| 2019 Tonga measles outbreak | |
|---|---|
 | |
| Disease | Measles |
| Virus strain | D8 strain (genotype) of measles virus [1] |
| Index case | October, 2019 |
| Dates | 22 October 2019 – present [2] |
| Confirmed cases | 612 [3] |
Deaths | 0 |
| Government website | |
| https://reliefweb.int/report/tonga/tonga-measles-outbreak-2019-situation-report-8 | |
The 2019 Tonga measles outbreak began in October 2019 after a squad of Tongan rugby players came back from New Zealand. [4] As of 5 January, 2020, there have been 612 cases of measles.
Beginning in 2017, the WHO began tracking measles outbreaks in the Asia Pacific Region. Measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, Australia, Cambodia, Japan, the Republic of Korea, Malaysia, Thailand, Vietnam, Samoa, the Philippines and New Zealand. [5] [6] Previously, measles had been believed to be eradicated in the Asia Pacific Region, with the last reported case in 2014, prior to the outbreak. [6]
Samoa, Tonga and Fiji have all declared states of emergency to tackle their 2019 measles outbreaks. When contrasting the scores of deaths in Samoa to the lack of fatalities in Tonga and Fiji, this is put down to the far higher vaccination rates in Tonga and Fiji compared to the 31% in Samoa. [7]
Most of the cases have been on the island of Tongatapu where the first cases started, with 88% of all cases located on Tongatapu and 10% located on the neighboring island of Vava'u. [8] [9]
The outbreak has been attributed to a sharp drop in measles vaccination in Samoa from the previous year, following an incident in 2018 when two infants died in Samoa shortly after receiving measles vaccinations, which led the country to suspend its measles vaccination program. [10] The reason for the two infants' deaths was incorrect preparation of the vaccine by two nurses who mixed vaccine powder with expired anaesthetic. [11] The nurses responsible were sentenced to 5 years in prison with manslaughter charges and Samoa began arresting anti-vaccination advocates. [12] The United States' Center of Disease Control sent representatives to Samoa, Tonga, and Fiji to coordinate vaccine efforts and combate vaccine misinformation. [12]
Ministry of Health chief executive, Siale 'Akau'ola, said more than 12,000 people had been re-vaccinated. This vaccination program targeted school children and 6-11 month-old infants. A second vaccination program was conducted in February 2020, targeting children ages 1–9 years old. [13] The vaccination rate in Tonga was over 90% which might stem the infection rates seen in Samoa and New Zealand. [14] In November, 2019, the Tongan Minister of Education shut down all primary schools until the beginning of 2020. [15]
UNICEF has sent almost 300,000 vaccines to Vanuatu, Cook Islands, Nauru, Niue, Tokelau and Tuvalu, Samoa, Tonga, and Fiji. [16] Samoa, Tonga, and Fiji have also declared states of emergency. [17] The WHO and UNICEF have developed a toolkit for Pacific Island Nations following the outbreak to aid in further measles prevention. [16] Tonga closed all schools for several days while American Samoa required all travelers from Tonga and Samoa to present proof of vaccination. [18] The United States' Center for Disease control placed a Level 1 travel ban to the Kingdom of Tonga following the outbreak. [15]
Since 1 October, UNICEF has delivered 12,000 measles vaccines to Tonga. [19] UNICEF later provided 6,000 additional doses of the vaccine cold chain following the success of the first administration. [15] Through domestic and internationally coordinated efforts, 44,605 individuals under the age of 24 were vaccinated by January 2020. This included administration of supplementary vaccines for previously vaccinated individuals in conjunction with routine childhood vaccination. [20]
On 10 December, American Samoa declared a measle outbreak and closed public schools and park gatherings [21] and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa. [22]
Tonga, officially the Kingdom of Tonga, is a Polynesian country and an archipelago. The country has 171 islands – of which 45 are inhabited. Its total surface area is about 750 km2 (290 sq mi), scattered over 700,000 km2 (270,000 sq mi) in the southern Pacific Ocean. As of 2021, according to Johnson's Tribune, Tonga has a population of 104,494, 70% of whom reside on the main island, Tongatapu. The country stretches approximately 800 km (500 mi) north-south. It is surrounded by Fiji and Wallis and Futuna (France) to the northwest; Samoa to the northeast; New Caledonia (France) and Vanuatu to the west; Niue to the east; and Kermadec to the southwest. Tonga is about 1,800 km (1,100 mi) from New Zealand's North Island. Tonga is a member of The Commonwealth.
The history of Tonga is recorded since the ninth century BC, when seafarers associated with the Lapita diaspora first settled the islands which now make up the Kingdom of Tonga. Along with Fiji and Samoa, the area served as a gateway into the rest of the Pacific region known as Polynesia. Ancient Tongan mythologies recorded by early European explorers report the islands of 'Ata and Tongatapu as the first islands having been hauled to the surface from the deep ocean by Maui.
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. 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.
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 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 decrease. 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.
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.
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.
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.
The 2019 Samoa measles outbreak began in September 2019. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. Over three percent of the population were infected. 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%.
Taylor Winterstein is an Australian-Samoan online influencer 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".
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.
The COVID-19 pandemic was confirmed to have reached Tonga on 29 October 2021 with a traveller who tested positive in quarantine. Several more cases were found in January and February 2022 in a minor outbreak during the aftermath of the 2022 Hunga Tonga–Hunga Ha'apai eruption and tsunami as other countries delivered aid. These are currently the only cases in the country so far; Tonga has followed a "Covid-free" policy.
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.
The COVID-19 vaccination campaign began in Fiji on the first quarter of 2021 and will continue throughout the year with the goal of vaccinating all eligible Fijians. The government has made it mandatory for all eligible adults to take the COVID-19 vaccines.