2019 Samoa measles outbreak | |
---|---|
Disease | Measles |
Virus strain | D8 strain (genotype) of measles virus [1] |
Index case | 30 September 2019 |
Dates | 30 September 2019 – 22 December 2019 [2] |
Confirmed cases | 5,707 [3] |
Deaths | 83 [4] |
Government website | |
http://www.samoagovt.ws/ |
The 2019 Samoa measles outbreak began in September 2019. [5] As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. [4] [6] Over three per cent of the population were infected. [7] The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%.
A state of emergency was declared on 17 November, ordering the closure of all schools, keeping children under 17 away from public events, and vaccination became mandatory. On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings. Families seeking MMR vaccination were asked by the government to display an item of red cloth in front of their homes so as to alert mobile medical teams traveling the island during the lockdown. [8] Some added messages like "Help!" or "I want to live!". [9] On 5 and 6 December, the government shut down everything to bring civil servants over to the vaccination campaign. This curfew was lifted on 7 December when the government estimated that the vaccination program had reached 90% of the population. On 14 December, the state of emergency was extended to 29 December. [10] Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order". Finally, as of 22 December 2019, an estimated 94% of the eligible population had been vaccinated. [7]
Measles first arrived in Samoa in 1893, carried by a steamer from New Zealand. By the end of 1893, over 1,000 people (of a total population of 34,500 at that time) had died from the disease. [11]
In the early part of 2019, measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, the Philippines and New Zealand. [12]
In March 2019, the WHO and UN children's agency UNICEF warned the Pacific to take proactive measures and improve immunisation rates. [13]
In August 2019, an infected passenger on one of the more than 8,000 annual flights between New Zealand and Samoa probably brought the disease from Auckland to Upolu. [8] A full outbreak began in October 2019 and continued for the next four months. As of 22 December, there were 79 deaths (0.4 per 1,000, based on a population of 200,874, [7] [6] a rate of 14.3 deaths per 1000 infected) and 5,520 cases (2.75% of the population) of measles in Samoa. [2] [7] [6] 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15. [14] [15]
At least 20% of babies aged six to 11 months have contracted measles, and one in 150 babies have died. [16]
As of 20 December 2019, 94% of the population had been vaccinated. [16] [17] 95% is required to acquire herd immunity for measles. [16] Measles is much more contagious compared to other infectious diseases such as polio, which only requires an 80% vaccination rate for the population to attain herd immunity. [18]
The outbreak has been attributed to a sharp drop in measles vaccination from the previous year. [19]
In 2013, 90% of babies in Samoa received the measles-mumps-rubella vaccination at one year of age. [9]
On 6 July 2018 on the east coast of Savai'i, two 12-month-old children died after receiving MMR vaccinations. [8] The cause of death was incorrect preparation of the vaccine by two nurses who mixed vaccine powder with expired anaesthetic instead of the appropriate diluent. [20] These two deaths were picked up by anti-vaccine groups and used to incite fear towards vaccination on social media, causing the government to suspend its measles vaccination programme for ten months, despite advice from the WHO. [21] [19] The incident caused many Samoan residents to lose trust in the healthcare system. [22]
After the subsequent measles outbreak started, anti-vaxxers credited the dozens of measles deaths to poverty and poor nutrition or even to the vaccine itself, but this has been discounted by the international emergency medical support that arrived in November and December. [8] The Food and Agriculture Organization of the United Nations found that 30% of Samoan households were not meeting vitamin A requirements. [23] Another report of the Food and Agriculture Organization of the United Nations from 2018 found that the average daily vitamin A intake in Samoa was 310 micrograms, which is above the average daily requirement of 282 micrograms, but there were large disparities in the level of consumption across groups. [24] Indeed, Vitamin A deficiency is a recognized risk factor for severe measles infections. [25] To address this, UNICEF provided both vitamin A and measles vaccines, sufficient to address the needs by October 1, 2019. [26] [27] Despite the role of vitamin A in mitigating the harms of measles infections, and deficiency as a risk factor for severe disease, pediatricians responding to the outbreak reported that they did not see evidence of overt vitamin A deficiency in the measles patients, nor evidence of immunodeficiency. [28]
UNICEF and the World Health Organization estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018, [12] [29] similar to some of the poorest countries in Africa. [9] Ideally, countries should have 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, [30] and American Samoa. [31]
Before seeking proper medical treatment, some parents first took their children to 'traditional healers' who used machines purchased from Australia that are claimed to produce immune-protective water. [9]
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 country's low vaccination rate (31%). In Tonga and Fiji, the lack of fatalities is explained by far higher vaccination rates. [30]
Initially, schools remained open after the outbreak was declared. The Samoan government initially did not accept humanitarian support. [19]
A state of emergency was declared on 17 November, ordering the closure of all schools, keeping children under 17 away from public events, and making vaccination mandatory. [32] UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency. [33] Tonga closed all schools for several days, while American Samoa required all travellers from Tonga and Samoa to present proof of vaccination. [34] In Fiji, vaccines were prioritised for young children and people travelling overseas. [35]
On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings. [36] [37] All unvaccinated families were ordered to display a red flag or red cloth in front of their homes to warn others and to aid mass vaccination efforts. [38] As part of aid efforts, the Royal New Zealand Air Force transported medical supplies and equipment to Samoa. Medical teams from New Zealand, Australia, the United Kingdom, France and its overseas territory of French Polynesia also assisted Samoan medical authorities. [39]
On 5 and 6 December, the government shut down everything other than public utilities to assign all available civil servants to the vaccination campaign efforts. [40]
Edwin Tamasese, an anti-vaccination activist with no medical training who is also the chair of a coconut farmers’ collective, [8] was charged with "incitement against a government order". [40] He had posted online comments like "Enjoy your killing spree." [8] He encouraged people to refuse immunisation, as he believed the vaccine caused measles, [41] and even discouraged life-saving antibiotics. [8] Tamasese faced up to two years in prison. [8]
The curfew was lifted on 7 December when the government estimated that 90% of the population had been reached by the vaccination program. [42] Parliament passed a bill on 19 December to make measles vaccinations mandatory in 2020. [43]
Nevertheless, as of 29 December, a public inquiry into the government's role in suspending vaccinations had not been announced. Deputy director of health Gaualofa Matalavea Saaga stated, "Having our case blasted out to the world is the last thing we want." [8] Samoa's political opposition called for the health minister to be removed from his position. [8]
On 31 December, Tuilaʻepa Saʻilele Malielegaoi, the Prime Minister of Samoa, addressed the nation to ring in the New Year; the measles outbreak was a focus of his speech. He acknowledged the support of the Samoan diaspora and 49 medical teams from the following countries and organisations: Australia, China, France/French Polynesia, Fiji through UNFPA, Israel, United States/Hawaii, Japan, Papua New Guinea, New Zealand, Norway, United Nations Agencies, United Kingdom and UK Save the Children, Solomon Islands and Kiribati through the Pacific Community, American Samoa, Médecins Sans Frontières, Blacktown Doctors Medical Centre, and Samoan Doctors Worldwide. [44]
The low vaccination rate of Samoa came as a surprise to New Zealand's government. [45] The Samoa Observer reported that New Zealand's Minister for Pacific People, William Sio, was "'of the impression' that Samoa had high immunisation rates. So to learn they were in fact fatality[ sic ] low was a shock." [45]
Since the outbreak, several organisations and countries have responded:
As of 24 December, the following agencies had sent Emergency Medical Team personnel to assist with the outbreak: [57]
Tuilaepa said he would propose legislation that would penalise parents who refused to vaccinate their children. [58] The Samoan government allocated US$2.5 million for relief work. [58]
Immunology experts are now questioning the role of social media, primarily Facebook, and how social media facilitated the spread of vaccination hesitancy during the lethal outbreak. The Immunisation Advisory Centre in New Zealand sees the Samoan crisis as a sign that social media needs to deal with dangerous misinformation. [59]
By 25 January 2020, Tuilaepa had resisted calls for an inquiry. [60] Opposition MP Olo Fiti Vaʻai continued to call for an inquiry and was "apologising on behalf of Parliament and telling the people of Samoa that the government had failed miserably." [61] [19]
Following the ousting of the HRPP in the 2021 Samoan general election, new Health Minister Valasi Toogamaga Tafito announced he was considering establishing an inquiry into the epidemic. [62]
Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.
Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. Although adverse effects associated with vaccines are occasionally observed, the scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.
A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by state or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available.
Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.
The 2009–2010 West African meningitis outbreak was an epidemic of bacterial meningitis which occurred in Burkina Faso, Mali, Niger, and Nigeria since January 2009, an annual risk in the African meningitis belt. A total of 13,516 people have been infected with meningitis, and 931 have died. Nigeria has been the most adversely affected, with over half of the total cases and deaths occurring in the nation. The WHO reported on 27 March 2009 that 1,100 had died and there were 25,000 suspected cases. It is the worst outbreak in the region since 1996, and a third of the world's emergency vaccine stockpile for the bacterial form has been consumed. The GAVI Alliance has been trying to secure more vaccines.
Warnings About Vaccination Expectations NZ (WAVESnz), formerly the Immunisation Awareness Society (IAS), is a New Zealand anti-vaccination lobby group.
Measles is extremely contagious, but surviving the infection results in lifelong immunity, so its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000. Due to the development of vaccination against measles, the world has seen a 99% decrease in measles related cases compared cases before the vaccine was developed.
Within the Pacific, Tonga is recognised to have some of the highest overall health standards, implementing a combination of preventative and immediate strategies to curb rates of communicable disease, child mortality and overall life expectancy. The Tongan government aims to continue such levels of health through achieving their Millennium Development Goals (MDG) detailing their focus on improving their healthcare system within the areas of maternal and infant health as well as improve access to immunisation, safe water and sanitation.
The 2019 Philippines measles outbreak began in early 2019. An outbreak of measles was officially declared in February 2019 in select administrative regions in Luzon and Visayas including Metro Manila by the Philippine government. The outbreak is attributed to lower vaccination rates, from a high of 88% 10 to 15 years previous to 74% at the time of the outbreak, allegedly caused by the Dengvaxia controversy.
The 2019 measles outbreaks refer to a substantial global increase in the number of measles cases reported, relative to 2018. As of April 2019, the number of measles cases reported worldwide represented a 300% increase from the number of cases seen in the previous year, constituting over 110,000 measles cases reported in the first three months of 2019. In the first half of 2019, the World Health Organization received reports of 364,808 measles cases from 182 countries, up 182% from the same time period of 2018 when 129,239 confirmed cases were reported by 181 countries.
Measles was declared eliminated from the United States in 2000 by the World Health Organization due to the success of vaccination efforts. However, it continues to be reintroduced by international travelers, and in recent years, anti-vaccination sentiment has allowed for the reemergence of measles outbreaks.
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The 2019–2020 New Zealand measles outbreak was an epidemic that affected New Zealand, primarily the Auckland region. The outbreak was the worst epidemic in New Zealand since an influenza epidemic in 1999, and is the worst measles epidemic since 1938.
The 2019–2021 polio outbreak in the Philippines was an epidemic. For the previous 19 years, the Philippines was free of any polio-related diseases. On September 14, 2019, the disease began to resurface through a positive test result done to a 3-year-old girl from Mindanao. After the confirmation of a second case from tests done on a 5-year-old boy, the government of the Philippines publicly declared a polio outbreak on September 19, 2019. On June 11, 2021, the WHO announced that the outbreak has ended.
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Taylor Winterstein is an Australian-Samoan online influencer and conspiracy theorist best known for her public anti-vaccination stance. Winterstein has been heavily criticised in several South Pacific, and Australasian countries for her anti-vaccination rhetoric and her seminars have been called "irresponsible" by the Australian Medical Association and a "public health threat" by the Samoan Ministry of Health. She claims she has not encouraged non-vaccination, rather, "informed consent" and "freedom of choice".
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The Immunisation Advisory Centre (IMAC) is a New Zealand-wide organisation which provides information and training about immunization and vaccine-preventable diseases to health care professionals, government bodies, and individuals. It co-ordinates the nation's immunisation programmes, policy advice and research. It was launched in 1997, and is based at The University of Auckland.
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