Measles-Handbook-Final 231208 142435

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CONTRIBUTORS
Feby Kyle G. Sanchez, RMT, ASCPi, PhD
Director, Biopath Clinical Diagnostics; Professor, Silliman University
Precious Jewel T. Cinco, RMT, MD, PhD (Ob-Gyn)

Head Regional Epidemiologist, DOH Region VII
Maria Isabel E. Golviogo, RMT, ASCPi

Chief Medical Technologist, Vicente Sotto Memorial Center
Karisa Gail R. Calamba, MD, PhD

Clinical Professor, Cebu Doctors University College of Medicine; Director, Hi-Precision Diagnostics
Jeronne Clare S. Sabornido, RMT, MD

Medical Officer IV, Head of Communicable Diseases Section, DOH Region VII
Russ Philip H. Cimafranca, RMT, MD

Senior Statistician, DOH REGION VII ; Assistant head of histology department, Velez College
Kent Daniel S. Impok, RMT, ASCPi, MD (Nephrology)

Assistant Head Provincial Epidemiologist, Cebu, DOH Region VII
Genesis B. Kiok, RMT, RN, PTRP, MOT

Head of Histology Department; Velez College
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COPYRIGHT
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TABLE OF CONTENTS
I. Basic Information About Standard Measles.......................................................................... 7
A. Cause and Risk Factors...................................................................................................... 7
B. Transmissions of Measles................................................................................................... 7
C. Sign and Symptoms............................................................................................................ 8
D. Prognosis of Measles..........................................................................................................8
E. Complications associated with Measles..............................................................................9
II. Basic Information About German Measles..........................................................................11
A. Cause and Risk Factors.................................................................................................... 11
B. Transmissions of German Measles................................................................................... 11
C. Sign and Symptoms.......................................................................................................... 11
D. Prognosis of German Measles.........................................................................................12
E. Complications associated with German Measles.............................................................12
III. Steps in Outbreak Investigation..........................................................................................13
A. Prepare for Field Work...................................................................................................... 13
B. Establish the Existence of an Outbreak............................................................................ 13
C. Verify the Diagnosis.......................................................................................................... 21
D. Construct a Working Case Definition................................................................................ 22
E. Find cases systematically and record information.............................................................23
F. Perform Descriptive Epidemiology.....................................................................................24
G. Develop Hypothesis.......................................................................................................... 31
H. Evaluate Hypotheses Epidemiologically........................................................................... 32
I. Ask necessary, reconsider, refine, and re-evaluate hypotheses.........................................39
J. Compare and reconcile with Laboratory and/or environmental studies............................. 40
K. Implement control and prevention measures.................................................................... 41
L. Initiate or Maintain Surveillance.........................................................................................43
M. Communicate Findings..................................................................................................... 44
IV. Conclusion............................................................................................................................ 47
A. Time Component Summary...............................................................................................48
B. Place Component..............................................................................................................48
C. Person Component........................................................................................................... 48
D. Two-Way ANOVA............................................................................................................. 49
E. Case Is Not An Outbreak.................................................................................................. 49
V. Health Promotion and Disease Prevention......................................................................... 51
A. Management..................................................................................................................... 51
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B. Prevention......................................................................................................................... 52
C. Post exposure prevention................................................................................................. 53
D. Treatment.......................................................................................................................... 54
APPENDIX.................................................................................................................................. 54
REFERENCES............................................................................................................................ 69
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I. Basic Information About Standard Measles
A. Cause and Risk Factors

Measles is the result of a single-stranded, enveloped RNA virus with 1 serotype. Its causative
agent falls within the Morbillivirus genus of the Paramyxoviridae. This virus predominantly
replicates in the nose and throat. Notably, the virus can remain airborne on surfaces for up to 2
hours following the departure of an individual exhibiting measles symptoms. This increased
airborne persistence emphasizes the contagious nature of the virus and underscores the
importance of preventive measures for limiting its spread. In understanding the dynamics of
measles, it is crucial to dive into the associated risk factors that contribute to their onset and
progression.
● Risk Factors:
○ Young, unvaccinated child - considered to be the most significant risk factor for
contracting the measles virus and experiencing complications. If the individual is
exposed to the measles without vaccination the likelihood of contracting the virus
is 90% regardless of age.
○ Infants unvaccinated for medical reasons
○ Incomplete vaccination
○ Fully vaccinated but not developing immunity
○ Immunocompromised
○ Vitamin A deficiency
B. Transmissions of Measles
● Direct contact with infectious droplets or by airborne spread
○ It infects the respiratory tract and then spreads throughout the body.
○ As a highly contagious virus that lives in the nose and throat mucus of an
infected person, it can spread to others through coughing and sneezing.
○ If other people breathe the contaminated air or touch the infected surface, then
touch their eyes, noses, or mouths, they can become infected.
○ Animals do not get or spread measles.
● The virus can live for up to two hours in an airspace.

○ Measles is so contagious that if one person has it, up to 90% of the people close
to that person who are not immune will also become infected; or up to 9 out of 10
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susceptible persons with close contact to a measles patient will develop
measles.
○ Measles can be transmitted by infected individuals from four days prior to the rash's
onset through four days after it appears.
○ Measles virus can live for up to two hours in an airspace after an infected person
leaves an area.
C. Sign and Symptoms

● Measles is a rapid onset viral respiratory illness characterized by an initial stage of:
a. High fever
b. Malaise
c. Three “C”
■ Cough
■ Coryza (inflammation of mucous membrane in the nose)
■ Conjunctivitis “pink eye”
● Following the initial phase, characterized by Koplik spots, individuals develop a

maculopapular rash. This rash typically manifests approximately 14 days post-exposure,
starting from the head and extending to the trunk and lower extremities. Contagiousness
begins four days prior to the rash's emergence and persists for four days after its
appearance.
NOTE: Immunocompromised individuals may not exhibit the characteristic rash.
D. Prognosis of Measles
● Prognosis in healthy individuals
○ In healthy individuals, the prognosis for measles is usually good.
○ Most people recover completely within two to three weeks.
○ However, some people may experience mild complications:
■ Ear infection
■ Pneumonia
■ Bronchitis
NOTE: These complications are typically treatable with antibiotics or other medications.
● Prognosis in high-risk individuals

○ People at high risk of complications from measles include:
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■ Infants under 12 months of age
■ Pregnant women
■ People with weakened immune systems, such as those with HIV/AIDS or
those who are taking immunosuppressive drugs
○ In these high-risk individuals, measles can be more serious and may lead to
complications such as:
■ Pneumonia: This is the most common cause of death from measles. It
can be caused by the measles virus itself or by a secondary bacterial
infection.
■ Encephalitis: This is an inflammation of the brain that can cause seizures,
deafness, and permanent brain damage.
■ Subacute sclerosing panencephalitis (SSPE): This is a rare but fatal
neurological disorder that can occur years after a measles infection.
E. Complications associated with Measles

● Most deaths from measles are from complications related to the disease.
○ Complications can include:
■ Encephalitis: An infection causing brain swelling and potentially brain
damage in which about 1 child out of every 1,000 who get measles will
develop this that can lead to convulsions and can leave the child deaf or
with intellectual disability.
■ Severe diarrhea and related dehydration: Reported in less than one out
of 10 people with measles.
■ Ear infections: Occur in about one out of every 10 children with measles.
■ Severe breathing problems including pneumonia: In as many as 1 out
of every 20 children with measles, the most common cause of death from
measles in young children.
■ Death: In which nearly 1 to 3 of every 1,000 children who become
infected with measles will die from respiratory and neurologic
complications.
■ Blindness: If a woman catches measles during pregnancy, this can be
dangerous for the mother and increases the risk of complications
during pregnancy such as miscarriage, premature labor, low birth weight
infants.
● Extremely rarely, in about one in every 100,000 people who have had measles,
subacute sclerosing panencephalitis (SSPE) can occur. This is an extremely rare
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progressive inflammation of the brain that causes brain degeneration and is always fatal;
It usually begins about 7 years after the measles infection.
● Complications are most common in children under 5 years and adults over age 30.
The risk is heightened among malnourished children, particularly those deficient in
vitamin A or afflicted with conditions such as HIV, which compromise the immune
system. Moreover, measles not only weakens the immune system but also disrupts its
ability to retain resistance against infections, rendering children significantly more
susceptible to various illnesses.
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II. Basic Information About German Measles
A. Cause and Risk Factors

German Measles is also known as “Three Day Measles” or most of the time “Rubella”. Rubella
is a latin word that means “little red”. It was initially considered to be a variation of measles
however, gained its own distinct disease. It was first documented in a German medical
literature.
B. Transmissions of German Measles

● Rubella is transmitted primarily through direct or droplet contact from nasopharyngeal
secretions.
● Humans are the only natural hosts. In temperate climates, infections usually occur
during late winter and early spring.
● The average incubation period of rubella virus is 17 days, with a range of 12 to 23 days.
○ People infected with rubella are most contagious when the rash is erupting, but
they can be contagious from 7 days before to 7 days after the rash appears.
C. Sign and Symptoms

● In children, rubella is usually mild, with few noticeable symptoms.
○ For children who do have symptoms, a red rash is typically the first sign.
○ The rash generally first appears on the face, then spreads to the rest of the body
and lasts about three days.
○ Other symptoms that may occur 1 to 5 days before the rash appears include:
■ low-grade fever
■ headache
■ mild pink eye (redness or swelling of the white of the eye)
■ general discomfort
■ swollen and enlarged lymph nodes
■ cough
■ runny nose
● Most adults who get rubella usually have:
■ mild illness
■ low-grade fever
■ sore throat
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■ rash that starts on the face and spreads to the rest of the body
● Some adults may also have:
■ headache
■ pink eye
■ general discomfort before the rash appears
● About 25 to 50% of people infected with rubella will not experience any symptoms.
D. Prognosis of German Measles

● Rubella usually causes mild illness and goes away on its own.
○ Since it can be contagious for up to two weeks, you should avoid being around
other people as much as possible while you have symptoms and for a week after
your rash appears.
● Complications are rare, but the greatest concern arises when pregnant women contract
rubella, as it can lead to serious birth defects in the developing fetus.
● If you suspect rubella or have health concerns, it's important to consult with a healthcare
professional.
E. Complications associated with German Measles

● German measles “rubella” can lead to complications such as arthritis, more prevalent in
women with up to a 70% occurrence.
● In rare cases, serious issues may arise, including brain infections and bleeding problems.
● If an unvaccinated pregnant woman gets infected with rubella virus she can have a
miscarriage or her baby can die just after birth.
○ Also, she can pass the virus to her developing baby who can develop serious
birth defects such as:
■ heart problems
■ loss of hearing and eyesight
■ intellectual disability
■ liver or spleen damage
○ Serious birth defects are more common if a woman is infected early in her
pregnancy, especially in the first trimester. These severe birth defects are known
as congenital rubella syndrome (CRS).
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III. Steps in Outbreak Investigation
A. Prepare for Field Work

Public health officials conduct field investigations after confirming an increase in cases and
verifying the diagnosis. Detection of a rise in disease cases often precedes the decision to
initiate a field investigation, with thorough preparation being crucial regardless of timing.
Preparation falls into two main categories:
I. Scientific and Investigative Issues

● Acquire scientific knowledge, tools, and equipment before heading to the field.
● Coordinate with lab personnel for proper materials, collection, storage and
transportation methods.
● Ensure appropriate safety measures, such as wearing PPEs for contagious
diseases like measles.
● Formulate a clear plan with defined objectives and a step-by-step approach
before departing.
II. Management and Operational Issues

● Select team members with designated roles and responsibilities.
● Harmonize perspectives, methodologies, and priorities among agencies involved
in the investigation.
● Establish a communication plan, including conference call frequency,
spokesperson, and responsible individuals for alerts and releases.
● Attend operational and logistical details, such as packing essentials and
pre-planning meetings with local officials if arriving from outside the area.
● Address personal affairs beforehand for prolonged investigations.
B. Establish the Existence of an Outbreak
An outbreak or epidemic involves a higher-than-anticipated number of disease cases in a

defined area or group during a specific time frame. In contrast, a cluster refers to cases
gathering in an area over time, regardless of exceeding expected numbers. Field investigators
initially verify whether a group of cases constitutes an actual outbreak. Clusters can be genuine
outbreaks from a common source, isolated cases of the same illness, or unrelated cases of
similar yet different diseases. In epidemiology, comparisons are made between observed and
anticipated occurrences, often based on previous data. Responses can also address small or
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individual cases based on factors like severity, transmission potential, control measures,
political considerations, public relations and resource availability.
DOH REGION VII ACTION
Upon receiving surveillance records, the research and investigation team identified the following:
● Where the cluster of measles and german measles (rubella) cases is.
● Number of cases of measles and german measles (rubella) according to the provinces of
Region VII.
● Prevalence of measles and german measles (rubella) according to city or municipality.
● Significance of the occurrence of measles across different municipalities in Region VII.
DATA SET CLUSTER
The Research and Investigation team was able to acquire the information of all 79 reported
cases of measles and german measles in Region VII. Of the 79 cases within a 12 month
surveillance period, 46.8% of the cases of both diseases (measles and german measles/rubella)
originate from the Province of Bohol. This was then followed with 27.8% cases in Cebu Province,
24.1% in Negros Oriental, and 1.3% with unknown or unidentifiable location.
Figure 1. Number of Cases of German Measles and Measles according to the Provinces of Region 7
To be able to identify the cause of the rise in cases, the researchers further determined the total
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number of cases per municipality in Bohol, Cebu, and Negros Oriental. Of the 79 cases,
Alburquerque, Bohol had the highest number of cases, 7 german measles/rubella and 14
measles cases. In the Province of Cebu, Cebu City had the highest number of cases, 8 cases of
german measles and 12 cases of measles. In Negros Oriental, Santa Calina had the highest
number of measles cases while Dumaguete City and Guihulingan had 2 german measle cases.
For the unknown, only 1 german measles case was identified and no cases of measles were
traced.
Province City/Municipality German Measles Measles

Alburquerque 7 14
Corella 0 2
Guindulman 1 0
Bohol Loay 1 1
Sikatuna 2 4
Talibon 2 0
Tubigon 2 0
Valencia 0 1
Cebu City 8 12
Cebu
Lapu-Lapu City 1 1
Dumaguete City 2 4
Negros Oriental Guihulngan 2 2
Santa Catalina 1 8
Unknown Unknown 1 0
Table 1. Prevalence of German Measles and Measles according to CIty/Municipality
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Figure 2. Prevalence of German Measles and Measles according to CIty/Municipality
As indicated by the data, the concentration of the disease is observed to be higher in Cities with
denser populations and well-developed tourism sectors. Cebu City, characterized by its notably
high population density of 3,202 per square kilometer by World Population Review (2022), is
highlighted as having a significant number of cases, indicating a correlation between high
population density and increased infection rates. Based on the analysis of the place component
of the disease in Region 7, it can be observed that in the year 2022, Cebu City was the first
recorded city to have a case of German Measles.
FIgure 3. German Measles and Measles Cases in Cebu City
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Over subsequent weeks, the incidence of both diseases gradually increased within the city.
Notably, despite this increase, the cases appeared sporadic and widely distributed, resulting in a
total of only 20 cases reported by the year's end, contributing to 25.32% of the total cases in all
Cities and Municipalities within Region 7. This observation suggests that while the number of
cases rose over time, the occurrences were not clustered or closely linked, indicating a
potentially scattered pattern of transmission within the city.
Figure 4. German Measles and Measles Cases in Albuquerque, Bohol
In addition, it can be observed that within the same year, Alburuquerque had the highest total
number of cases amounting to 20 cases, which is equivalent to 26.58% of the total cases in all
Cities and Municipalities within Region 7. In contrast, Alburuquerque in Bohol boasts a much
lower population density of 420 per square kilometer. Surprisingly, despite its lower density,
Alburuquerque experiences a considerable number of cases. Despite Alburuquerque having a
lower population density, its total case count equaling that of Cebu City suggests a higher rate of
transmission within Albuquerque. This is noteworthy because the lower population density might
typically imply a reduced risk of widespread infection compared to a densely populated city like
Cebu. Hence, the higher incidence in Albuquerque might indicate localized clusters or specific
factors contributing to the disease's spread within that municipality, such as its close proximity
to Tagbilaran City, which has a high population density of 2,900 per square kilometer and is
merely 18.1 kilometers or 29 minutes away.
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The significant number of cases in Albuquerque can be attributed to the movement of people
from Tagbilaran City (and potentially other cities) into Albuquerque. The influx of tourists visiting
attractions such as the Tarsier Sanctuaries and churches in Albuquerque could contribute to the
spread of these diseases.
Figure 5. German Measles and Measles Cases in Santa Catalina, Negros Oriental
The same can be said for Santa Catalina, a 1st Class Municipality of Negros Oriental having a
population density of 148 per kilometer squared (PhilAtlas, 2020). As observed in the Graph, it
has a high number of Measles cases compared to other Cities and Municipalities despite its
small population density. Like Alburuqueque, Santa Catalina is popular as a tourist destination in
Negros Oriental due to their attractions, such as their beaches, the Pakol Festival, and their
Monkey Sanctuary.
Significance of the occurrence of measles across different municipalities in Region VII
Since measles and german measles (rubella) is a notifiable disease in the Philippines, the
expected number of cases is based on the surveillance record. Hence, to identify whether an
outbreak is happening, the Research and Investigation Team used a Two-Way ANOVA to
compare the occurrence of measles and German measles with regards to the interaction
between the different municipalities and morbidity weeks in Region VII.
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GERMAN MEASLES: TWO-WAY ANOVA
H0 : There is no significant interaction between Municipalities and Morbidity Week on the number
of German Measles Cases
HA : There is a significant interaction between Municipalities and Morbidity Week on the number
of German Measles Cases
Significance Level: 0.05
P-Value: 0.240
From the findings on the conducted Two-Way ANOVA Without Replication, based on a p-value
of 0.240, we accept the null hypothesis there is no significant interaction between municipalities
and morbidity week on the number of german measles cases within region 7. It is important to
note that 2 pending German Measles IgM cases were not included in the calculation.
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MEASLES: TWO-WAY ANOVA
H0 : There is no significant interaction between Municipalities and Morbidity Week on the number
of Measles Cases
HA : There is a significant interaction between Municipalities and Morbidity Week on the number
of Measles Cases
Significance Level: 0.05
P-Value: 0.666
From the findings on the conducted Two-Way ANOVA Without Replication, based on a p-value
of 0.666, we fail to reject the null hypothesis that there is no significant interaction between
municipalities and morbidity week on the number of german measles cases within region 7. This
suggests that there isn't enough evidence to support the claim that the occurrence of measles
varies significantly across these municipalities with their respective time span of disease
occurrence in Region 7.
The results obtained from the Two-Way ANOVA Without Replication, considering the p-values of
0.240 for German measles and 0.666 for measles across various municipalities within Region 7,
present crucial insights into the epidemiological landscape of this area. The failure to reject the
null hypothesis in both cases, indicating no significant difference in the occurrence of these
diseases between the interaction of the morbidity week and municipalities, holds key
implications.
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Firstly, the absence of a significant variance in the occurrence of measles and German measles
implies a homogeneity in the prevalence of these diseases across Bohol Province, Cebu
Province, and Negros Oriental within Region 7. This uniformity is indicative of a relatively
consistent pattern in disease prevalence, suggesting that these areas are not experiencing a
notable outbreak of either measles or German measles. Additionally, the socio-demographic and
environmental factors prevalent in Region 7 could also contribute to the lack of an outbreak.
Factors like population density, healthcare accessibility, sanitation standards, and general health
practices might collectively contribute to a stable disease prevalence rate across municipalities.
Based on the information identified, The Research and Investigation Team has determined that
there's currently no outbreak of measles or German measles in the region. Nevertheless, the
investigation will persist to pinpoint the cause of the clustered cases and to enforce preventive
measures effectively.
C. Verify the Diagnosis
Verifying the diagnosis is integral to confirming an outbreak’s existence for two key reasons:
● Ensuring accurate disease identification for tailored control measures

● Excluding the possibility of laboratory errors causing the reported cases surge
Acquiring medical records and lab reports, carefully examining clinical findings and test
outcomes, conducting additional tests if necessary, and compiling clinical features through
frequency distributions are essential steps. These distributions, often presented in the initial
table of an investigation’s report, play a pivotal role in substantiating the accuracy of the
diagnosis.
The Research and Investigation Team collaborated with the Disease Reporting Units' (DRUs)
laboratorians to validate the identified cases as either measles or German measles/rubella.
In addition to reviewing patient medical histories and records, the laboratorians conducted
specific diagnostic tests to conclusively confirm the presence of either measles or German
measles in these cases.
● Serological Tests
● PCR Test
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Upon reviewing data from the DRUs, researchers cross-referenced laboratory results with
corresponding clinical presentations and patient histories. This comprehensive analysis
allowed researchers to formulate initial hypotheses regarding the acquisition of measles or
German measles based on shared symptoms and medical backgrounds among the
affected individuals.
D. Construct a Working Case Definition

A case definition provides standardized guidelines for identifying individuals with a specific
health condition, incorporating clinical criteria and constraints on time, location, and individuals
involved. Consistent application of these criteria is crucial in investigations.
In outbreaks, defining time and place parameters is essential for a comprehensive outbreak
case definition. A detailed definition aids in precisely identifying individuals meeting specified
criteria within the outbreak context.
● Clinical Criteria
○ Should be simple and based on objective measures
○ Examples: fever ; 40 C; hypertension ≥ 140 mmHg/90mmHg
● Restrictions by Time, Place, and Person
● Restriction by Time
○ to persons with onset respiratory symptoms and fever within the past three (3)
weeks (Influenza)
○ to persons with onset of characteristic measles rash and fever within the past
twenty-one (21) days (Measles)
● Restriction by Place
○ to individuals with specific respiratory infection limited to residents of a particular
neighborhood or community
○ to individuals with certain infectious disease limited to students and staff of a
particular school
● Restriction by Person
○ to females, aged 17-30 years-old
○ to pregnant women
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E. Find cases systematically and record information
Outbreaks reported by healthcare providers or citizens often represent only a fraction of total
cases. To accurately identify affected populations, public health workers seek additional cases,
focusing on healthcare facilities through stimulated or enhanced passive surveillance.
Alternately, active surveillance involves proactive contact through call or on-site visits. These
efforts are critical to comprehensive understanding of the outbreak and for timely intervention.
Public health officials may use media channels to inform the public, facilitating swift
communication.
In confined populations with possible undetected mild or asymptomatic cases, a

comprehensive survey may be conducted to determine the full extent of infection. Alternatively,
laboratory specimens can directly assess asymptomatic cases, guiding interventions.
Investigating case-patients for knowledge of others with similar conditions helps uncover
clusters, identify exposures, and understand outbreak dynamics. Customized data collection
forms tailored to the outbreak specifics are crucial, encompassing essential information for
each case:
● Identifying Information- name, address, telephone

● Demographic Information-age sex occupation
● Clinical Information- signs and symptoms, date onset for charting the time and
supplementary details
● Risk factor Information- risk factors
● Reporter information- source of the report
The information described above is gathered using a standard case report form,
questionnaire, or data abstraction form. Subsequently, investigators summarize selected
critical items from these sources onto a form known as “line listing”.
Line listing is a condensed summary that compiles key information from individual cases in a
tabular format. It typically includes a row for each case and columns for relevant details or
variables (e.g., name or identification number, age, sex, case classification, etc.). The line
listing serves as a concise and organized tool that facilitates quick analysis and identification
of patterns within the outbreak. It allows investigators to observe trends, identify
commonalities among cases, and make comparisons. This structured approach streamlines
the data analysis process and enhances the investigators’ ability to draw meaningful
conclusions from the gathered information.
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F. Perform Descriptive Epidemiology
The next conceptual step in investigating an outbreak involves systematically describing key
characteristics of the affected individuals. This process, known as “descriptive epidemiology”,
aims to characterize the outbreak in terms of time, place, and person. It may be repeated
multiple times during the investigation as additional cases are identified or as new information
becomes available. With Descriptive Epidemiology, investigators are provided with a snapshot of
the outbreak’s patterns which then aids in identifying trends or commonalities among cases,
allowing investigators to refine their understanding of the outbreak dynamics and guide
subsequent phases of the investigation.
Descriptive epidemiology plays a foundational role in outbreak investigations by providing a

detailed characterization of the affected populations and circumstances. This information is
instrumental in formulating hypotheses, guiding interventions, and maintaining the quality of the
data throughout the investigation.
A. Time:
Epidemic curves, a specialized form of histogram, traditionally depict an outbreak's time

course. This visual tool provides a clear representation of the outbreak's size and
progression over time, serving as a fundamental asset in outbreak investigations due to
its informative nature. Key roles of epidemic curves include:
● Epidemic curves offer a clear visual representation of an outbreak's size and

progression over time.
● They distinguish between epidemic and endemic diseases by highlighting
unusual patterns.
● These curves identify correlated events, helping link cases to potential sources or
events.
● The curve's shape reveals how the disease spreads (e.g., point source,
intermittent source).
● It shows the current epidemic status and aids in predicting its future course.
● Epidemic curves assess intervention effectiveness and timing.
● Outliers on the curve can reveal unique aspects or atypical cases of the outbreak.
● They help deduce probable exposure times, guiding further investigation with
focused questionnaires.
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Figure 6. Weekly Cases of German Measles and Measles
Points: Peak of measles is in week 17, in april
In the chart shown above, the first case of German measles occurred in week 4 (January
2022) and the 1st case of measles was recorded the next week (February 2022). It can
be seen that measles spiked at its peak in the month of April with 8 cases especially in
week 17, having a decline the next month and spiking again in the month of June, then
August, then going up to 7 cases in the month of October.
The observation notes a pattern where the occurrence of new cases of both diseases
follows a sequential order. This means that a newer case emerges after the previous
case has been resolved or ended. In other words, there's a temporal sequence where
cases are not overlapping; instead, they appear successively one after the other. This
suggests a linear spread rather than a simultaneous occurrence of cases. In addition to
this, according to the CDC, the average incubation for Measles and Rubella is about
10-12 days and 12-23 days respectively, which conforms to the data provided as cases
only occur in a 1-3 week interval, which may yield a varying number of cases in that
specific week or time frame.
Another crucial observation is that these cases are not concentrated in the same
geographical area or place. This aspect is significant because if the occurrences were
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clustered or localized in one area, it might suggest a more concentrated source of
infection or a higher risk of an outbreak in that specific location. However, the fact that
cases are emerging in different places implies a dispersed or sporadic occurrence rather
than a localized outbreak. This concept will be further discussed in the Place
Component of the Analysis.
The combination of the sequential nature of case appearance (where newer cases follow
older ones) and their occurrence in different locations suggests a lower probability of an
outbreak. Unlike an outbreak characterized by a sudden surge of cases in a specific area
or population, the observed pattern indicates a more scattered and non-concentrated
spread. In addition, both ANOVA tests, measles and german measles respectively,
resulted in a p-value of greater than 0.05, signifying that there is no significant statistical
difference in the occurrence of measles among the municipalities in Region 7 within 52
weeks.
Therefore, based on these observations, it can be inferred that the cases of these
diseases are spreading sequentially, with new cases emerging after the resolution of
previous cases. Furthermore, the fact that these occurrences are dispersed across
different locations indicates a reduced likelihood of an immediate or widespread
outbreak.
B. Place
Assessing an outbreak through geographical analysis not only exposes the problem's
spread but also uncovers clusters or patterns that hold key clues about its cause.
Utilizing spot maps—visual representations pinpointing where cases reside, work, or
potentially encounter the source—proves invaluable in this assessment.
Spot maps serve as valuable tools in outbreak assessments, visually representing where
cases are located or might have been exposed to the source. These maps often mark
each patient's residence, highlighting concentrations or specific patterns that prompt
investigators to explore potential explanations. Factors like water supplies, wind
patterns, or proximity to specific establishments offer insights into the possible mode of
transmission. Despite their effectiveness in showcasing cases within a defined area,
spot maps overlook the underlying population size.
For a more accurate comparison of incidence rates in regions with different population
densities, area maps that depict rates specific to each area are preferable. In a recent
26 | P A G E
investigation, a spot map was utilized to identify clustered municipalities, providing
crucial information for further analysis and decision-making.
Table 2. Incidence Rate in Region VII
Image 1. Spot Map
Based on the spot map and table above, it is shown that, out of the cities/municipalities
in Region 7, the metropolitan areas, specifically the Municipality of Alburquerque in Bohol
and Cebu City, had garnered the most number of cases in both German Measles and
Measles. More specifically, the table showed that Cebu City and the Municipality of
Alburquerque in Bohol comprised 50% of the German Measles cases and 53.06% of the
Measles cases in Region 7, respectively. It is also worth noting that there are variations
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in the prevalence of German Measles and Measles across different municipalities/cities
throughout the provinces in Region 7. These variations may be influenced by factors
such as vaccination coverage, population density, and healthcare infrastructures and
accessibility.
C. Person
Understanding an outbreak involves analyzing the individuals affected, shedding light on

both case-patients and those vulnerable to the illness. Person-related characteristics,
spanning from age, race, and medical condition to potential exposures like occupation or
activities, play pivotal roles in influencing both the likelihood of contracting the disease
and the potential for exposure. Initially, the focus might be on the sheer number of cases,
but as the investigation progresses, researchers shift towards calculating rates by
relating cases to the population or those at risk. While numbers unveil the disease
burden and assist in planning and service delivery, rates become instrumental in
identifying groups at higher risk. This dual approach provides a comprehensive grasp of
the outbreak's impact, enabling tailored interventions based on identified risk factors.
To summarize the different variables affecting persons, a bar graph was used. Based on
the following graphs, the following information were established:
● Children below 8 years old have the highest total cases of Measles in Region 7.
● People aged 8 to 16 years yield the most cases of German Measles or Rubella
Infection.
● There are more cases among females for both German Measles and Measles.
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Figure 7. Cases of German Measles and Measles by Age Group
*2 Pending German Measles IgM cases (1 for 0-8 and 1 for 16-24)
As shown in the table above, children below 8 years old have a total of 10 German
measles cases and 18 measles cases with a positivity rate of 9.35% and 16.82%
respectively. Children from the age of 8 to 16 years old have 12 German measles cases
and 13 measles cases with a positivity rate of 11.21% and 12.15% respectively. People
aged from 16 to 24 years of age have 2 cases of German measles and 8 cases of
measles with a positivity rate of 1.87% to 7.48%. Also, people aged from 24 years to 32
years of age have no cases of German measles but have 6 cases of measles with a
positivity rate of 5.61%. People from the age of 32 to 40 years old have 1 case of German
measles and no cases of measles with a positivity rate of 0.93%and people at the age of
40 to 48 years old also have 1 case of German measles while also having 1 case of
measles, with a positivity rate of both 0.93%. Lastly, people at the age of 48 to 56 years
have 1 case of German measles and no cases of measles with a positivity rate of 0.93%.
From what is observed based on the information provided, the children below 8 years old
have the highest total cases of Measles in Region 7. Measles is a highly contagious
disease that may affect all age groups. According to the CDC (2020), children below the
age of 5 are most affected. In addition to this, WHO (2023) states that measles weakens
the immune system making children more vulnerable, as children especially those below
the age of 5 already have a weak immune system. Also, Measles is most likely only
contracted once in life as the body builds up resistance to the virus after the initial
infection which is why cases decline along the age groups. On the other hand, people
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aged 8 to 16 years yield the most cases of German Measles or Rubella Infection.
Ben-Joseph (2021), states that children between the ages of 5 to 9 years old are highly
vulnerable and are most affected by Rubella. Similar to Measles, initial Rubella infection
builds lifelong resistance to the virus making it unlikely to get a second infection as
stated by the Department of Health of the Victoria Government of Melbourne Australia
(2023), which explains why the number of cases again decreases along the age groups.
Figure 8. Prevalence of Disease according to Gender
In the data provided, the distribution of cases for each disease based on gender. For
German measles, there are more cases in females (19 cases) compared to males (11
cases) so females have a 33.93% positivity rate while males have a 21.57% positivity
rate. On the other hand, for Measles, the distribution is more balanced,with slightly more
cases among females (25 cases) at a 44.64% positivity rate compared to males (24
cases) at a 47.06% positivity rate. It can be observed in the data that there are more
cases among females for both German Measles and Measles, this information shows
that females are more susceptible to the virus compared to males, which may be due to
multiple key factors.
According to Dr. Ferberding (2004), for infectious diseases, women are at higher risk and
have a more severe course of illness than men for many reasons, including biological
differences, social inequities and restrictive cultural norms. Women play crucial roles as
caregivers and health advocates within their families. These responsibilities may elevate
30 | P A G E
their vulnerability to infectious diseases and create challenges in accessing timely and
sufficient medical care.
G. Develop Hypothesis
Hypotheses are pivotal in outbreak investigations, aiming to unravel the disease's origin, modes
of transmission, and possible exposures. They delve into understanding the agent's reservoir,
how it spreads, associated vehicles, and risk factors, going beyond the obvious to explore
unconventional sources. Investigators meticulously examine patient environments, seeking
insights from local health departments, which can be invaluable. Analyzing epidemic curves
through descriptive epidemiology helps shape these hypotheses into testable ideas. Queries
about exposure timeframes, significant events, and disparities in susceptibility among different
groups play a guiding role in steering the investigation towards potential causes and pathways
of the outbreak.
In outbreaks, hypotheses arise from various avenues. Initially, they stem from understanding the
disease: where the agent usually comes from, its typical transmission routes, common vehicles
involved, and identified risk factors. Another approach involves engaging with case-patients;
their experiences often provide valuable insights into potential causes. Similarly, local health
department staff play a crucial role as they possess intimate knowledge of the community, its
people, and their habits. Drawing from this familiarity, they often contribute hypotheses
grounded in their community-based expertise. These multifaceted perspectives help in
constructing and refining hypotheses that guide the investigation towards probable sources and
modes of transmission for the outbreak.
Building on the information gathered earlier, researchers formulated the following

hypotheses:
Hypothesis 1: Are gender and age significant factors that contribute to higher instances of
measles occurrence?
Hypothesis 2: Is there a correlation between occurrences of rubella (German measles) and
measles in Cebu, Bohol, and Negros Oriental?
Hypothesis 3: Is there a necessity for preventive measures in the absence of an outbreak?
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H. Evaluate Hypotheses Epidemiologically
Field investigations rely on a combination of environmental evidence, laboratory analysis, and

epidemiological methods to assess hypotheses. Epidemiologists evaluate hypotheses through
two primary approaches: either by aligning them with established facts or by utilizing analytic
epidemiology to gauge connections and account for chance.
The former method, typically used when strong support exists from various evidence sources,
often renders formal hypothesis testing unnecessary. However, in cases where evidence is less
conclusive and case information lacks persuasion, epidemiologists resort to analytic
epidemiology for hypothesis validation. This approach involves comparing observed patterns
among affected individuals or exposed groups with expected patterns among non-affected or
unexposed groups to discern significant deviations and understand the extent of differences.
Analytic epidemiology relies on a comparison group, enabling epidemiologists to contrast the

observed patterns among case-patients with what's anticipated among non-case. This
comparison helps determine if the observed pattern significantly deviates from the expected,
offering insight into the degree of difference, if any.
Using the gathered data and published studies, the Research and Investigation team
effectively addressed the initial hypotheses.
Are gender and age significant factors that contribute to higher instances of measles
occurrence?
The data indicates a higher prevalence of measles among children below 8 years old,
consistent with established findings from the CDC (2020) and WHO (2023) highlighting the
increased vulnerability of younger children to measles due to their weaker immune systems.
Similarly, the age group of 8 to 16 years demonstrates a heightened prevalence of German
measles or Rubella infection, aligning with Ben-Joseph's research (2021) emphasizing the
vulnerability of children aged 5 to 9 years to Rubella. Furthermore, the distribution of cases
shows a notable predominance among females for both German measles and Measles. This
aligns with Dr. Ferberding's insights (2004), suggesting women's heightened susceptibility and
more severe illness in infectious diseases due to various factors, including biological
disparities and social inequities.
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Hence, based on the provided information and supported by relevant sources, it can be
concluded that both gender and age significantly contribute to the increased instances of
measles occurrence.
Using analytic epidemiology, the researchers were able to determine whether urbanization
contributes to an increased likelihood of measles occurrence and if there is a necessity for
preventive measures in the absence of an outbreak.
Analytical Epidemiology: Case-Control Study
● Case-Control Study in Region 7 (Cebu, Bohol, and Negros Oriental) with 107 patients.
(Note: This analysis is based on 104 patients for whom a complete set of information
was obtained.)
○ Control
■ Negative with German Measles (Rubella) AND Measles
○ Cases
■ Positive with German Measles (Rubella) AND/OR Measles
● Exposed: Residents of (or was previously exposed to) a municipality/city within a
province (Cebu, Bohol, or Negros Oriental) of Region 7
● Unexposed: Non-Residents of (or wasn’t previously exposed to) a municipality/city
within a province (Cebu, Bohol, or Negros Oriental) of Region 7
● The sample size is 104 with a 95% level of confidence.
Is there a correlation between susceptibility to German Measles (Rubella and Measles and
exposure to the provinces of Region 7 (Cebu, Bohol, or Negros Oriental?
To determine whether there is a correlation between the susceptibility to Rubella (German

Measles) and Measles and exposure to a province of Region 7, the researchers utilized the
Chi-Square Test for Independence.
Difference Between the Susceptibility to German Measles and Measles

in Cebu
Cases Controls Total
Exposed 22 8 30
Unexposed 57 17 74
Table 3. Difference Between the Susceptibility to German Measles and Measles in Cebu
33 | P A G E
Calculation
2
107 𝑥 ((22 𝑥 17) − (8 𝑥 57))
Chi-Square = 30 𝑥 75 𝑥 79 𝑥 25
Chi-Square = 0.16
After conducting a Chi-Square Test of Independence, a Chi-Square value of 0.16 and a p-value
of 0.44 (p > 0.05) obtained. Based on these values, the Null Hypothesis is accepted and, thus,
it is concluded that there is no significant difference between the susceptibility to German
Measles and Measles following exposure to a municipality/city in Cebu.

in Bohol
Exposed 37 11 48
Unexposed 42 14 56
Table 4. Difference Between the Susceptibility to German Measles and Measles in Bohol
Note: In the analysis presented, a total population of 104 has been

used for the calculations instead of the reported total population of
107. This adjustment is made to address discrepancies identified in
the data provided.
34 | P A G E
Calculation
2
107 𝑥 ((37 𝑥 14) − (11 𝑥 42))
Chi-Square = 0.06
it is concluded that there is no significant difference between the susceptibility to German
Measles and Measles following exposure to a municipality/city in Bohol.

in Negros Oriental
Exposed 19 6 25
Unexposed 60 19 79
Table 5. Difference Between the Susceptibility to German Measles and Measles in Negros

the data provided.
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Calculation
it is concluded that there is no significant difference between the susceptibility of German
Measles and Measles Cases following exposure to a municipality/city in Negros Oriental.
Based on the gathered findings, it is concluded that there is no significant correlation between
the susceptibility to German Measles and Measles and exposure to the provinces of Region 7.
This further indicates that exposure or non-exposure to one of the provinces of Region 7 does
not significantly influence an individual’s susceptibility to German Measles (Rubella) and
Measles. Furthermore, these findings suggest that other factors, such as vaccination
coverage, healthcare infrastructure and accessibility, and/or population density, may play a
role in the prevalence of these diseases in Region 7.
Is there a necessity for preventive measures in the absence of an outbreak?
The researchers used the Odds ratio to determine whether municipalities/cities in Cebu,
Bohol, and Negros Oriental weakly or greatly associated with German Measles and/or
Measles infection.
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Difference Between the Occurrence of German Measles and Measles
Cases in Cebu
Exposed 22 8 30
Unexposed 57 17 75
Table 6. Difference Between the Occurrence to German Measles and Measles in Cebu

the data provided.
Calculation
(𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑐𝑎𝑠𝑒𝑠) 𝑥 (𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑐𝑜𝑛𝑡𝑟𝑜𝑙𝑠)
OR = (𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑐𝑜𝑛𝑡𝑟𝑜𝑙𝑠) 𝑥 (𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑐𝑎𝑠𝑒𝑠)
(22) 𝑥 (17)
OR = (8) 𝑥 (57)
OR = 0.82
With an Odds ratio of 0.82 (<1.0) in Cebu, it shows that the odds of exposure among cases is
lower than the odds of exposure among controls, indicating that the exposure to
municipalities/cities in Cebu are weakly associated with German Measles and/or Measles
infection. Furthermore, this may indicate that exposure to the municipalities in Cebu may be
protective for the disease. With this data, it is forecasted that persons exposed to
municipalities/cities in Cebu will have approximately 0.82 odds of contracting German
Measles and/or Measles than persons not exposed to the municipalities/cities in Cebu.

Cases in Bohol
Exposed 37 11 48
Unexposed 42 14 55
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Table 7. Difference Between the Occurrence to German Measles and Measles in Bohol

the data provided.
Calculation
(37) 𝑥 (14)
OR = (11) 𝑥 (42)
OR = 1.12
An Odds Ratio of 1.12 (>1.0) shows that the odds of exposure among cases is greater than
the odds of exposure among controls, indicating that the municipalities/cities in Bohol are
greatly associated with German Measles and/or Measles infection. Furthermore, this may
indicate that exposure to the municipalities in Bohol may be a risk factor for the disease. With
this data, it is forecasted that persons exposed to municipalities/cities in Bohol will have
approximately 1.12 odds of contracting German Measles and/or Measles than persons not
exposed to the municipalities/cities in Bohol.

Cases in Negros Oriental
Exposed 19 6 25
Unexposed 60 19 80
Table 8. Difference Between the Occurrence to German Measles and Measles in Negros
Oriental

107. This adjustment is made to address discrepancies identified in the
data provided.
38 | P A G E
Calculation

(19) 𝑥 (19)
OR = (6) 𝑥 (60)
OR = 1.00
An Odds Ratio of 1.06 (=1.0) show that the odds of exposure among cases is similar to the
odds of exposure among controls, indicating that the municipalities/cities in Negros Oriental
is not associated with German Measles and/or Measles infection. With this data, it is
forecasted that persons exposed to municipalities/cities in Negros Oriental will have
approximately 1.00 odds of contracting German Measles and/or Measles than persons not
exposed to the municipalities/cities in Negros Oriental.
Based on the Odds Ratios calculated for Cebu, Bohol, and Negros Oriental, there appears to
be varying levels of association between exposure in these regions and the risk of contracting
German Measles and/or Measles.
Overall, while Cebu and Negros Oriental shows a weaker association, both Bohol indicate a
potentially higher risk associated with exposure. However, it's important to note that these
Odds Ratios highlight associations and not necessarily causation. In the absence of an
outbreak, considering the varying associations observed, preventive measures might still be
warranted, particularly in Bohol, to mitigate the potential risk of German Measles and/or
Measles transmission in these regions.
I. Ask necessary, reconsider, refine, and re-evaluate hypotheses
If analytic epidemiology does not yield insights, reconsider hypotheses by engaging with
case-patients to identify common connections or visiting their homes to examine potential
sources. Remain open to alternative vehicles or modes of transmission.
Outbreak investigations, while revealing associations between exposure and disease, often
necessitate refining hypotheses to consider more specific control groups for precise testing.
These investigations serve as vital "experiments of nature," contributing not only to the
development of effective control and prevention strategies but also to the deeper
comprehension of health issues that might not have been previously explored. Within the
context of an outbreak, whether routine or unusual, there lies an opportunity to address lingering
39 | P A G E
questions about the disease. This entails planning studies to delve into various aspects such as
transmission modes, agent characteristics, host factors, and other relevant elements, thereby
enhancing our understanding of the disease.
Given the straightforward nature of the epidemiological evidence without extensive

hypothesis testing, our current focus lies in intensifying efforts towards controlling and
preventing the transmission of measles and German measles. This targeted approach aims to
swiftly curb their spread and implement effective preventive measures.
J. Compare and reconcile with laboratory and/or environmental studies
In the case of measles outbreaks, epidemiological evidence often initiates the investigation by
identifying patterns and potential associations among affected individuals. However, to bolster
these findings and confirm the presence of the measles virus, laboratory studies play a critical
role. They directly analyze samples from patients, confirming the pathogen's presence and
providing concrete evidence. Simultaneously, environmental studies can be crucial in
pinpointing the origin of the outbreak and examining potential sources of exposure and
transmission.
Integrating data from these diverse sources—epidemiological, laboratory, and

environmental—creates a comprehensive understanding of the outbreak's dynamics. Comparing
epidemiological patterns with laboratory-confirmed cases ensures a coherent narrative,
establishing a causal link between the measles virus and the illness observed. This convergence
of data types doesn't just confirm the outbreak's source; it forms a robust foundation for public
health responses, guiding interventions and control measures to contain the spread effectively.
Reconciling these findings across different domains ensures the accuracy and reliability of the
investigation, lending credibility to the conclusions drawn and confirming the measles virus as
the causative agent behind the outbreak.
In our continuous commitment to monitor the situation comprehensively, there is a close

collaboration with health institutions and Disease Reporting Units (DRUs) to ensure a
continuous flow of data, combining laboratory results with clinical findings.
40 | P A G E
This collaborative effort serves to constantly monitor the situation, cross-referencing and
analyzing information to gain deeper insights into the evolving scenario. Beyond this, they've
proactively engaged with local government units to conduct thorough ocular and sanitation
inspections in affected areas.
These comprehensive assessments aim not just to identify specific locations that might serve
as potential breeding grounds for pathogens but also to pinpoint municipalities requiring
urgent clean-up and maintenance efforts. This multidimensional approach, spanning from
microscopic laboratory investigations to on-the-ground inspections, strengthens the depth of
their understanding, facilitating more targeted and effective intervention strategies.
K. Implement control and prevention measures

In outbreak investigations, the primary goal is to control and prevent further cases. While the
conceptual sequence designates the implementation of control measures as Step 11, in
practice, these activities should start early. The health department’s foremost responsibility is
public health protection. If suitable control measures are known, they should be activated even
before the start of an epidemiologic investigation. For instance, identifying a child with measles
in a community may prompt a vaccination campaign before investigating the infection’s origin.
Effective strategies target different stages in the transmission chain, focusing on disease agent
eradication through sanitization or eradication campaigns. Efforts also concentrate on
disrupting transmission by isolating infected individuals and advising against specific contacts.
For diseases transmitted through vehicles or airborne routes, interventions involve
decontamination or modifying air quality. Vaccination plays a pivotal role in enhancing
immunity. By addressing these points in the transmission chain, these measures collectively
mitigate disease spread and promote public health.
Despite confirming the absence of an outbreak, the researchers emphasize the importance of
implementing control and prevention measures due to the widespread prevalence of measles
in the country.
Understanding the ongoing risk, they've outlined recommended measures for both local
governments and the general public to adopt. These guidelines aim to proactively address the
continuous threat posed by measles, emphasizing preemptive actions to mitigate potential
outbreaks and sustain public health safety.
41 | P A G E
I. Healthcare Provider TrainingD
● In order to help achieve and maintain the elimination of measles and rubella, it is
crucial to support the implementation of high-quality interventions. Participants in this
session will learn about the suggested strategies for handling measles epidemics.
○ The following are the content for this training:
■ Measles disease and outbreak characteristics - To identify measles
disease and outbreak characteristics, such as measles scientific
classification, clinical manifestations, differential diagnosis of fever and
rash, clinical course of measles, complications associated with
measles, the risk and factors and herd immunity thresholds.
■ Preparedness - To guarantee that systems are put in place to allow for
a prompt, efficient response.
■ Detection - To identify and validate cases of measles in order to
facilitate effective case management and the adoption of suitable
public health measures to prevent future spread.
■ Investigation - Determine the source of the infection, including whether
it was endemic, importation-related, or caused by travel; identify
potential contacts to target those at particular risk of disease for
intervention; identify populations and areas with low coverage and
higher risk of outbreaks that call for increased vaccination efforts.
■ Response -To stop the spread of the measles virus, lower measles
morbidity, mortality, complications, and sequelae, and identify the
underlying reasons so that deficiencies in the immune system or other
systemic issues can be fixed to lower the likelihood of future outbreaks.
■ Recover - Determine the best ways to close immunity gaps by
increasing vaccination coverage, coordinating recovery efforts, utilizing
tools to support the recovery process, and identifying factors that
contributed to the outbreak in order to improve the health status of the
population affected by it.
II. Vaccination Program

● Ensure routine vaccination:
○ Promote and assist children's routine vaccination against the measles, mumps,
and rubella (MMR) vaccine, which is normally given at age one and again at
age four.
● Catch-up Campaigns:
42 | P A G E
○ To make up for missed or insufficient vaccinations should be held on a regular
basis to reach adults and adolescents who may not have received the
recommended vaccinations.
● Sustain high vaccination rates:
○ In order to create herd immunity and safeguard individuals who are not
vaccinated, communities should work to attain and sustain high vaccination
rates.
III. Public Health Education
Raise awareness:
Inform the public, medical professionals, and local authorities about the
value of getting vaccinated against measles, as well as the risks involved in
the illness.
Address Vaccine hesitancy:
Create and put into action plans that address misinformation, foster
targeted communication, and increase public confidence in the healthcare
system.
L. Initiate or Maintain Surveillance

Continuing surveillance is crucial once control and prevention measures are established. If
ongoing surveillance is absent, initiating active surveillance is necessary. If active surveillance
was initiated during case-finding, it should be sustained for two key reasons. Firstly, it is vital to
assess the effectiveness of measures by monitoring the trend of new cases- whether they are
decreasing, ideally ceasing, or still emerging, and if so, their distribution. Secondly, it is essential
to determine if the outbreak has spread to new areas, necessitating prompt implementation of
control measures. This ongoing surveillance is indispensable for responsive actions based on
the evolving dynamics of the outbreak.
In the Philippines, the Department of Health has implemented an Epidemiology and

Surveillance Unit (ESU). In the event of an unanticipated rise in measles cases in a specific
43 | P A G E
locality, health institutions promptly report this information to the Regional Department of
Health (DOH) for potential investigation. The researchers and investigation team consistently
track the rise in measles cases especially in a population where there is low vaccine coverage
leading to a lack of herd immunity. Ongoing surveillance aims to observe case numbers,
implement preventive measures to curb the increase and assess the potential for an imminent
outbreak.
M. Communicate Findings
Effective communication, a crucial aspect highlighted in Step 1 (Prepare for fieldwork), involves
summarizing the investigation, findings, and outcomes in two key forms:
I. Oral briefing for the local authorities
Field investigators, responsible for epidemiology, conduct an oral briefing for local health
authorities overseeing control and prevention measures. Given the likelihood that these
authorities may not be epidemiologists, it is essential to present findings clearly and
persuasively, providing justified recommendations. This allows investigators to outline
discoveries and proposed actions in a scientifically objective manner, capable of
defending conclusions and recommendations.
II. A written report
Investigators should prepare a written report in the standard scientific format, covering
introduction, background, methods, results, discussions, and recommendations. This
report serves as a guide for future actions, a performance record, and a document for
potential legal considerations. It becomes a reference for the health department in
similar future circumstances. Furthermore, publication of the report in public health
literature contributes to the advancement of knowledge in epidemiology and public
health.
Following a comprehensive investigation into the measles cases in Region VII, specifically in
Cebu, Bohol, and Negros Oriental, the research and investigation team has concluded their
findings and is prepared to communicate these to local authorities. Their aim is to offer
targeted recommendations on prevention measures to curtail transmission and to address
public concerns effectively. This dissemination of information will be conducted through a
press conference.
44 | P A G E
Additionally, the researchers plan to enhance surveillance records by publishing a handbook
accessible to the public. They also intend to distribute posters focused on measles awareness
and develop an informative video to aid in the control and prevention of both current and
future measles cases.
SUMMARY
Frequency of Outbreaks:
● Outbreaks occur frequently.
● Not all outbreaks are reported, but those that do require decisions from public health
agencies.
Decision-Making for Field Investigations:

● Agencies must decide whether to handle outbreaks remotely or conduct field
investigations.
● Field investigations involve significant time, energy, and resources.
Purpose of Investigations:
● The primary reason for investigations is to gather information for implementing
control and prevention measures.
● Other purposes include advancing knowledge about the disease, agents, risk
factors, interventions, and scientific issues.
● Responding to public, political, or legal concerns is also a motivation.
● Evaluating health program effectiveness and weaknesses and providing training are
additional reasons.
Nature of Outbreaks:
● Outbreaks are unexpected events.
● Media attention and public concern often prompt investigators to work quickly.
Coordination and Communication:

● Involvement of multiple agencies makes coordination and communication crucial.
● Field investigations add complexity due to the lack of office conveniences and
routines.
Importance of Systematic Planning:

● Given the unexpected nature of outbreaks, having a systematic plan for
45 | P A G E
investigations is essential.
Below is a summarized version of the steps of an outbreak investigation. Its order is

conceptual, leaving investigators the decision to execute these steps in another order which
is appropriate for what outbreak.
STEPS Planning for field work, establishing the existence of an outbreak, and verifying
1-3 the diagnosis are usually the first steps, sometimes done in that order, sometimes
done in reverse order, sometimes done simultaneously.
STEPS After the diagnosis has been confirmed investigators create a workable case
4&5 definition, then go out and look for additional cases. Information about these
cases is organized either in a line listing or in a computer database that allows
staffers to check for duplicate records, update records as additional information
comes in, and perform descriptive epidemiology.
STEP 6 Descriptive epidemiology — organizing the data by time, place, and person — is
essential for characterizing the outbreak, identifying populations at risk,
developing hypotheses about risk factors, and targeting control/prevention
strategies. An epidemic curve — a histogram of the number of cases by time of
onset of illness — provides a handy visual display of the outbreak’s magnitude
and time trend.
STEP 7 Hypotheses, based on what is known about the disease, descriptive

epidemiology, and what others have postulated, must be developed before
conducting any kind of epidemiologic study (what are you going to study if you
don’t know what you are looking for?).
STEP 8 While not every outbreak requires an analytic study, those that do are usually
addressed by either a cohort study or a case-control study. Both types of study
attempt to identify associations between exposures (risk factors or causes) and
the disease of interest. In a cohort study, best suited for an outbreak in a
well-defined population such as guests at a wedding, investigators usually
attempt to enroll everyone, determine exposures and outcomes, calculate attack
rates, and compare attack rates with a risk ratio or relative risk to identify
associations. In a case-control study, which is well suited for outbreaks without a
well-defined population, investigators usually enroll all of the case-patients plus a
sample of persons who did not get ill, then ask about exposures and compute an
odds ratio to look for associations.
46 | P A G E
STEP 9 If needed, hypotheses can be refined and re-evaluated. In many investigations,
& 10 while the epidemiologists are conducting their epidemiologic investigations,
environmental health specialists and laboratorians are conducting studies and
tests of their own. Ideally, this multidisciplinary approach points to a single
conclusion.
STEP While implementing control and prevention measures is listed as Step 11, it is the
11 & 12 primary goal of most outbreak investigations and usually occurs early in the
investigation. Such measures can be implemented as soon as any link in the
chain of disease transmission that is susceptible to intervention can be identified.
If the source and mode of transmission is known, disease control measures need
not wait. However, there is no guarantee that these measures will work, so
continued surveillance is essential.
STEP Finally, communicating what was found and what should be or was done in a
13 written report provides key public health, scientific, and legal documentation.
47 | P A G E
IV. Conclusion
Measles and rubella are highly contagious viral infections. Measles, caused by the measles
virus, leads to severe symptoms like high fever, cough, and a spreading red rash. It's incredibly
contagious, spreading through coughing or sneezing and remains so four days before and after
the rash appears. Rubella, caused by a different virus, presents milder symptoms such as a pink
rash, low-grade fever, and swollen glands. While less severe, rubella is concerning for pregnant
women as it can cause severe birth defects.
A. Time Component Summary

In early 2022, the first case of rubella was reported, followed by measles a month later. Measles
peaked in April, dipped in May, then spiked again in June, August, and October. New cases
followed a sequential pattern, emerging after previous ones were resolved. The average
incubation period for measles and rubella aligns with the 1 to 3 week intervals observed
between cases.
Cases are scattered geographically, indicating sporadic rather than localized outbreaks. This
sequential spread across different locations suggests a lower likelihood of an immediate
widespread outbreak. Overall, these observations imply that the diseases are spreading in a
sequential manner, reducing the immediate risk of a widespread outbreak.
B. Place Component
Measles and Rubella, viral and contagious, spread directly through droplets when an infected
person sneezes or coughs. Disease onset location is crucial for infectivity and pathogenicity due
to transmission dynamics.
Over the following weeks, the occurrence of both diseases gradually rose within the city. Despite
this increase, the cases displayed a scattered and widely distributed pattern, resulting in a
year-end total of only 20 cases, contributing to 25.32% of the total cases in Region 7's Cities and
Municipalities. This indicates that although the number of cases increased, they were not
clustered or closely connected, suggesting a potentially dispersed transmission pattern within
the city. Additionally, external factors like tourism played a significant role, leading to a notable
number of Measles cases despite the city's relatively low population density.
48 | P A G E
C. Person Component
In analyzing the demographic trends of measles and rubella infections it showed that Measles
tends to affect children under 8, especially those under 5, while rubella impacts 8 to 16
year-olds, particularly 5 to 9 year-olds. In terms of gender, females exhibit a higher infection rate
than males, emphasizing their increased vulnerability to these viruses. This disparity
underscores how various factors—biological, social, and cultural contribute to disease
prevalence and severity among genders.
In conclusion, while the demographic analysis reveals distinct vulnerability patterns based on
age and gender for measles and rubella, the absence of a marked surge or widespread
occurrence in a particular area or time frame suggests that the observed cases might not
signify an outbreak. However, the nuanced understanding of susceptibility among age groups
and gender disparities remains crucial in ongoing surveillance to prevent potential outbreaks
and mitigate the impact of the disease.
D. Two-Way ANOVA
A Two-Way ANOVA Without Replication was conducted to compare the occurrence of measles
and German measles across different municipalities in Region VII. The p-values obtained for
both German measles (0.240) and measles (0.666) were greater than the significance level of
0.05. Therefore, we reject the null hypothesis and accept the alternative hypothesis in both
cases, suggesting that there is no significant difference in the occurrence of either disease
among the municipalities within Region 7. This implies that there is no evidence to support an
outbreak of either measles or German measles in the region.
E. Case Is Not An Outbreak

Before we conclude that a disease has already peak to its outbreak there are things that we
need to consider:
1. An outbreak is typically characterized by an unexpected increase in the number of cases
of a particular disease within a specific population or geographical area over a defined
period.
2. Outbreaks typically involve a sudden surge in cases over a relatively short period, often
within weeks or months.
3. An outbreak refers to the occurrence of a particular disease in a specific geographical
area that is greater than what is normally expected.
49 | P A G E
Whereas on the basis of our case, it is contradicting, it does not fall exactly how outbreaks are
described.
NUMBER OF CASES. Our case highlights a different disease pattern in cities with dense
populations and active tourism sectors. The higher concentration of the disease doesn't show
clustering or close links, suggesting a scattered transmission pattern within these urban areas.
This differs from typical outbreaks that exhibit closely connected cases in specific locations.
Instead, cases are spread across various parts of these cities, indicating a more sporadic
spread of the diseases. This scattered distribution in densely populated, tourist-heavy areas
doesn't match the expected outbreak behavior, pointing to a complex transmission influenced by
factors like population movements and varied exposure opportunities. While cases are higher in
urban centers, the lack of tightly linked clusters suggests a different, more dispersed
transmission pattern, challenging our understanding of outbreaks in these settings.
TIME COMPONENT. Our case suggests otherwise because new cases of both
diseases–German Measles and Measles follow a sequential pattern, with new cases emerging
after previous cases have been resolved. The timing of the cases reveals a different pattern
compared to an outbreak. New cases of German measles and measles appear in a sequence,
one after the other, without overlapping. The first case of German measles showed up in
January 2022, followed by measles a week later in February 2022, reflecting this sequential
order. This sequencing aligns with the expected time it takes for these diseases to show
symptoms, according to the CDC. Their average incubation periods correspond to the intervals
between the cases we observed, reinforcing this sequential pattern. Moreover, the absence of
concentrated cases in one place is crucial. If they were clustered in a specific area, it might
signal a higher outbreak risk there. But our cases are scattered across different locations,
suggesting a more sporadic spread. In summary, the way cases emerge one another, the timing
between them, and their scattered nature across locations all indicate a different scenario from
a typical outbreak. This suggests a more dispersed and non-concentrated spread of these
diseases.
PLACE COMPONENT. The geographical analysis of disease distribution in Region 7 accentuates

Bohol as the primary hotspot, contributing 46.8% of the total cases, followed by Cebu (27.8%)
and Negros Oriental (24.1%). Within the urban confines of Cebu City, a gradual uptick in disease
incidences unfolded over successive weeks. Despite this escalation, the cases exhibited a
scattered and diffused pattern, culminating in only 20 reported cases by the year's conclusion,
encompassing 25.32% of Region 7's total cases across all Cities and Municipalities. The spread
of cases across different areas challenges the idea of a localized outbreak. Typically, outbreaks
involve clustered cases, suggesting a concentrated source of infection in that region. However,
our data show a dispersed distribution without clear clustering. This absence of localized
50 | P A G E
clusters suggests a different pattern, where new cases emerge independently, not directly linked
to previous ones. Despite increasing case numbers, the lack of geographic clustering or close
connections between cases implies a dispersed transmission pattern. This divergence from the
usual outbreak scenario emphasizes the unique way these diseases are spreading in these
regions.
In Conclusion, the observed disease pattern in densely populated urban areas challenges the
conventional definition of an outbreak due to its scattered transmission, sequential occurrence,
and dispersed geographical distribution. These findings suggest the need for a more nuanced
understanding of disease transmission dynamics in these settings. Outbreak definitions and
surveillance systems may need to be adapted to effectively capture these unique transmission
characteristics.
51 | P A G E
V. Health Promotion and Disease Prevention
A. Management
I. Isolation
○ Healthcare personnel should follow standard and airborne precautions when
managing patients with suspected or confirmed measles, including immediate
patient placement into an airborne infection isolation room and use of a
respirator that is at least as protective as a fit-tested N95 respirator.
○ All measles patients should be isolated for four days following the onset of
symptoms in order to prevent the infection from spreading to others.
II. Maintenance of hygiene
○ To stop the spread, all dirty and contaminated tissues, handkerchiefs, etc., must
be cleaned and disposed of with caution.
○ Toys and other used items should be cleaned with a powerful detergent.
○ Used items that can't be washed should ideally be cleaned with alcohol swabs.
○ Numerous measles cases can be avoided by washing your hands frequently and
protecting your mouth and nose when you cough or sneeze.
B. Prevention
I. Vaccination
1. MMR VACCINE
a) Three infections are prevented by the vaccine: rubella, mumps, and
measles. The MMR vaccine should be given to children in two doses, the
first at 12 to 15 months of age, the second at 4 to 6 years of age,
according to CDC recommendations. Adults and teenagers should also
have received their MMR.
b) The MMR vaccine has high efficacy and safety. The MMR vaccine is 97%
effective in preventing measles after two doses, and 93% effective after
one dose.
52 | P A G E
c) Measles can still be avoided in children who have not had vaccinations by
getting the shot within three days of being exposed to the virus.
d) See your healthcare practitioner about receiving the vaccination if you're
an adult and not sure if you've received it. It's crucial if you intend to travel
abroad in particular.
e) Pregnant people are not allowed to get MMR vaccine. Unvaccinated
people should get MMR vaccine immediately after their pregnancy.
2. MMRV VACCINE
a) Only children between the ages of 12 months and 12 years old are eligible
for this immunization. At 12 to 15 months of age, your child should
receive one vaccination. The second shot should be given to your child
between the ages of 4 and 6. On the other hand, the second dose might
be administered three months following the first. The ideal time for your
child should be discussed with their healthcare professional.
C. Post exposure prevention

I. For unvaccinated infants aged 6 to 13 months:
○ An MMR vaccination is typically administered to a child exposed to the measles

virus in order to prevent them from contracting the disease.
○ The vaccination must be given no later than 72 hours after the infection is first
discovered.
○ As part of the childhood immunization regimen, the child needs two additional
doses: one before starting school and one around the age of 13 months.
II. For newborns under six months of age who have not had a vaccination:
○ Children whose mothers have previously contracted the measles are typically
immune to the illness because the mother transmits protective antibodies to the
developing kid. For the first six months of the child's existence, these antibodies
provide protection.
○ The child may receive an injection of human normal immunoglobulin (HNIG) if

the mother has never had the measles.
53 | P A G E
1. HNIG is not a vaccine. A concentration of antibodies known as HNIG can
provide instantaneous, temporary protection against the measles. For
adults and children whose immune systems are weakened, HNIG is also
taken into consideration within five days of exposure.
2. Intramuscular normal immunoglobulin may also be considered for

pregnant women who have been exposed to measles.
D. Treatment
1. After the symptoms first appear, the illness normally fades away on its own in two
weeks. The goals of treatment are to reduce symptoms and avoid complications.
Treatment options could be:
● Relax.
● Consuming adequate liquids to keep hydrated. Your youngster might need
intravenous fluids if they become dehydrated.
● Medication that:
○ Cut down on itchiness (antihistamine).
○ Lower the fever.
● Vitamins A supplements
A child might require antibiotic medication if they also get a bacterial infection. Measles
cannot be cured by antibiotics.
2. Individuals who experience diarrhea, middle ear infections, pneumonia, or other serious
illnesses should talk to their doctor about their treatment options.
54 | P A G E
APPENDIX
Graphs
Figure 1. Number of Cases of German Measles and Measles according to the Provinces of Region 7
Figure 2. Prevalence of German Measles and Measles according to CIty/Municipality
55 | P A G E
FIgure 3. German Measles and Measles Cases in Cebu City
Figure 4. German Measles and Measles Cases in Albuquerque, Bohol
56 | P A G E
Figure 5. German Measles and Measles Cases in Santa Catalina, Negros Oriental
Figure 6. Weekly Cases of German Measles and Measles
57 | P A G E
Figure 7. Cases of German Measles and Measles by Age Group
Figure 8. Prevalence of Disease according to Gender
58 | P A G E
Tables
Province City/Municipality German Measles Measles

Alburquerque 7 14
Corella 0 2
Guindulman 1 0
Bohol Loay 1 1
Sikatuna 2 4
Talibon 2 0
Tubigon 2 0
Valencia 0 1
Cebu City 8 12
Cebu
Lapu-Lapu City 1 1
Dumaguete City 2 4
Negros Oriental Guihulngan 2 2
Santa Catalina 1 8
Unknown Unknown 1 0
Table 1. Prevalence of German Measles and Measles according to CIty/Municipality
Table 2. Incidence Rate in Region VII
59 | P A G E
in Cebu
Exposed 22 8 30
Unexposed 57 17 74
Table 3. Difference Between the Susceptibility to German Measles and Measles in Cebu

in Bohol
Exposed 37 11 48
Unexposed 42 14 56
Table 4. Difference Between the Susceptibility to German Measles and Measles in BohoL

in Negros Oriental
Exposed 19 6 25
Unexposed 60 19 79
Table 5. Difference Between the Susceptibility to German Measles and Measles in Negros Oriental
60 | P A G E
Cases in Cebu
Exposed 22 8 30
Unexposed 57 17 75
Table 6. Difference Between the Occurrence to German Measles and Measles Cases in Cebu

Cases in Bohol
Exposed 37 11 48
Unexposed 42 14 55
Table 7. Difference Between the Occurrence to German Measles and Measles Cases in Bohol

Cases in Negros Oriental
Exposed 19 6 25
Unexposed 60 19 80
Table 8. Difference Between the Occurrence to German Measles and Measles Cases in Negros Oriental
61 | P A G E
Calculations
2
107 𝑥 ((22 𝑥 17) − (8 𝑥 57))
Chi-Square = 0.16
Calculation 1. Difference Between the Susceptibility to German Measles and Measles

in Cebu Chi-Square Test
2
107 𝑥 ((37 𝑥 14) − (11 𝑥 42))
Chi-Square = 0.06

in Bohol Chi-Square Test
62 | P A G E
2
107 𝑥 ((19 𝑥 19) − (6 𝑥 60))
Chi-Square = 0.00

in Negros Oriental Chi-Square Test

(22) 𝑥 (17)
OR = (8) 𝑥 (57)
OR = 0.82
Calculation 4. Difference Between the Occurrence of German Measles and Measles Cases in Cebu Odds Ratio

(37) 𝑥 (14)
OR = (11) 𝑥 (42)
OR = 1.12
Calculation 5. Difference Between the Occurrence of German Measles and Measles Cases in Bohol Odds Ratio
63 | P A G E
(19) 𝑥 (19)
OR = (6) 𝑥 (60)
OR = 1.00
Calculation 6. Difference Between the Occurrence of German Measles and Measles Cases
in Negros Oriental Odds Ratio
Image
Image 1. Spot Map
64 | P A G E
Infographics
Infographic 1. Measles Outbreak in a High-Income Country: Are Pediatricians Ready?
65 | P A G E
Infographic 2. Rapid Diagnostic Test: To address challenges for Global Measles Surveillance
66 | P A G E
Infographic 3. A Lesson From a Measles Outbreak among Healthcare Workers in a Single Hospital in South Korea: The
Importance of Knowing the Prevalence of Susceptibility
67 | P A G E
Infographic 4. Measles: An Overview of Re-Emerging Disease in Children and Immunocompromised Patients
68 | P A G E
REFERENCES
CDC. (2019a). Rubella. Centers for Disease Control and Prevention. Retrieved from:
https://tinyurl.com/3e6v99a2
CDC. (2019b, June 13). Measles Symptoms and Complications. Centers for Disease
Control and Prevention. Retrieved from: https://tinyurl.com/287b3km8
Centers for Disease Control and Prevention. (2019). Measles. Centers for Disease
Control and Prevention. Retrieved from: https://tinyurl.com/4mthvs2f
Centers for Disease Control and Prevention. (2020). Transmission of Measles. Centers
for Disease Control and Prevention. Retrieved from: https://tinyurl.com/muv8u2z4
Centers for Disease Control and Prevention. (2020). Transmission of Measles. Centers
for Disease Control and Prevention. Retrieved from: https://tinyurl.com/muv8u2z4
Centers for Disease Control and Prevention. (2022, November 23). Rubella Information
For Healthcare Professionals | CDC. Retrieved from: https://tinyurl.com/bdh3uyr4
Domai, F. M., Agrupis, K. A., Han, S. M., Sayo, A. R., Ramirez, J. S., Nepomuceno, R.,
... & Miranda, E. (2022). Measles outbreak in the Philippines: epidemiological and clinical
characteristics of hospitalized children, 2016-2019. The Lancet Regional Health–Western
Pacific, 19.
Mayo Clinic . (2022, May 11). Measles - Symptoms and causes. Mayo Clinic. Retrieved
from: https://tinyurl.com/3dyecdsc
Mayo Clinic. (2022, May 11). Rubella - Symptoms and causes. Mayo Clinic. Retrieved
from: https://tinyurl.com/387bnreb
New York State Department of Health. (2012). Rubella (German Measles or Three-Day
Measles). Ny.gov. Retrieved from: https://tinyurl.com/ywfjmwpx
Pinkbook: Rubella | CDC. (2021, August 17). Www.cdc.gov. Retrieved from:

https://tinyurl.com/f3h4mpam
69 | P A G E
Quest Diagnostics: Test Directory. (n.d.). Testdirectory.questdiagnostics.com. Retrieved
November 26, 2023. Retrieved from https://tinyurl.com/55kmk68k
Rubella Information For Healthcare Professionals | CDC. (2022, November 23).
Www.cdc.gov. Retrieved from: https://tinyurl.com/bdh3uyr4
World Health Organization. (2003, August 9). Measles. Www.who.int. Retrieved from:
https://tinyurl.com/4uaf6xrv
World Health Organization. (2023, August 9). Measles. Who.int; World Health
Organization: WHO. Retrieved from: https://tinyurl.com/yc2fhnjp
70 | P A G E

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1

Precious Jewel T. Cinco, RMT, MD, PhD (Ob-Gyn)

Maria Isabel E. Golviogo, RMT, ASCPi

Karisa Gail R. Calamba, MD, PhD

Jeronne Clare S. Sabornido, RMT, MD

Russ Philip H. Cimafranca, RMT, MD

Kent Daniel S. Impok, RMT, ASCPi, MD (Nephrology)

Genesis B. Kiok, RMT, RN, PTRP, MOT

Publisher: MediQuill Publication Co.

A. Cause and Risk Factors

● The virus can live for up to two hours in an airspace.

C. Sign and Symptoms

● Following the initial phase, characterized by Koplik spots, individuals develop a

NOTE: Immunocompromised individuals may not exhibit the characteristic rash.

● Prognosis in high-risk individuals

E. Complications associated with Measles

A. Cause and Risk Factors

B. Transmissions of German Measles

C. Sign and Symptoms

D. Prognosis of German Measles

E. Complications associated with German Measles

A. Prepare for Field Work

I. Scientific and Investigative Issues

II. Management and Operational Issues

B. Establish the Existence of an Outbreak

An outbreak or epidemic involves a higher-than-anticipated number of disease cases in a

DOH REGION VII ACTION

DATA SET CLUSTER

Province City/Municipality German Measles Measles

FIgure 3. German Measles and Measles Cases in Cebu City

Figure 4. German Measles and Measles Cases in Albuquerque, Bohol

Significance of the occurrence of measles across different municipalities in Region VII

C. Verify the Diagnosis

● Ensuring accurate disease identification for tailored control measures

DOH REGION VII ACTION

D. Construct a Working Case Definition

● Restrictions by Time, Place, and Person

In confined populations with possible undetected mild or asymptomatic cases, a

● Identifying Information- name, address, telephone

DOH REGION VII ACTION

Descriptive epidemiology plays a foundational role in outbreak investigations by providing a

Epidemic curves, a specialized form of histogram, traditionally depict an outbreak's time

● Epidemic curves offer a clear visual representation of an outbreak's size and

Points: Peak of measles is in week 17, in april

Table 2. Incidence Rate in Region VII

Image 1. Spot Map

Understanding an outbreak involves analyzing the individuals affected, shedding light on

Figure 8. Prevalence of Disease according to Gender

DOH REGION VII ACTION

Building on the information gathered earlier, researchers formulated the following

Field investigations rely on a combination of environmental evidence, laboratory analysis, and

Analytic epidemiology relies on a comparison group, enabling epidemiologists to contrast the

DOH REGION VII ACTION

Analytical Epidemiology: Case-Control Study

To determine whether there is a correlation between the susceptibility to Rubella (German

Difference Between the Susceptibility to German Measles and Measles

Cases Controls Total

Difference Between the Susceptibility to German Measles and Measles

Cases Controls Total

Note: In the analysis presented, a total population of 104 has been

Difference Between the Susceptibility to German Measles and Measles

Cases Controls Total

Note: In the analysis presented, a total population of 104 has been