Measles heralds state of emergency in Samoa

By Dr. Liji Thomas, MDNov 18 2019

https://www.health.gov.ws/All students in Samoa should stay at home, because all schools are closed – this message may bring joy to juvenile hearts but not to those of parents and other adults, who know this is because of the destruction caused by the deadly measles epidemic that is spreading across the Pacific islands. This message is just part of a general state of emergency proclaimed on November 16, 2019, in an effort to halt the wave of measles deaths, which started towards the end of October. All individuals below the age of 17 years have been ordered to stay away from public gatherings.

In the peaceful island state of Samoa with only 200,000 permanent residents, 7 people, mostly babies, have died since then, all with the number of measles cases shooting up to well over 700 so far. About 4 in 10 cases have it badly enough to be hospitalized.

In this island, located between Hawaii and New Zealand, it has just become necessary, since the announcement, for all its citizens to get vaccinated for measles if they haven’t done so already – which applies to over a third of the population, according to health statistics. The Samoan director-general of health, Leausa Take Naseri, predicted gloomily: “The way it is going now and the poor (immunisation) coverage, we are anticipating the worst to come.” The fact that none of the infants who died were vaccinated lends point to his prophecy.

New Zealand has been identified as the source of the Samoan outbreak. It is ready to help, with the foreign minister, Winston Peters, promising 3,000 vaccines and 12 nurses to help contain this epidemic. He said, “Measles is highly contagious, and the outbreak has taken lives in Samoa. It is in everybody’s interests that we work together to stop its spread.” Meanwhile, Western Australia is also reeling under a heavy spate of cases.

Measles

Measles is a viral illness, carried by airborne droplets. As a result, it spreads very fast through coughs, sneezing and breathing. It is typically seen as a high fever with cough, a runny nose, and red tearing eyes. The eyes also become sensitive to light. Soon, within 5 days, a raised red rash appears spreading from the head or body. The child appears weakened. White spots may be seen on the palate.

Severely ill children may become blind, develop pneumonia, brain damage, and severe dehydration. Any person with measles who appears to be getting worse must be taken to hospital at once to prevent such complications.

To prevent transmission, the child must be kept isolated, given plenty of fluids to prevent dehydration, and treated for fever with cold sponging as well as an antipyretic like acetaminophen.

Transmission can be minimized by covering the mouth and nose when sneezing and/or coughing, followed by handwashing. A mask is very useful.  

Measles viruses. 3D illustration showing structure of measles virus with surface glycoprotein spikes heamagglutinin-neuraminidase and fusion protein - 3D illustration. Credit: Kateryna Kon / Shutterstock

Measles vaccination

Vaccination is the best way to avoid measles. In the USA, it is recommended that children be given 2 doses of the measles vaccine in the form of the combined measles, mumps and rubella vaccine (MMR). The first dose is at 12-15 months and the second at 4-6 years. The efficacy of prevention is about 97% with two doses, and 93% with a single dose.

Measles had died down to a very low level with the introduction of effective measles vaccines. However, over the last few decades, a massive level of misinformation has been spreading about vaccination in general, and the measles vaccine in particular. Citing medical, religious and philosophical reasons, immunization is being rejected by parents in both American and European developed countries.

Before vaccination for measles began in the USA in 1963, about 3-4 million people had measles every year, with 400-500 deaths out of the measly 500,000 that were actually reported. About 48,000 required hospitalization, and a thousand had brain involvement. After the program of immunization began, the number of measles cases has fallen by 99%, but it can still be brought in from abroad by people who have not been vaccinated.

Other Pacific island stories

The Tongan rugby team returned from New Zealand with more than they bargained for, when they brought on a measles outbreak – 251 cases and counting, according to the ministry of health in Tonga. This island is 900 km from Samoa and has a 90% immunization rate. No measles-related deaths have occurred so far, but all primary and kindergarten schools run by the government have been shut for the month.

American Samoa, which is a US territory next to Samoa, also has a 90% immunization rate, but has already been in a state of emergency since Thursday, after the virus attacked both Samoa and Tonga. All visitors must have a valid measles immunization certificate at present.