2019 Samoa measles outbreak

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2019 Samoa measles outbreak
Samoa - Location Map (2013) - WSM - UNOCHA.svg
DiseaseMeasles
First caseSeptember 30, 2019
DatesSeptember 30, 2019 –
ongoing[1]
Deaths72
Confirmed cases5,080
Official website
http://www.samoagovt.ws/

The 2019 Samoa measles outbreak began in September 2019.[2] As of December 13, there were 5,080 confirmed cases of measles and 72 deaths, out of a Samoan population of 201,316.

A state of emergency was declared on November 17, ordering the closure of all schools, keeping children under 17 away from public events, and making vaccination mandatory. Samoan anti-vaccination activist, Edwin Tamasese, was arrested and charged with "incitement against a government order".

On December 2, 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings. All unvaccinated families have been ordered to display a red flag or red cloth in front of their homes to warn others and to aid mass vaccination efforts. On December 5th and 6th, the government shut down everything other than public utilities to move all civil servants over to the vaccination campaign. This curfew was lifted on December 7th when the government estimated that 90% of the population was reached by the vaccination program.

Background[edit]

A hypothetical measles timeline exposure to illness

Measles was first reported when it arrived to Samoa in a mild form in two epidemics at the end of 1891 and January 1893.[3] At least 1,200 of 34,500 residents were killed in the outbreak, with the lack of vaccination contributing greatly to the mortality. At least 50% of the victims were adults.[3] There was a greater incidence of chest infections after the outbreaks.[3]

Measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, the Philippines and New Zealand.[4]

2019 outbreak[edit]

The 2019 Samoa measles outbreak began in October 2019 and is ongoing as of December 2019. As of December 9, there have been 72 deaths (0.36 per 1,000, based on a population of 201,316[5], a rate of 14.41 deaths per 1000 infected) and over 4,995 cases (2.5% of the population) of measles in Samoa.[6][7][8][1] 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15.[9]

At least 20% of babies aged six to 11 months have contracted measles and one in 150 babies have died.[10]

In late November 2019 it was expected that around 70 people would die and up to 6,500 people would be infected.[11]

As of December 12th, 93% of the population has been vaccinated.[10] 95% is required to acquire herd immunity.[10]

Vaccine hesitancy[edit]

The outbreak has been attributed to a sharp drop in measles vaccination from the previous year. In 2018, two infants died shortly after receiving measles vaccinations, and this was picked up by anti-vaccine groups and used to stoke vaccine fears on social media causing the government to suspend its measles vaccination program.[12] The cause of death in the 2018 incident was incorrect preparation of the vaccine by two nurses who mixed vaccine powder with expired anaesthetic instead of the appropriate diluent.[13] Following the incident, the government temporarily stopped its vaccination program, however Samoan residents lost trust in the healthcare system.[14]

UNICEF and the World Health Organisation estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018.[4][15] Ideally, countries should have an immunisation levels above 90%. Prior to the outbreak vaccination rates had dropped to 31% in Samoa, compared to 99% in nearby Nauru, Niue, Cook Islands[16] and American Samoa.[17]

Samoa, Tonga and Fiji have all declared states of emergency to tackle their 2019 measles outbreaks. The high mortality rate in Samoa is attributed to the low (31%) vaccination rate in Samoa. In Tonga and Fiji, the lack of fatalities is explained by the far higher vaccination rates.[16]

Government response[edit]

A state of emergency was declared on November 17, ordering the closure of all schools, keeping children under 17 away from public events, and making vaccination mandatory.[18] UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency.[19] Tonga closed all schools for several days while American Samoa required all travellers from Tonga and Samoa to present proof of vaccination.[20] In Fiji, vaccines are being prioritised for young children and people traveling overseas.[21]

On December 2, 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings.[22][23] All unvaccinated families have been ordered to display a red flag or red cloth in front of their homes to warn others and to aid mass vaccination efforts.[24] As part of aid efforts, the Royal New Zealand Air Force has transported medical supplies and equipment to Samoa. In addition, New Zealand, Australia, British, French Polynesian and French medical teams have been assisting Samoan medical authorities.[25]

On December 5th and 6th, the government shut down everything other than public utilities in order to assign all available civil servants to the vaccination campaign.[26] It also arrested anti-vaccination activist, Edwin Tamasese, who was charged with "incitement against a government order"[26] after he had encouraged his patients to not get immunised as he believed the vaccine caused measles.[27] This curfew was lifted on December 7th when the government estimated that 90% of the population was reached by the vaccination program.[28]

Aftermath[edit]

Tuilaepa Sailele Malielegaoi, the Prime Minister of Samoa, said he will propose a legislation that would penalize parents who refuse to vaccinate their children.[29] The Samoa government allocated US$2.5 million for relief work.[29]

International response[edit]

Australia first responded on the 4th of November and has since sent a team of nurses, doctors and public health experts as well as medical equipment and supplies to Samoa.[30]

New Zealand, sent 12 nurses and 3,000 vaccination doses to Samoa mid November,[31] and then sent an additional 18 nurses, bringing the total to 30.[32] Residents of Rotorua, New Zealand sent two dozen infant-size coffins decorated with flowers and butterflies to Samoan families.[33]

The United Kingdom and Israel sent medical teams to Samoa to help with relief.[34]

Hawaii sent a medical mission of 75 doctors and nurses for two days at the beginning of the outbreak. On December 10th, American Samoa declared a measles outbreak and closed public schools and park gatherings[35] and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa.[36]

UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency.[19]

The World Bank gave a US$3.5 million grant to support the response to the outbreak and another US$9.3m grant over the next five years to improve the health system.[34]

See also[edit]

References[edit]

  1. ^ a b "Samoa, Fiji and Tonga - Measles outbreak (DG ECHO, WHO, UNICEF and media) (ECHO Daily Flash of 25 November 2019) - Samoa". ReliefWeb. UN Office for the Coordination of Humanitarian Affairs (OCHA). 25 November 2019. Archived from the original on 2 December 2019.
  2. ^ "Ministry of Health Press Release 1 - Measles Epidemic - Samoa". ReliefWeb. Government of Samoa. 16 November 2019. Archived from the original on 1 December 2019.
  3. ^ a b c Davies, S. H. (1894). "Epidemic Measles at Samoa". BMJ. 1 (1742): 1077. doi:10.1136/bmj.1.1742.1077. PMC 2404975. PMID 20754822.
  4. ^ a b Whyte, Chelsea (6 December 2019). "Samoan government takes drastic measures to fight measles outbreak". Retrieved 8 December 2019. Cite journal requires |journal= (help)
  5. ^ "Australia - Oceania :: Samoa — The World Factbook - Central Intelligence Agency (July 2018 est.)". www.cia.gov. Retrieved 6 December 2019.
  6. ^ "Measles death toll rises to 68 in Samoa". Radio NZ. 8 December 2019. Archived from the original on 8 December 2019.
  7. ^ Samoa, Government of (5 December 2019). "Latest update: 4,357 measles cases have been reported since the outbreak with 140 recorded in the last 24 hours. To date, 63 measles related deaths have been recorded". Twitter. Retrieved 6 December 2019.
  8. ^ Pacific Beat (26 November 2019). "Samoa makes measles vaccinations compulsory after outbreak kills 32". ABC News. Archived from the original on 2 December 2019.
  9. ^ Barrett, Jonathan (9 December 2019). "Decorated with butterflies, infant-sized coffins sent to measles-ravaged Samoa". Reuters. New York, NY, US. Archived from the original on 10 December 2019.
  10. ^ a b c Gibney, Katherine. "Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster". Retrieved 12 December 2019.
  11. ^ Russell, Emma (29 November 2019). "Samoan measles outbreak: 70 deaths projected and 6500 infected". New Zealand Herald. ISSN 1170-0777. Archived from the original on 3 December 2019.
  12. ^ Agence France-Presse (28 November 2019). "Samoa measles outbreak: WHO blames anti-vaccine scare as death toll hits 39". The Guardian. UK. Archived from the original on 29 November 2019.
  13. ^ Beat, Pacific (2 August 2019). "'Her body was turning black': Samoan nurses jailed for infant vaccination deaths". ABC News. Retrieved 29 November 2019.
  14. ^ Clarke, Melissa (8 December 2019). "Anatomy of an epidemic: How measles took hold of Samoa". ABC News. Australian Broadcasting Corp. Archived from the original on 10 December 2019.
  15. ^ "Samoa: WHO and UNICEF estimates of immunization coverage: 2018 revision" (PDF). World Health Organization. 2018. Archived (PDF) from the original on 8 December 2019.
  16. ^ a b "The wrong jab that helped cause a measles crisis". BBC News. UK. 2 December 2019. Archived from the original on 5 December 2019.
  17. ^ "American Samoa declares measles outbreak". SBS News. Australia. 8 December 2019. Archived from the original on 9 December 2019.
  18. ^ "Samoa declares state of emergency over deadly measles outbreak". www.abc.net.au. 17 November 2019. Retrieved 26 November 2019.
  19. ^ a b "Samoa measles outbreak worsens". BBC News. UK. 23 November 2019. Archived from the original on 5 December 2019.
  20. ^ Wibawa, Tasha (19 November 2019). "'Deaths keep climbing': How did a measles outbreak become deadly in Samoa?". ABC News. Archived from the original on 2 December 2019.
  21. ^ "Authorities in Fiji urge public to respect quarantine". RNZ. 25 November 2019. Retrieved 26 November 2019.
  22. ^ "Children stay home, Christmas gatherings cancelled in Samoa". RNZ. 2 December 2019. Retrieved 3 December 2019.
  23. ^ "Samoa measles outbreak: Police urge public to keep to curfew". RNZ. 2 December 2019. Retrieved 3 December 2019.
  24. ^ Welle (www.dw.com), Deutsche. "Samoan measles epidemic: Unvaccinated advised to display red flags in front of their homes". DW.COM. Retrieved 4 December 2019.
  25. ^ "NZDF supporting Samoa measles epidemic response". Radio New Zealand. 3 December 2019. Retrieved 4 December 2019.
  26. ^ a b "Samoa Arrests Anti-Vaccination Activist As Measles Death Toll Rises". Retrieved 7 December 2019.
  27. ^ Purtill, James (5 December 2019). "Samoan measles anti-vaxxer with links to Australia arrested after spreading conspiracy theories". triple j - Hack. Australian Broadcasting Corp. Archived from the original on 7 December 2019.
  28. ^ "Samoa measles vaccination hits target but new cases still rising". Retrieved 8 December 2019.
  29. ^ a b "Samoa govt allocates more funds for measles epidemic". RNZ. 30 November 2019. Retrieved 1 December 2019.
  30. ^ "Statement on Samoa measles outbreak". ReliefWeb. Government of Australia. 21 November 2019. Archived from the original on 22 November 2019.
  31. ^ "Measles outbreak: Samoa declares state of emergency after 6 fatalities". Deutsche Welle. Germany. 18 November 2019. Archived from the original on 19 November 2019.
  32. ^ "Further support for Samoan measles outbreak - Samoa". ReliefWeb. Government of New Zealand. 18 November 2019. Archived from the original on 18 November 2019.
  33. ^ Gerson, Michael (10 December 2019). "Samoa has become a case study for 'anti-vax' success". Washington Post. US. Archived from the original on 10 December 2019.
  34. ^ a b "Jabs could knock out kid-killing measles epidemic in Samoa". New Zealand Herald. 10 December 2019. Archived from the original on 10 December 2019.
  35. ^ Hofschneider, Anita (10 December 2019). "Hawaii Lt Gov Says Samoa Medical Mission Won't Be The Last". Honolulu Civil Beat. Archived from the original on 10 December 2019.
  36. ^ "American Samoa tightens entry as measles fears grow". Radio New Zealand. 10 December 2019. Archived from the original on 10 December 2019.