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[SYDNEY] Fifty-three people, including 48 children under the age of four years, have died of measles in the small Pacific island nation of Samoa, which is facing the worst outbreak of this highly contagious disease driven by low vaccination levels.

Samoa’s Prime Minister Tuilaepa Lupesoliai Neioti Aiono Sailele Malielegaoi announced on Monday (2 December) that all branches of government, except water and electricity departments, will be closed on Thursday and Friday this week and civil servants will be redeployed to help in the mass immunisation drive to vaccinate everybody up to the age of 60 years.

The World Health Organization (WHO) estimates Samoa’s total population immunity to be as low as 31 per cent. To prevent measles outbreaks, it is recommended that countries should aim to achieve and sustain at least 95 per cent immunisation coverage.

“Unless all countries urgently accelerate progress to reach all children with two timely doses of measles vaccine, large and costly outbreaks will continue to occur, including in countries that have achieved elimination”

Jose Hagan, WHO Regional Office for the Western Pacific

Measles has seen a wide resurgence around the world both in lower income countries of Asia and Africa and in high-income countries of Europe and North America. Preliminary global data shows that reported cases rose by 300 per cent in the first three months of 2019, compared to the same period in 2018.

Jose Hagan, medical officer, WHO Regional Office for the Western Pacific tells SciDev.Net: “Measles outbreaks in the Pacific are occurring in the context of a global surge in measles cases. Currently Samoa, Tonga and Fiji have declared and are responding to measles outbreaks.”

Large gatherings have been banned, schools have been closed and children have been urged to stay away from Christmas congregations. Restrictions have been imposed on travel ahead of the Christmas holiday season.

Samoa health facility sign
Sign hanging outside the Tupua Tamasese Meaole (TTM) Hospital at Motootua. Image credit: UNICEF/Mulivai.

Measles is an airborne viral disease that can spread easily through breathing, coughing, and sneezing amongst people who are not immune i.e. people who have not been vaccinated or those who have never had the disease. Symptoms may include fever, red flat rash, cough, runny nose and watery eyes.

Most people recover from a measles infection in 8-10 days, but for some, severe complications such as pneumonia or encephalitis may occur, which can be fatal.

“The case fatality rate in Samoa (currently below two per cent) is sadly well within the expected range of developing countries (which can be up to five per cent or more). The virus cannot be directly treated, but supplementation with Vitamin A can reduce the risk of death,” Hagan says.  

There are now over 3,700 cases of measles recorded in the small island state of just around 200,000 people.

Globally, the number one factor for under-immunisation is lack of access to vaccines. Other factors include complacency and the spread of misinformation about vaccines.

In Samoa, the low vaccination rate was in part attributed to public distrust of the vaccine following the deaths of two infants in July 2018 soon after receiving the MMR (measles, mumps and rubella) vaccine. However, later it was found that the deaths were because the nurses had mixed the vaccine with a muscle relaxant drug instead of water.

Hagan warned that “unless all countries urgently accelerate progress to reach all children with two timely doses of measles vaccine, large and costly outbreaks will continue to occur, including in countries that have achieved elimination”.

Since 1 October, UNICEF has delivered more than 400,000 measles vaccines with required diluent, syringes and safety boxes to Samoa, Fiji, Tonga, Cook Islands, Fiji Nauru, Niue, Samoa Tokelau, Tuvalu and Vanuatu. UNICEF has also delivered tents, specially designed refrigerators — for the vaccine cold chain — emergency trolleys and sufficient supplies of Vitamin A to countries most at need.

“Fiji and Tonga have high measles coverage but the lack of catch up vaccination of those who have missed out meant that these countries have also accumulated vulnerable population. The chance of spread to other countries is also very high because of the social and economic relationships amongst the Pacific Island countries,” Sheldon Yett, UNICEF Pacific Representative, tells SciDev.Net.

WHO and UNICEF have also developed a Pacific Measles Preparedness and Response Communication Toolkit to help Pacific health authorities communicate about measles. It includes a range of communication products targeting three main audiences: general public, health workers and travellers. “In today’s world of high-volume international travel, such outbreaks pose a risk of onward spread to any country with less than optimal protection of its population through high measles vaccination coverage,” Mike Catton, co-deputy director of the Peter Doherty Institute for Infection and Immunity in Melbourne, tells SciDev.Net.

In proximity to Pacific Island countries and areas, outbreaks of measles have been reported in Australia, Cambodia, China (including Hong Kong and Macao), Japan, Lao People's Democratic Republic, Malaysia, New Zealand, Philippines, Republic of Korea, US and Vietnam. 
 
This piece was produced by SciDev.Net’s Asia & Pacific desk.
 

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