Samoan government ends state of emergency over measles outbreak

Wednesday, January 1, 2020

On Sunday, the state of emergency begun on November 15 over a measles outbreak ended in Samoa. The island nation's cabinet unanimously voted to lift it on Saturday afternoon, and the National Emergency Operation Centre (NEOC) announced the decision that night. NEOC reported a 95% immunization rate on December 24, and the last measles-related death during the state of emergency on December 26.

In an effort to discredit fears of vaccination, the government televised the vaccination of cabinet members, including prime minister Tuilaepa Sailele. (Image: Government of Samoa)

Restrictions on public gathering and travel were to be lifted, and schools to reopen. The Health Emergency Operation Center were to take over the relief efforts centralized under the National Emergency Operation Centre. The Ministry of Health and the Ministry of Foreign Affairs were tasked to produce a recovery plan within two weeks for consideration by the cabinet.

As of Sunday, the Disease Surveillance Team reported a total of 5667 cases during the outbreak. Out these, 1846 persons were hospitalized and 1720 had already been discharged, while 81 had lost their lives. The December 6 National Measles Response and Recovery Appeal identified children under 5 years of age as having the highest mortality, corresponding with the relative shortfall of vaccination in the age group.

Tupua Tamasese Meaole Hospital returned to normal operation on Sunday, joining Faleolo District Hospital and Leulumoega District Hospital, which returned to normal on Friday. During the peak of the outbreak, Tupua Tamasese Meaole's Acute Primary Care Clinic and Leulumoega District hospital were made measles wards, and Leulumoega District Hospital was designated to deal with patients without measles, in an effort to quarantine infected individuals. The Australian medical mission's fifth rotation is to remain on the islands until January 4 to help facilitate the transition. On Sunday teams had already begun to disassemble the tents erected to deal with the large number of admissions.

The state of emergency was expected to end on December 15, but on December 14 it was extended by two weeks to allow the immunization campaign to continue. At the time, the prime minister called for a 100% immunization rate, and stated 92% had been reached. As of Sunday, the rate had reached 95% according to NEOC data. Aid agencies say populations with sufficiently high vaccination rates have enough herd immunity to prevent any further infections from spreading out of control, meaning an infected person is not likely to come into contact with enough unvaccinated people to cause a chain reaction.

UNICEF reported they had delivered over 105 thousand doses of vaccine to Samoa by November 22. The national vaccination campaign started on November 20. A government order made vaccination mandatory and free of charge for children between six months and 19 years of age and for women between 20 and 35, considered childbearing age. On December 5 and 6, the government of Samoa executed a planned shutdown of public services and the private sector to leave room for a nationwide door-to-door immunization drive. The government said 128 vaccination teams participated.

To curb the spread of disease, the government prohibited inter-island travel for those under 19, schools were closed, and authorities recommended residents avoid public gatherings and medical facilities unless they were in need of medical attention. Unvaccinated pregnant women were prohibited from going to their workplaces.

The outbreak was first confirmed by the government on October 16, after the Victorian Infectious Disease Reference Laboratory in Melbourne tested 7 out of 20 suspected cases positive for measles.

In 2019 in the Pacific region, outbreaks of measles were declared in parts of the Philippines first on February 6, Tonga on October 22, Fiji on November 7, and American Samoa on December 8. The D8 strain, which caused a New Zealand outbreak, has been identified in Samoa and Fiji. New Zealand serves as a travel hub for small Pacific nations. According to data from the World Health Organisation, in 2018 there were approximately 10 million cases of measles and 140 thousand related deaths worldwide.