2019 Samoa measles outbreak

Last updated

2019 Samoa measles outbreak
Samoa - Location Map (2013) - WSM - UNOCHA.svg
Disease Measles
Virus strainD8 strain (genotype) of measles virus [1]
Index case 30 September 2019
Dates30 September 2019 –
22 December 2019 [2]
Confirmed cases5,707 [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%.

Contents

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]

Background

Hypothetical measles timeline from exposure to illness Measles timeline exposure to illness.gif
Hypothetical measles timeline from exposure to illness

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]

2019 outbreak

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]

Vaccine hesitancy

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]

Government response

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 are being 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 has transported medical supplies and equipment to Samoa. Also, New Zealand, Australian, British, French Polynesian, and French medical teams have been assisting 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 faces 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, Tuilaepa Sailele 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]

International response

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:

Others

As of 24 December, the following agencies had sent Emergency Medical Team personnel to assist with the outbreak: [57]

  • Japan
  • PACMAT
  • Norway
  • Save the Children
  • UNFPA
  • Papua New Guinea
  • Samoa mo Samoa Doctors Worldwide
  • French Polynesia
  • Counties Manuka District Health Board
  • NZMAT
  • MSF
  • ADRA
  • Pacific Community (SPC)
  • World Health Organization

Aftermath

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]

As of 25 January 2020, Tuilaepa has so far resisted calls for an inquiry. [60] Opposition MP Olo Fiti Va'ai continues 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]

See also

Related Research Articles

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

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.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

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. 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.

<span class="mw-page-title-main">Measles vaccine</span> Vaccine used to prevent measles

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.

Warnings About Vaccination Expectations NZ (WAVESnz), formerly the Immunisation Awareness Society (IAS), is a New Zealand anti-vaccination lobby group.

<span class="mw-page-title-main">Epidemiology of measles</span>

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.

In early months of 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; outbreaks in 2019 in areas including Brooklyn and Rockland County, New York have since seen far greater numbers of cases.

<span class="mw-page-title-main">2019 measles outbreak in the Philippines</span> Disease outbreak in the Philippines

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.

In early September 2018, cases of measles began to appear in Antananarivo, Madagascar. Capitol health authorities challenged by the district's poverty and Madagascar's relatively-low vaccination rate were unable to contain the highly-contagious disease, and what followed became the largest measles outbreak yet in Madagascar's history. With more than 115,000 people infected and more than 1,200 dying, the outbreak has become Madagascar's most serious outbreak of measles in the 21st century.

<span class="mw-page-title-main">2019–2020 New Zealand measles outbreak</span> Measles epidemic affecting New Zealand

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.

<span class="mw-page-title-main">2019–2021 polio outbreak in the Philippines</span> Disease outbreak in the Philippines

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.

<span class="mw-page-title-main">2019–2020 measles outbreak in the Democratic Republic of the Congo</span> Measles epidemic in the DRC in 2019

In 2019, a measles epidemic broke out in the Democratic Republic of the Congo (DRC). The epidemic started in early 2019 in the southeast corner of the DRC and then spread to all provinces. By June 2019 the epidemic was reported to have exceeded the death toll of the concurrent Ebola epidemic. By April 2020, it had infected more than 341,000 people and claimed about 6,400 fatalities. This has primarily affected children under the age of five, representing 74% of infections and nearly 90% of deaths.

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".

<span class="mw-page-title-main">2019 Tonga measles outbreak</span> Measles epidemic in Tonga in late 2019

The 2019 Tonga measles outbreak began in October 2019 after a squad of Tongan rugby players came back from New Zealand. As of 5 January, 2020, there have been 612 cases of measles.

<span class="mw-page-title-main">COVID-19 pandemic in Oceania</span> Ongoing COVID-19 pandemic in Oceania

The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020 with the first confirmed case reported in Melbourne, Australia. The virus has spread to all sovereign states and territories in the region. Australia and New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction in the community.

<span class="mw-page-title-main">COVID-19 pandemic in Samoa</span> Ongoing COVID-19 viral pandemic in Samoa

The COVID-19 pandemic in Samoa is part of the ongoing worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2. The virus was confirmed to have reached Samoa on 18 November 2020. The country reported its second case on 27 November.

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.

<span class="mw-page-title-main">Anti-vaccine activism</span>

Anti-vaccine activism, also called the "anti-vax" movement, is organized activity designed to increase vaccine hesitancy, often by disseminating misinformation or disinformation. Although myths, conspiracy theories, misinformation and disinformation spread by the anti-vaccination movement and fringe doctors increases vaccine hesitancy and public debates around the medical, ethical, and legal issues related to vaccines, there is no serious hesitancy or debate within mainstream medical and scientific circles about the benefits of vaccination.

References

  1. ↑ "WHO/UNICEF Secretariat Supporting Measles Outbreak Preparedness And Response In The Pacific" (PDF). who.int. World Health Organization. 22 November 2019. Archived (PDF) from the original on 13 December 2019.
  2. 1 2 "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.
  3. ↑ "Health Emergency Operation Centre: Update on the measles outbreak, January 20, 2020 - Samoa". ReliefWeb. Government of Samoa. 20 January 2020. Archived from the original on 15 February 2020.
  4. 1 2 "Two more deaths from measles in samoa over new year period". Radio New Zealand . 7 January 2020. Archived from the original on 7 January 2020.
  5. ↑ "Ministry of Health Press Release 1 - Measles Epidemic - Samoa". ReliefWeb. Government of Samoa. 16 November 2019. Archived from the original on 1 December 2019.
  6. 1 2 3 "Population & Demography Indicator Summary". Samoa Bureau of Statistics. 22 December 2019. Archived from the original on 8 December 2019.
  7. 1 2 3 4 Government of Samoa (22 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 36) 22 December, 2019". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
  8. 1 2 3 4 5 6 7 8 9 10 Deer, Brian (20 December 2019). "Samoa's perfect storm: How a collapse in vaccination rates killed more than 70 children". The Telegraph. London, UK. ISSN   0307-1235. Archived from the original on 21 December 2019.
  9. 1 2 3 4 Kwai, Isabella (19 December 2019). "'Why My Baby?' How Measles Robbed Samoa of Its Young". The New York Times. US. Archived from the original on 31 December 2019.
  10. ↑ "Samoa measles state of emergency extended". Radio New Zealand. 14 December 2019. Archived from the original on 14 December 2019.
  11. ↑ Davies, Samuel H. (1894). "Epidemic Measles at Samoa". The British Medical Journal. 1 (1742): 1077. doi:10.1136/bmj.1.1742.1077. PMC   2404975 . PMID   20754822.
  12. 1 2 Whyte, Chelsea (6 December 2019). "Samoan government takes drastic measures to fight measles outbreak". New Scientist. Archived from the original on 10 December 2019. Retrieved 8 December 2019.
  13. ↑ Duckor-Jones, Avi (5 February 2020). "Tragedy in paradise: How Samoa is faring after the measles epidemic". The Listener. NZ: Bauer Media Pty Ltd. Archived from the original on 23 February 2020.
  14. ↑ Government of Samoa (9 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 23) 9 December". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
  15. ↑ 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.
  16. 1 2 3 Gibney, Katherine (12 December 2019). "Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster". The Conversation. Melbourne, Australia: The Conversation Media Trust. Archived from the original on 12 December 2019.
  17. ↑ Kerr, Florence (20 December 2019). "Samoa measles outbreak: Death toll continues to rise, 39 new cases". stuff.co.nz. NZ: Stuff Ltd. Archived from the original on 20 December 2019.
  18. ↑ Belluz, Julia (18 December 2019). "Tiny Samoa has had nearly 5,000 measles cases. Here's how it got so bad". Vox. US: Vox Media LLC. Archived from the original on 8 January 2020.
  19. 1 2 3 4 Jackson, Lagipoiva Cherelle; Lyons, Kate (17 December 2019). "'These babies should not have died': How the measles outbreak took hold in Samoa". The Guardian. UK. ISSN   0261-3077. Archived from the original on 18 December 2019.
  20. ↑ Pacific Beat (2 August 2019). "Samoan nurses jailed over deaths of two babies who were given incorrectly mixed vaccines". ABC News. Australian Broadcasting Corp. Archived from the original on 14 December 2019.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ Samoa Household Nutrition in Brief pafpnet.spc.int
  24. ↑ Publication preview page | FAO | Food and Agriculture Organization of the United Nations. 2020. doi:10.4060/cb0613en. ISBN   978-92-5-133157-6. S2CID   243356457 . Retrieved 13 February 2024.{{cite book}}: |website= ignored (help)
  25. ↑ Yang, Hui Ming; Mao, Meng; Wan, Chaomin (19 October 2005). "Vitamin A for treating measles in children". The Cochrane Database of Systematic Reviews. 2005 (4): CD001479. doi:10.1002/14651858.CD001479.pub3. PMC   7076287 . PMID   16235283.
  26. ↑ "SAMOA MEASLES UPDATE: Death toll rises to 42". www.samoanews.com. 29 November 2019. Retrieved 13 February 2024.
  27. ↑ "WHO/UNICEF SECRETARIAT SUPPORTING MEASLES OUTBREAK PREPAREDNESS AND RESPONSE IN THE PACIFIC - MEASLES OUTBREAK IN THE PACIFIC - SITUATION REPORT No 5" (PDF). WHO.int. 6 December 2019. Archived (PDF) from the original on 13 February 2024. Retrieved 12 February 2023.
  28. ↑ "Samoa's perfect storm: How a collapse in vaccination rates killed more than 70 children". The Telegraph. 20 December 2019. ISSN   0307-1235 . Retrieved 13 February 2024.
  29. ↑ "Samoa: WHO and UNICEF estimates of immunization coverage: 2018 revision" (PDF). World Health Organization. 2018. Archived (PDF) from the original on 8 December 2019.
  30. 1 2 "The wrong jab that helped cause a measles crisis". BBC News. UK. 2 December 2019. Archived from the original on 5 December 2019.
  31. ↑ "American Samoa declares measles outbreak". SBS News. Australia. 8 December 2019. Archived from the original on 9 December 2019.
  32. ↑ "Samoa declares state of emergency over deadly measles outbreak". ABC News. Australian Broadcasting Corp. 17 November 2019. Archived from the original on 2 December 2019.
  33. 1 2 "Samoa measles outbreak worsens". BBC News. UK. 23 November 2019. Archived from the original on 5 December 2019.
  34. ↑ 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.
  35. ↑ "Authorities in Fiji urge public to respect quarantine". Radio New Zealand. 25 November 2019. Archived from the original on 2 December 2019.
  36. ↑ "Children stay home, Christmas gatherings cancelled in Samoa". Radio New Zealand. 2 December 2019. Archived from the original on 26 February 2020.
  37. ↑ "Samoa measles outbreak: Police urge public to keep to curfew". Radio New Zealand. 2 December 2019. Archived from the original on 21 December 2019.
  38. ↑ Silk, John; AFP (4 December 2019). "Samoan measles epidemic: Unvaccinated advised to display red flags in front of their homes". Deutsche Welle. Germany. Archived from the original on 5 December 2019.
  39. ↑ "NZDF supporting Samoa measles epidemic response". Radio New Zealand. 3 December 2019. Archived from the original on 3 December 2019.
  40. 1 2 Kennedy, Merrit (6 December 2019). "Samoa Arrests Anti-Vaccination Activist As Measles Death Toll Rises". NPR. US. Archived from the original on 31 January 2020.
  41. ↑ 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.
  42. ↑ "Samoa measles vaccination hits target but new cases still rising". Al Jazeera English. 7 December 2019. Archived from the original on 9 December 2019.
  43. ↑ "Samoa's measles death toll rises to 78". Radio New Zealand. 20 December 2019. Archived from the original on 20 December 2019.
  44. ↑ Feagaimaali'i, Joyetter (1 January 2020). "Prime Minister addresses nation at start of 2020". Samoa Observer. Archived from the original on 1 January 2020.
  45. 1 2 Mayron, Sapeer (5 January 2020). "It's okay to vaccinate, Minister Aupito spreads the message". Samoa Observer. Archived from the original on 25 January 2020.
  46. ↑ "Statement on Samoa measles outbreak". ReliefWeb. Government of Australia. 21 November 2019. Archived from the original on 22 November 2019.
  47. ↑ Wilson, Soli (5 January 2020). "Australia's emergency measles mission ends". Samoa Observer. Archived from the original on 16 March 2020.
  48. ↑ "Measles outbreak: Samoa declares state of emergency after 6 fatalities". Deutsche Welle. Germany. 18 November 2019. Archived from the original on 19 November 2019.
  49. ↑ 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.
  50. ↑ "Samoa measles outbreak: New Zealand gives $1m for preventive action in Pacific". Stuff. New Zealand: Stuff Limited. 14 December 2019. Archived from the original on 14 December 2019.
  51. ↑ Department for International Development (29 November 2019). "UK medics fight deadly measles outbreak in Samoa - Press release". UK Government. Archived from the original on 30 November 2019.
  52. 1 2 Meyer, Jenny; RNZ (10 December 2019). "Jabs could knock out kid-killing measles epidemic in Samoa". New Zealand Herald. NZME. Archived from the original on 10 December 2019.
  53. ↑ Hofschneider, Anita (9 December 2019). "Hawaii Lt Gov Says Samoa Medical Mission Won't Be The Last". Honolulu Civil Beat. HI, US. Archived from the original on 10 December 2019.
  54. ↑ "American Samoa tightens entry as measles fears grow". Radio New Zealand. 10 December 2019. Archived from the original on 10 December 2019.
  55. 1 2 "UN team aids Samoa response to deadly measles epidemic". UN News. 5 December 2019. Archived from the original on 6 December 2019. Retrieved 21 April 2021.
  56. ↑ Leichman, Abigail Klein (8 December 2019). "Israeli medical experts fly to help Samoan measles victims". Israel21c news. San Francisco, US. Archived from the original on 8 January 2020.
  57. ↑ Govt Press Release (25 December 2019). "Emergency Medical Teams Work Through Christmas". Samoa Global News. Archived from the original on 16 January 2020.
  58. 1 2 "Samoa govt allocates more funds for measles epidemic". Radio New Zealand. 30 November 2019. Archived from the original on 30 November 2019.
  59. ↑ Hendrie, Doug (11 December 2019). "Facebook challenged over spread of anti-vaccine content in measles-stricken Samoa". newsGP. The Royal Australian College of General Practitioners. Archived from the original on 18 December 2019.
  60. ↑ "Samoa's measles crisis wanes, but questions remain unanswered". Radio New Zealand. 24 January 2020. Archived from the original on 25 January 2020.
  61. ↑ "MP calls for inquiry into Samoa's measles epidemic". Radio New Zealand. 21 January 2020. Archived from the original on 25 January 2020.
  62. ↑ Joyetter Feagaimaali'i (18 August 2021). "Government considers measles inquiry". Samoa Observer. Archived from the original on 18 August 2021. Retrieved 29 August 2021.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.