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2019 Samoa measles outbreak

The 2019 Samoa measles outbreak began in September 2019.[3] As of 16 December, there were 5,331 confirmed cases of measles and 75 deaths, out of a Samoan population of 201,316.[4] Over two percent of the population has been infected.[4]

2019 Samoa measles outbreak
Samoa - Location Map (2013) - WSM - UNOCHA.svg
DiseaseMeasles
Virus strainD8 strain (genotype) of measles virus [1]
First case30 September 2019
Dates30 September 2019 –
ongoing[2]
Deaths75
Confirmed cases5,331
Official website
http://www.samoagovt.ws/

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. On 14 December, the state of emergency was extended to the 29 December.[5] Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order".

On 2 December 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 5 and 6 December, the government shut down everything other than public utilities to move all civil servants over to the vaccination campaign. This curfew was lifted on 7 December when the government estimated that 90% of the population was reached by the vaccination program. As of 12 December, 93% of the population had been vaccinated.

BackgroundEdit

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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.[6] 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.[6] There was a greater incidence of chest infections after the outbreaks.[6]

Measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, the Philippines and New Zealand.[7]

2019 outbreakEdit

The 2019 Samoa measles outbreak began in October 2019 and is ongoing as of December 2019. As of 9 December, there have been 72 deaths (0.36 per 1,000, based on a population of 201,316,[8] a rate of 14.2 deaths per 1000 infected) and over 5,080 cases (2.5% of the population) of measles in Samoa.[9][10][11][2] 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15.[12]

At least 20% of babies aged six to 11 months have contracted measles and one in 150 babies have died.[13]

In late November 2019, it was expected that around 70 people would die and up to 6,500 people would be infected.[14]

As of 12 December, 93% of the population has been vaccinated.[13] 95% is required to acquire herd immunity.[13]

Vaccine hesitancyEdit

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.[15] 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.[16] Following the incident, the government temporarily stopped its vaccination program. However, the incident caused many Samoan residents to lose trust in the healthcare system.[17]

UNICEF and the World Health Organisation estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018.[7][18] 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[19] and American Samoa.[20]

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.[19]

Government responseEdit

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.[21] UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency.[22] Tonga closed all schools for several days while American Samoa required all travellers from Tonga and Samoa to present proof of vaccination.[23] In Fiji, vaccines are being prioritised for young children and people traveling overseas.[24]

On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings.[25][26] 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.[27] 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.[28]

On 5 and 6 December, the government shut down everything other than public utilities in order to assign all available civil servants to the vaccination campaign.[29] It also arrested anti-vaccination activist, Edwin Tamasese, who was charged with "incitement against a government order"[29] after he had encouraged his patients to not get immunised as he believed the vaccine caused measles.[30] This curfew was lifted on 7 December when the government estimated that 90% of the population was reached by the vaccination program.[31]

AftermathEdit

Tuilaepa Sailele Malielegaoi, the Prime Minister of Samoa, said he will propose a legislation that would penalize parents who refuse to vaccinate their children.[32] The Samoa government allocated US$2.5 million for relief work.[32]

International responseEdit

Australia first responded on 4 November and has since sent a team of nurses, doctors and public health experts as well as medical equipment and supplies to Samoa.[33]

New Zealand sent 12 nurses and 3,000 vaccination doses to Samoa mid November,[34] and then sent an additional 18 nurses, bringing the total to 30.[35] Residents of Rotorua, New Zealand sent two dozen infant-size coffins decorated with flowers and butterflies to Samoan families.[36] On 14 December 2019, New Zealand Foreign Minister Winston Peters announced $1 million in funds towards preventive efforts in the Pacific.[37]

The United Kingdom and Israel sent medical teams to Samoa to help with relief.[38]

Hawaii sent a medical mission of 75 doctors and nurses for two days at the beginning of the outbreak. On 10 December, American Samoa declared a measles outbreak and closed public schools and park gatherings[39] and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa.[40]

UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency.[22]

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.[38]

See alsoEdit

ReferencesEdit

  1. ^ (PDF). WHO. Retrieved 16 December 2019.
  2. ^ a b . ReliefWeb. UN Office for the Coordination of Humanitarian Affairs (OCHA). 25 November 2019. Archived from the original on 2 December 2019.
  3. ^ . ReliefWeb. Government of Samoa. 16 November 2019. Archived from the original on 1 December 2019.
  4. ^ a b McNamara, Audrey (14 December 2019). . CBS News. US: CBS Interactive Inc. Archived from the original on 15 December 2019.
  5. ^ . Radio New Zealand. 14 December 2019. Archived from the original on 14 December 2019.
  6. ^ a b c Davies, S. H. (1894). . BMJ. 1 (1742): 1077. doi:10.1136/bmj.1.1742.1077. PMC?2404975. PMID?20754822.
  7. ^ a b Whyte, Chelsea (6 December 2019). . Retrieved 8 December 2019. Cite journal requires |journal= (help)
  8. ^ . www.cia.gov. Retrieved 6 December 2019.
  9. ^ . Radio NZ. 8 December 2019. Archived from the original on 8 December 2019.
  10. ^ Samoa, Government of (5 December 2019). . Twitter. Retrieved 6 December 2019.
  11. ^ Pacific Beat (26 November 2019). . ABC News. Archived from the original on 2 December 2019.
  12. ^ Barrett, Jonathan (9 December 2019). . Reuters. New York, NY, US. Archived from the original on 10 December 2019.
  13. ^ a b c Gibney, Katherine (12 December 2019). . The Conversation. Melbourne, Australia: The Conversation Media Trust. Archived from the original on 12 December 2019.
  14. ^ Russell, Emma (29 November 2019). . New Zealand Herald. ISSN?1170-0777. Archived from the original on 3 December 2019.
  15. ^ Agence France-Presse (28 November 2019). . The Guardian. UK. Archived from the original on 29 November 2019.
  16. ^ Beat, Pacific (2 August 2019). 'Her body was turning black': Samoan nurses jailed for infant vaccination deaths". ABC News. Retrieved 29 November 2019.
  17. ^ Clarke, Melissa (8 December 2019). . ABC News. Australian Broadcasting Corp. Archived from the original on 10 December 2019.
  18. ^ (PDF). World Health Organization. 2018. Archived (PDF) from the original on 8 December 2019.
  19. ^ a b . BBC News. UK. 2 December 2019. Archived from the original on 5 December 2019.
  20. ^ . SBS News. Australia. 8 December 2019. Archived from the original on 9 December 2019.
  21. ^ . www.abc.net.au. 17 November 2019. Retrieved 26 November 2019.
  22. ^ a b . BBC News. UK. 23 November 2019. Archived from the original on 5 December 2019.
  23. ^ 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.
  24. ^ . RNZ. 25 November 2019. Retrieved 26 November 2019.
  25. ^ . RNZ. 2 December 2019. Retrieved 3 December 2019.
  26. ^ . RNZ. 2 December 2019. Retrieved 3 December 2019.
  27. ^ Welle (www.dw.com), Deutsche. . DW.COM. Retrieved 4 December 2019.
  28. ^ . Radio New Zealand. 3 December 2019. Retrieved 4 December 2019.
  29. ^ a b . Retrieved 7 December 2019.
  30. ^ Purtill, James (5 December 2019). . triple j - Hack. Australian Broadcasting Corp. Archived from the original on 7 December 2019.
  31. ^ . Retrieved 8 December 2019.
  32. ^ a b . RNZ. 30 November 2019. Retrieved 1 December 2019.
  33. ^ . ReliefWeb. Government of Australia. 21 November 2019. Archived from the original on 22 November 2019.
  34. ^ . Deutsche Welle. Germany. 18 November 2019. Archived from the original on 19 November 2019.
  35. ^ . ReliefWeb. Government of New Zealand. 18 November 2019. Archived from the original on 18 November 2019.
  36. ^ Gerson, Michael (10 December 2019). . Washington Post. US. Archived from the original on 10 December 2019.
  37. ^ . Stuff. 14 December 2019. Retrieved 14 December 2019.
  38. ^ a b . New Zealand Herald. 10 December 2019. Archived from the original on 10 December 2019.
  39. ^ Hofschneider, Anita (10 December 2019). . Honolulu Civil Beat. Archived from the original on 10 December 2019.
  40. ^ . Radio New Zealand. 10 December 2019. Archived from the original on 10 December 2019.
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