SINGAPORE: The number of measles cases in Singapore has hit the highest level since an outbreak in 1997, figures from the Ministry of Health (MOH) on Thursday (Oct 24) showed.

According to the latest weekly infectious diseases bulletin published on Thursday, there were 149 measles cases in Singapore as of Oct 19.



That is more than four times the number of cases for the whole of 2018, when there were 34.

The number of measles cases in Singapore hit 1,413 in 1997, before the Government introduced the two-dose MMR vaccination schedule in 1998. The number of cases fell to just 114 that year.

In July this year, MOH urged Singaporeans to remain vigilant, as measles cases around the world have increased substantially.



The ministry has also alerted general practitioners to be on the look-out for measles cases, particularly in patients who have recently travelled overseas or who have not been vaccinated.





The disease, which is highly contagious among unvaccinated individuals, can been prevented through taking two doses of the MMR (Mumps, Measles, Rubella) vaccine.



A vial of the measles, mumps, and rubella virus (MMR) vaccine. (File photo: Reuters/Lindsey Wasson)

MEASLES CASES IN SINGAPORE

According to the latest Communicable Diseases Surveillance report released by MOH in 2018, the number of reported measles cases has “rapidly declined” since the introduction of compulsory measles vaccination in August 1985.

In 1992 and 1997, there was a spike in the number of reported cases across all age groups. The “catch-up” immunisation initiative was implemented between July 1997 and November 1997, and the two-dose MMR vaccination started in January 1998.

The number of measles cases ranged between 13 and 96 between 2001 and 2010, before an increase in 2011 to 148 cases. Since then the number of cases has fluctuated, with 38 cases in 2012 and 46 cases in 2013, jumping to 142 cases in 2014.

There were 42 measles cases in 2015 and 136 cases in 2016. That dipped to 70 cases for the whole of 2017 and dropped further to 34 cases in 2018.

SINGAPOREANS URGED TO REMAIN VIGILANT

In response to queries, MOH said on Oct 31 that the majority of reported cases in Singapore in 2019 are "local and single sporadic infections" and that there have been no further spread in the community.

No deaths from measles were reported in Singapore this year.

"In recent years, there has been a global increase in measles outbreak because of declining vaccination coverage in many countries," the ministry said.

"This has resulted in a significant increase of non-immune individuals in the community, making it easier for the disease to spread.

"Being a travel hub, Singapore is also exposed to imported cases.

"It is therefore important for Singapore to maintain a high level of vaccination coverage at the population level to reduce the risk of large outbreaks arising from sporadic cases."



Singaporeans should remain vigilant and parents should ensure their children's measles vaccinations are up to date to prevent community outbreaks locally and to maintain high vaccination coverage, MOH said.

The measles vaccination coverage among resident children reached 95 per cent for the first dose at two years old and 93 per cent for the second dose at seven years old.

"Nonetheless MOH is looking into ways to raise the vaccination coverage further. Some of the measures being considered include sending reminders to parents ahead of vaccination due dates," the ministry added.

"We will also look into how we can raise the vaccination rate of children before they enter pre-school and primary school."

GLOBAL OUTBREAK

There have been outbreaks around the world as the virus exploits gaps in vaccination coverage, the World Health Organization (WHO) said this month.

FILE PHOTO: A measles poster is seen at Venice Family Clinic in Los Angeles, California February 5, 2015. REUTERS/Lucy Nicholson/File Photo

The disease, which is one of the world’s most contagious according to the WHO, rose by 300 per cent globally in the first three months of 2019, compared to the same period in 2018. There have been consecutive increases over the last two years.

There is no specific antiviral treatment for measles, but it can be prevented with two doses of vaccine. The vast majority of cases of infection are in unvaccinated or under-vaccinated people.



The disease affects a person’s respiratory system and is spread through direct contact with the saliva or mucus of an infected person.

It can be contracted at any age if a person had not taken an MMR vaccination.

The early symptoms include coughing, a runny nose, red eyes, tearing and a fever. In days, bluish-white spots may appear on the inside of cheeks while there might be a skin rash on joints or the face.

Diarrhoea, vomiting and inflammation of the eyes are also possible symptoms.

Most patients recover completely from measles, but it can also lead to ear infection and pneumonia for older patients.

In rare cases, measles may cause encephalitis - an acute inflammation of the brain - and increase the risk of seizures, epilepsy, mental disability, coma or death.

Children are at high risk of developing complications.

This story has been updated with MOH's response.