Measles: Samoa declares emergency as cases continue to spike worldwide

Samoa is fighting a “huge outbreak” of measles, the World Health Organization has said, a year after a vaccine scare resulted in a collapse of immunisation rates.

So far 42 people have died from measles, almost all young children, and 3149 cases have been reported on the six islands that make up the Pacific nation, inhabited by about 200 000 people. Every day about 200 people with suspected cases arrive at hospital, said Ian Norton of WHO’s emergency medical unit, speaking to reporters from Geneva. The main hospital in the capital, Apia, which normally has four beds in its intensive care ward, currently has 14 children on ventilators, he said.

The government has closed schools nationwide and banned children from public gatherings indefinitely.

Medical teams are leaving for Samoa from the UK, the US, Australia, and New Zealand. Unicef is rushing 110 000 doses of measles vaccine to the islands, while New Zealand—which faces its own measles outbreak in Auckland—has sent a further 100 000 doses.

Uptake of the measles vaccine collapsed in Samoa last year, with the proportion of infants receiving their second dose falling to 28%, down from 77% in 2017.

“There was a very tragic medical error where in the course of vaccination some vaccines have to be mixed,” said WHO’s immunisation director, Kate O’Brien. “You take a dried part of the product and you mix it with a liquid. And the medical error happened when the incorrect liquid part was mixed with a vaccine and led to the death of two children. And as a result of that tragic event the confidence in the immunisation system fell.”

Then came a temporary government suspension of vaccinations and a social media campaign by an antivaccine group that “had a very remarkable impact on the immunisation programme,” said O’Brien. Its effect, she added, was “now being measured in the lives of children who have died in the course of this outbreak.”

The spike in Samoa comes as measles nears the bottom of its annual trough in terms of case numbers worldwide. Each year the global burden of measles peaks around March, reaching its minimum around September and October. But the peak in 2019 was much higher than any in recent years, continuing a two year surge in global case numbers that has left no continent untouched.

New figures released by WHO this week showed 440 200 cases reported around the world to 5 November this year, whereas the number was 350 000 for the whole of last year.1 Last year cases soared in South East Asia, Eastern Europe, and the Middle East. This year Eastern Europe remains hard hit, while cases surged in the Western Pacific and the previously quiescent African region.

While absolute numbers remain lower in Western Europe and North America, the US faced several outbreaks this year, having previously declared measles eradicated. The UK became one of four European countries to lose its WHO measles free certification this year, after experiencing 12 consecutive months of circulating virus.

Countries currently facing large outbreaks include Madagascar, Ukraine, Chad, Yemen, Nigeria, Thailand, Georgia, Myanmar, Guinea, Kazakhstan, New Zealand, Bangladesh, Brazil, Sudan, Somalia, Pakistan, Lebanon, Tunisia, and Iraq.

But the worst toll is in the Democratic Republic of the Congo, where a measles outbreak has killed 5110 people since being declared in February, claiming more than twice as many victims as the country’s more famous Ebola outbreak.2