Daily BulletinDaily Bulletin

News

  • Written by Katherine Gibney, NHMRC early career fellow, The Peter Doherty Institute for Infection and Immunity

The pacific island nation of Samoa has been making headlines over the past month due to a significant measles outbreak. At last count, 4,995 measles cases had been recorded, and 72 people, mostly young children, had died.

The actual number of cases and deaths is likely to exceed this, because not everyone with measles will present for medical treatment, and not all deaths occur in hospital.

Tragically, 40% of recorded deaths have been in babies under one year old, and nearly 90% among children less than five.

Read more: Why people born between 1966 and 1994 are at greater risk of measles – and what to do about it

With a population of 200,000, Samoa has fewer people than Geelong or Hobart. So a significant proportion of the population has been affected. More than one in five Samoan babies aged six to 11 months have contracted measles during this outbreak, and more than one in 150 babies in this age group have died.

Fortunately, with increasing vaccination coverage, we’re now finally seeing signs the number of new measles cases in Samoa is slowing.

Contagious but preventable

Measles causes a fever with cough, runny nose and red eyes, followed by a rash. Around one in three cases develop complications, most often diarrhoea and pneumonia.

Measles is probably the most contagious virus affecting humans. In a susceptible population – that is, people who have neither been vaccinated nor had measles previously – a single person with measles would infect 12 to 18 others.

Put another way, more than 90% of susceptible people exposed to someone with measles will themselves develop measles.

Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster A rash is one of the defining symptoms of measles. From shutterstock.com

The most frustrating and tragic thing about this outbreak is that a safe and effective vaccine is available. A single dose of measles vaccine (MMR or MMRV vaccine is used in Australia) provides protection to between 95% and 98% of recipients, while two doses protect 99% of vaccinated people.

Because measles is so infectious, about 94% of the population need to be vaccinated to stop it spreading. “Herd immunity” means unvaccinated people, including those unable to be vaccinated due to young age or specific medical conditions, are protected.

Read more: What is herd immunity and how many people need to be vaccinated to protect a community?

So how did this happen?

In July 2018, two Samoan children died shortly after receiving their MMR vaccinations.

These deaths were caused by human error and not the vaccine per se. The vaccines were inadvertently mixed with expired muscle relaxant anaesthetic instead of water.

This tragic incident resulted in the suspension of the national measles vaccination program and loss of confidence in vaccine safety. Because of this, vaccine coverage for one-year-old children for the first dose of measles vaccine fell from 76% in 2012 to 31% in 2018.

When a traveller re-introduced measles to Samoa in August this year, these unvaccinated children made it possible for measles to gain a foothold and spread throughout the country.

Read more: To protect us all, babies travelling overseas may need the measles shot at 6 months instead of 12

The first laboratory-confirmed measles cases were reported in September, and an outbreak was declared in October. In the face of rising measles cases and deaths, the Samoan government declared a state of emergency on November 15, setting the scene for a campaign of mandatory vaccination.

The government shut down on December 5 and 6 during a door-to-door vaccination campaign. People who had not been vaccinated were asked to leave a red flag or cloth outside their home.

Official estimates indicate 93% of the population have now been vaccinated. Achieving vaccination rates over 95% among children aged six months to four years will be key to stopping this measles outbreak.

Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster Health workers preparing vaccination packages ready for mobile distribution. National Critical Care and Trauma Response Centre, Author provided

Aiding the public health response

This outbreak has placed enormous pressure on hospital staff and the Samoan health system. Samoa’s largest hospital has more than doubled its usual capacity, including duplicating an emergency department, paediatric wards and intensive care unit in old hospital wings.

In response to a request from Samoa, the Australian Medical Assistance Team (AusMAT) has been in Samoa since early November. For two weeks in November, I was part of AusMAT’s “team bravo”, which included 34 specialist nurses, doctors and public health experts.

Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster AusMAT set up a temporary ward in Apia, Samoa, to treat young patients. National Critical Care and Trauma Response Centre, Author provided

AusMAT is one of several teams that have travelled from overseas to help Samoa manage this outbreak.

My role as a public health specialist included working with local and international staff on case diagnosis, analysis and reporting of measles cases and deaths, and identifying the most important groups to receive urgent vaccination.

Read more: Health Check: are you up to date with your vaccinations?

What about Australia?

Measles vaccines have been in widespread use in Australia since the early 1970s. The last recorded measles death in Australia was in 1995, and in 2014 the World Health Organisation declared Australia had eliminated measles.

Despite this, travellers regularly re-introduce measles to Australia, which can spread to susceptible people they come into contact with. As recently as this week, Victoria has been the subject of a measles warning, after three people were diagnosed in Melbourne.

High vaccine coverage (in 2018, 94.6% of five-year-old Australian children were fully vaccinated) means a measles outbreak of this magnitude would not occur in Australia at present. However, Samoa’s experience is a reminder there’s no room for complacency around vaccine preventable diseases.

Authors: Katherine Gibney, NHMRC early career fellow, The Peter Doherty Institute for Infection and Immunity

Read more http://theconversation.com/measles-in-samoa-how-a-small-island-nation-found-itself-in-the-grips-of-an-outbreak-disaster-128467

Assisted dying referendum: why NZ's law lacks necessary detail to make a fully informed decision

arrow_forward

Facial recognition technology is expanding rapidly across Australia. Are our laws keeping pace?

arrow_forward

Sure, let's bring production onshore, but it might not ensure supplies

arrow_forward

The Conversation
INTERWEBS DIGITAL AGENCY

Politics

Scott Morrison Covid 19 update

PRIME MINISTER: Good afternoon, everyone. Today I’m joined by Professor Paul Murphy - sorry, Professor Paul Kelly. I’ve got Brendan Murphy still on the brain. You are not far from us, Brendan. B...

Scott Morrison - avatar Scott Morrison

Prime Minister Interview with Ben Fordham, 2GB

FORDHAM: Thank you very much for talking to us. I know it's a difficult day for all of those Qantas workers. Look, they want to know in the short term, are you going to extend JobKeeper?   PRI...

Scott Morrison - avatar Scott Morrison

Prime Minister Scott Morrison interview with Neil Mitchell

NEIL MITCHELL: Prime minister, good morning.    PRIME MINISTER: Good morning, how are you?   MICHELL: I’m okay, a bit to get to I apologise, we haven't spoken for a while and I want to get t...

Scott Morrison - avatar Scott Morrison

Business News

Fifth Dimension: Identified as one of the world’s leading strategic consultancies

Sydney based consulting company, Fifth Dimension, has been recognised for its ground breaking work, receiving a place in the GreenBook Research Industry Trends (GRIT) Top 25 Strategic Consultancie...

Tess Sanders Lazarus - avatar Tess Sanders Lazarus

Understanding Your NextGen EHR System and Features

NextGen EHR (Electronic Health Records) systems can be rather confusing. However, they can offer the most powerful features and provide some of the most powerful solutions for your business’s EHR ne...

Rebecca Stuart - avatar Rebecca Stuart

SEO In A Time of COVID-19: A Life-Saver

The coronavirus pandemic has brought about a lot of uncertainty for everyone across the world. It has had one of the most devastating impacts on the day-to-day lives of many including business o...

a Guest Writer - avatar a Guest Writer



News Company Media Core

Content & Technology Connecting Global Audiences

More Information - Less Opinion