Measles ‘out of control’ in Samoa with 14 reported deaths and a health system under strain

Doug Hendrie

18/11/2019 3:45:27 PM

A state of emergency has been declared in the island nation, with the epidemic believed to have claimed more than a dozen lives.

Measles, vaccine, Samoa
Plummeting vaccination rates have set the scene for a major measles epidemic in Samoa.

Schools and universities have been closed until further notice in the island nation of 200,000.
Children are banned from public gatherings and all unvaccinated adults are now required to be vaccinated for measles under the declaration.  
But experts have still slammed the ‘slow’ response to the epidemic, with predictions that more deaths are likely.
MMR vaccine shortages are reportedly common, with more being rushed in from Australia and New Zealand.
Dr Take Naseri, Samoa’s Director General of Health, said in a statement the Government is expecting the ‘worst was to come’ due to low vaccination rates and the highly infectious nature of the virus.  
While the official number of deaths is at seven, an unnamed senior doctor told Samoa Global News the toll is double that, and that the virus is ‘out of control.’
The report has been backed by prominent New Zealand vaccinologist Dr Helen Petousis-Harris, who told newsGP she heard unofficially that 14 had died.
‘The outbreak is extensive and serious both in the number of cases and the associated deaths. It is likely that Samoa will have more deaths in the coming weeks,’ she said.
Dr Petousis-Harris last week warned that the virus is now ‘difficult to stop.’
‘It’s like a wildfire that is burning now out of control,’ she told Radio New Zealand.
Official figures show the nation has more than 700 suspected cases of measles, with 40% requiring hospitalisation.
Dr Petousis-Harris told newsGP the official response has broadly been inadequate.
‘There does not appear to have been effort to improve immunisation coverage over the years,’ she said.
‘After last year, the risk … from measles was abundantly clear. When the first cases appeared a few weeks ago, there does not appear to have been any aggressive outbreak control, with some 200 cases reported before an outbreak was declared.
‘By then the epidemic was well established in this vulnerable population.
‘Finally, there was only limited isolation and quarantine measures implemented and mass vaccination cannot happen overnight, it requires manpower and sufficient vaccines.’
The epidemic is one of many gripping Australia’s neighbours in the Pacific, with American Samoa, Tonga, New Zealand and Fiji also seeing recent outbreaks. Tonga has closed all primary schools for 10 days.
This year has seen significant measles outbreaks more widely, with the Philippines also in the grip of a major outbreak that has resulted in hundreds of deaths, while Madagascar has reported more than 1000 deaths.
The Samoan outbreak is thought to have come from New Zealand, which has had over 2000 confirmed cases. Two pregnant women have experienced miscarriages due to the virus. 
In response to a request from the Samoan Government, 26 medical practitioners from the Australian Medical Assistance Team (AUSMAT) have raced to the island nation and erected a portable eight-bed intensive care unit (ICU) for the sickest patients. They have also provided equipment, supplies and public health support.
The move comes as the Samoan health system struggles under the strain, with key ICUs already at capacity. Samoan residents have banded together to call for ventilators, infusion pumps and other hospital items.

An Australian Department of Health (DoH) spokesperson told newsGP there are no new border measures planned to tackle the current outbreaks.
‘The [DoH] believes existing border measures are sufficient to safeguard the Australian population from the current measles outbreaks in Samoa and other Pacific nations,’ the spokesperson said.
‘Australia has a high national coverage rate for measles immunisation. While there is a small cohort of adults who are only partially immunised, coverage rates in children – who are particularly vulnerable to serious disease outcomes as a result of measles infection – are generally over 90%.
‘These high immunisation rates are protecting Australia from ongoing community transmission, even when people with measles arrive onshore.’
The DoH is calling on travellers to ensure their vaccinations are up to date before going to and from affected countries.
The crisis has shed light on the plunging vaccination rates in Samoa, which last year dipped as low as 30% for MMR vaccines for infants – a precipitous drop from 90% only six years earlier, according to World Health Organization statistics.
The drop comes after the 2018 death of two infants shortly after receiving their MMR vaccine, which resulted in prison terms for the two administering nurses. One nurse had mixed the MMR vaccine powder with an expired muscle relaxant anaesthetic. The tragedy led to a temporary suspension of the immunisation program.
In the wake of the tragedy, Australian anti-vaccination campaigner Taylor Winterstein planned a workshop on ‘informed decisions’ and immunisations in June. She cancelled after her plans were criticised by Dr Naseri, who pointed out that ‘one serious, virulent virus can wipe out this population in less than two weeks’.

Samoa’s vaccination rates dipped as low as 30% for MMR vaccines for infants in 2018.

Dr Petousis-Harris said Samoa has one of the lowest vaccine coverages in the world.
‘There may be a long-term problem of vaccine hesitancy in Samoa,’ she said.
‘Certainly, the reasons for the deaths of the infants last year were not communicated, leaving people to assume it was the MMR vaccine that caused the deaths.
‘The level of trust and confidence in the health system and vaccination program is understandably very low. Trust needs to be gained and then maintained, and this will take time and commitment.’
Neighbouring American Samoa and Tonga have far higher immunisation rates, at around 90%, and have had no reported fatalities to date.
Nobel Laureate and immunologist Professor Peter Doherty told newsGP measles could be ‘devastating’ for developing countries.
‘A lot of people don’t seem to think it’s a bad disease, but when measles gets into a developing country, you will see higher death rates,’ he said. ‘In the Philippines, there are enormous numbers of cases and hundreds of deaths.
‘After vaccination became available, this virus essentially disappeared. Now it seems to be coming back.’
In a tweet, Professor Doherty linked the lower vaccination rates with the increased number of deaths in Samoa.
He said that, as a systemic infection, measles could also cause long-term problems such as middle-ear infections or the rare, but fatal, sub-acute sclerosing panencephalitis.
Professor Doherty warned that Australians who have not been vaccinated are at particular risk if they travel to affected nations.
‘If you’re not vaccinating your kids you might get away with it in Australia, but they will be at risk in a high-infection zone,’ he said.
Australia has been grappling with its own resurgence of measles due to travellers from affected areas, with Brisbane and the Illawarra the latest areas to be affected, with earlier flare ups in other major cities.

Login below to join the conversation.

herd immunity immunisation measles Samoa vaccinations

newsGP weekly poll Which public health issue will most significantly impact general practice in Australia in the next 10–20 years?

newsGP weekly poll Which public health issue will most significantly impact general practice in Australia in the next 10–20 years?



Login to comment