Samoa defends long wait on measles admission

Samoa’s top health official has defended waiting six weeks and for 200 diagnosed ‘suspected’ cases before declaring a national measles epidemic. 

Government data released publicly on Thursday shows Samoa had one case of measles reported to surveillance on August 28 2019.

Between then, and the Samoa Observer revealing at least 16 people were being treated in a special isolation ward at the Tupua Tamasese Meaole Hospital on October 12, at least 127 cases were reported.

There would be another 80 cases, and the death of 14-month-old Peter von Heiderbrandt before the Ministry of Health declared an epidemic on October 16. 

One international expert told the Samoa Observer Samoa’s apparent slow speed in notifying the public was in sharp contrast to the approach taken by Tonga and Fiji which moved swiftly after cases were reported. 

But asked why nothing was said sooner, Director General Leausa Dr. Take Naseri said the early cases were not confirmed as measles, and were only suspected.

“We don’t want to panic the people, we were not sure,” he said.

Dr. Helen Petousis-Harris, a University of Auckland vaccinologist, said a single case of measles in a country with no disease might be considered an outbreak and should be treated as such. Once there are a couple of additional cases it is absolutely an outbreak.

“Normally what would happen is there would be disease control measures that would be implemented, the contacts of that case would be traced, the person quarantined and vaccination of contacts would be offered, for example,” she said.

“It’s pretty much what you are seeing happen in Tonga and Fiji, they appear to be implementing solid infection control measures following the first cases.”

 Asked whether it is typical to not publically report a case of measles Dr. Petousis Harris simply said no, that is not her experience.

“Measles is a disease that is targeted for global eradication,” she said. Samoa, as a part of the Western Pacific region of the W.H.O is part of the Global Vaccine Action Plan, which aimed to eliminate measles by 2020.

Dr. Petousis-Harris was shocked, but not surprised at both the scale of the outbreak and the speed at which it developed, growing to 207 within six weeks. 

“It gives you an idea of the proportion of susceptible people in the community. If you didn’t have that many susceptible people it wouldn’t have gone so quickly.

“It’s a sharp contrast to Tonga and to Fiji. They moved really quickly.”

World Health Organisation (W.H.O.) guidelines, to which Samoa is party, test results on the first case of measles in a country should be reported back to health authorities within 24 hours.

Contact tracing (identifying people the case may have exposed to the virus and offering them the vaccine), quarantine and treatment should begin immediately.

Leausa did not explain why the 207 cases reported to surveillance were not reported as such and why they were not made public.

He said resuming the suspended measles, mumps and rubella vaccine campaign in April was a major effort by Government to close immunity gaps, some of which were a result of the suspension.

The vaccine was held an investigation and court case into the death of two infants following their M.M.R. vaccines was concluded. It found the two nurses involved guilty of manslaughter for incorrectly mixing the vaccine.

“People were reluctant then, because of what happened in Savaii,” he said. “There were a lot of anti-vax (vaccination) people that came and took advantage of that.

He said ultimately it is up to families whether or not to vaccinate their children, and that public health campaigns only go so far.

“Everybody was advised, all over Samoa. 

“Regardless of if you demand people to go [get vaccinated] it comes down to personal decision, your own consent to do it or not to do it.

“You cannot blame the system. You cannot blame us who are calling the shots, we are trying our best, and with the blessings from God and what he gives to us daily we do that.”

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