheeks can be observed in the initial stage. Rash then starts in the face and upper neck and spreads to the rest of the body.

Young children, pregnant women, and non-immune people are the most at risk for contracting the measles virus.

Socioeconomic factors contribute to risks as well. Before the sudden spike of measles cases in America and Europe in 2018 to 2019, over 95 percent of measles deaths occur globally in countries with weak health infrastructure and low per capita incomes. Many of those who die are young, malnourished children.

Sadly, undernutrition remains a serious problem in the Philippines, especially in the poorest families. The Food and Nutrition Research Institute’s (FNRI) latest survey revealed the chronic malnutrition rate in children aged 0 to 2 is at 26.2 percent, the highest in 10 years. For children under 5 years old, rates were at 33.5 percent an increase of 30.5 percent from 2013.

Common and Severe Complications

As we’ve learned from recent news, measles is not something we can shrug off like a cut or bungang araw. It can come with complications that can permanently affect a person’s quality of life or lead to death.

Common complications include diarrhea and ear infections, which can lead to permanent hearing loss. Severe complications include pneumonia, which is the common cause of death from measles in young children and encephalitis, a swelling of the brain, which can lead to deafness or intellectual disability in children.

The U.S. Centers for Disease and Control Prevention explains measles can be serious in all age groups, but children younger than 5 years and adults over 20 years old are more likely to suffer from measles complications.

There is no cure for measles.

Prevention through vaccination is the only way. Antiviral treatments for the measles virus do not exist and health workers can only administer treatments for the symptoms and to prevent severe complications.

How Vaccines Work

As the measles virus cannot be stopped or killed the way antibiotics work with bacteria, the best way to fight measles is to prevent it through vaccination.

Vaccination is like a training course for the immune system, as described by Live Science. Through vaccination or the introduction of dead or weakened forms of a virus or bacteria, the body’s immune system learns how to fight the introduced organism. If a protected person contracts the virus or bacteria they were vaccinated against, the body will immediately create the antibodies that will attack the foreign organism before it makes you sick.

Side effects, such as fever, pain or swelling in the injection site, headache, and fatigue can be felt, but most side effects are mild and easily manageable. Alice Tiu* a nurse from DOH’s Nurse Deployment program states “parents are instructed of what may possibly occur and its management before vaccines are introduced to babies” and adds “these discomforts are incomparable to the protection that vaccination will give.”

How Safe are Vaccines?

Pharmaceutical companies test and evaluate vaccines for safety and effectiveness prior to seeking licensing in countries. Once licensed and released in a country, vaccine safety and effectiveness are monitored and every batch of vaccine is tested for potency, purity, and sterility.

There are rare cases where people are allergic to vaccines, but medical personnel who administer vaccines are trained to deal with allergic reactions and can treat the child quickly.

A Social Responsibility

Vaccines may have risks, but their pay off may outweigh those risks. Before the measles vaccines were introduced in 1963, there were major epidemics about every 2-3 years,and measles, which caused some 2.6 million deaths each year.

With vaccines and vaccination programs, you’re not only protecting yourself and your family, you’re also protecting the unprotected. Not everyone can be vaccinated against measles. Newborns, pregnant women, people with allergies, people with immune system problems, and people who are too ill to be vaccinated (like some cancer patients) have no choice but to rely on the immunity of people around them.

When a significant amount of a population is immune to a disease, it creates “herd immunity,” which is a form of immunity giving protection to individuals who have not developed immunity.

Is it Better to Acquire Immunity Naturally?

Some parents believe it’s better to acquire immunity naturally by having the disease itself because unlike with vaccines, natural immunity guarantees you will be immune to the virus in the future. Other parents shrug off measles thinking, “Nagka tigdas ako, nabuhay naman ako.”

Although both are true, no one can predict who will get serious infections leading to hospitalizations, severe complications, and death.

To parents who believe in natural immunity, practicing physician Dr. Oliver James Dulay asks, “Why choose to have the tigdas if you can prevent it without life-threatening consequences?” He explains choosing to be vaccinated “not only increases [your] quality of life, you likewise did your part for other people not getting the disease, especially the most vulnerable members of the community – the very young, the very old, and the pregnant patients.”

For parents who refuse to have their children vaccinated because they had measles themselves and are fine now, Dr. Dulay asks us not to base our decisions on anecdotal evidence or personal experience alone. He explains, “A virus is very dynamic,” and we cannot generalize for certain that what happened to patient X will happen to patient Y.

Don’t Vaccines Cause Autism?

Several studies have been conducted on the link between autism and the measles-mumps-rubella (MMR) vaccine, and none of the studies found a link.

The belief that the MMR vaccine can cause autism became popular when Dr. Andrew Wakefield published a study on the Lancet about 12 children who had autism because of the MMR vaccine.

Despite being a small study, it received a lot of publicity as many children were being diagnosed with autism in the ‘90s. Many researchers tried to find a link but no reputable, relevant study confirmed Wakefield’s findings.

Most of Wakefield’s co-authors retracted their interpretation in the paper. In 2010, the Lancet officially retracted the MMR vaccine paper.

A year later British journalist Brian Deer published on BMJ the report that Wakefield’s study was fraudulent, falsifying data about the children’s conditions.

Wakefield has been banned from practicing medicine in Britain, and the study has repeatedly been proven false yet many people still want to believe that the MMR vaccine causes autism.

What About the Dengvaxia Vaccine?

Like any vaccine or medicine, Dengvaxia has contraindications, but to date, no death can be directly attributable to the vaccine.

Despite the Public Attorney’s (PAO) unsubstantiated claims that there is a pattern seen in the autopsies, none of the deaths are proven to have been caused by the vaccine. A medical doctor from the Philippine Children’s Medical Center even testified before the joint House investigation on the matter stating the PAO submitted a false conclusion and did not support their autopsy findings with data.

UP-PGH’s findings revealed the causes of death of the 14 children believed to have died because of Dengvaxia were either due to dengue or other diseases , and they recommend doing further studies.

Many doctors in the Philippines are also speaking out against the misinformation perpetuated about the vaccine’s safety. Over 700 doctors have signed a petition denouncing the “imprudent language and unsubstantiated conclusions by persons whose qualifications to render any expert opinion on the matter are questionable at best” and asking the Department of Health to not remove Dengvaxia from the market altogether as it provides long term protection to those who already contracted a dengue virus.

Sanofi also maintains its confidence in Dengvaxia despite announcing on November 2017, that the vaccine may have adverse effects on people who have not yet been infected by dengue, based on analysis of six years of clinical data.

Sanofi explains Dengaxia is the result of 20 years of research and development, and that the WHO continues to recommend Dengvaxia in endemic regions with a previous dengue infection. The pharma adds in the 10 years and 15 countries that the vaccine was used, there are no evidence the vaccine directly caused deaths.

Fear vs. An Informed Choice

Making decisions for our family’s health, especially of young children is understandably hard and worrying since many of us find it difficult to understand medical and scientific matters. But the recent measles outbreak, both local and global, highlights how important it is for us to make informed decisions.

Ms. Tiu urges parents to visit local health centers to inquire about programs suited for their family. She adds, “With regards to immunization, there is no answer or cure to fear but knowledge. Read as often as you can. Ask as much as you can. Always have an informed choice.”

On the same note, Dr. Dulay states, “On this issue, we learn our lesson on properly appraising our sources. Sadly, we have lost our capacity for scientific literacy . . . Always check who said it, his or her credentials, and read only [peer reviewed journal] articles that have been published locally or internationally.”

With the rampancy of fake news and leaders politicizing health matters, it is important now more than ever for us to be more vigilant with what we read or hear. Because it is a matter of life and death.