Measles in Samoa
Samoa is currently experiencing a significant measles outbreak. More than 4,200 cases of measles have been reported across Samoa in recent weeks, along with 62 deaths; this is the highest number of cases ever reported in Samoa, and the highest in the last 40 years by at least a factor of four. The population of the island nation is less than 200,000 -- about the size of Huntsville, Alabama—making the outbreak outsized proportionally. The two countries among the hardest hit by measles in 2019 are Madagascar and the Democratic Republic of Congo; those two African countries, whose combined cases topped 267,000 by August, represented 1.7% and 1.8% infection rates, respectively. Samoa’s outbreak, by comparison has infected 3.1% of the country in just the last two months. The Samoan government reports that the cases stem from a low rate of vaccinations, and open sources decry a “vocal anti-vaccination movement.” According to UNICEF, last year, only 30% of Samoans had received measles immunizations; it takes about 93% vaccine coverage to prevent a measles outbreak in any community.
In response to the crisis, the government declared a State of Emergency last month, mandating vaccinations for everyone in Samoa. The government closed all schools on November 15, and on December 5 closed all businesses and government services not working on the nationwide immunization drive. Health workers undertook a door-to-door mass vaccination campaign” on December 5-6. The government asked those who need vaccines to hang a red flag outside their door. Due to the State of Emergency, the U.S. Embassy has closed to the public.
What’s Behind Samoa’s Measles Outbreak
Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Measles virus can live for up to four hours in an airspace where an infected person exhaled. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, it will likely infect 90% of the people close to that person who are not immune. For more information about the disease, see the OSAC report, “OSAC Health Security Snapshot: Measles.”
The Government of Samoa has warned that children are at a particularly high risk. However, some in Samoa are hesitant to give their children vaccines. Last year, two infants died in a medical mishap in which healthcare workers incorrectly mixed the injection with muscle relaxant. The nurses plead guilty to manslaughter, and received five-year prison terms. International anti-vaccination groups targeted Samoa following the incident, playing on the resulting distrust of vaccinations.
This rise in a dangerous infectious disease thought to be virtually defeated is at least partially attributable to a rise of distrust in vaccinations and the proliferation of misinformation regarding the safety of vaccines. The disease is entirely preventable when taking correct measures. In Samoa particularly, many patients prefer to turn to traditional medicine rather than preventive vaccines, despite government efforts. The 30% vaccination rate in Samoa is in stark contrast to neighboring Nauru, Niue, and the Cook Islands, which all have 99% vaccination rates. Conversely, neighboring Tonga and Fiji have also declared states of emergency to tackle their own measles outbreaks, although neither has reported any deaths, and each has a much higher vaccination rate than Samoa.
Implications for Travelers to Samoa
Worldwide, the number of measles cases quadrupled in the first three months of 2019 compared to the same time last year, according to the World Health Organization (WHO). Vaccination is the best protection against measles. MMR vaccine, which protects against measles, mumps, and rubella, is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective. Before going to a foreign country, make sure you and your family are immune to measles. If you are unsure about your immunity, the U.S. Centers for Disease Control and Prevention (CDC) recommends talking with your doctor and visiting Who Needs Measles Vaccine. No specific antiviral treatment exists for measles virus. Most people who do not develop more serious complications will recover within 2-3 weeks.
Unvaccinated travelers are at high risk for measles virus. Specific populations may decide not to receive, or postpone receiving, the MMR vaccine. For a traveler not vaccinated against measles, there are guidelines for catch-up schedules that may include one or two doses and minimum intervals between them, depending on age and other indications.
For additional information on security in Samoa, contact OSAC’s Asia-Pacific Team and consider the following resources.