Hundreds of Measles Cases in Samoa, Almost Two Dozen Dead

Samoa is a small nation of about 195,000 people in the South Pacific. The nation is made up of two large islands and numerous smaller ones. Despite gaining independence from New Zealand in the 1960s, Samoa had a very close relationship with its island neighbors. Recently, Samoa has been hit with a rather large measles epidemic, the roots of which begin in 2018 after a vaccination incident, and many of its neighbors have launched relief efforts to help stop the epidemic.

A couple of weeks ago, we told you about a flu vaccine mix-up in Oklahoma that sent ten people to the hospital. In that instance, the vaccine material was exchanged with long-acting insulin. The result was a number of people with critically low blood glucose levels. In the Philippines, children who previously were not exposed to dengue, and were given the dengue vaccine, developed life-threatening reactions after being exposed dengue post-vaccine. This is because of the way that the immune system behaves in subsequent exposures to dengue virus.

In 2018, two babies died after receiving the MMR (measles, mumps, rubella) vaccine. As CNN reported:

“The babies were brought to Safotu Hospital in Savai’i on Friday, where they died within minutes of the receiving the MMR vaccine, Television New Zealand reported.

Samoan Prime Minister Tuilaepa Sailele Malielegaoi expressed his condolences to the families on Monday. “I have called a full inquiry into the circumstances leading up to this devastating incident which I do not take lightly,” he said. “There are already processes that will determine if negligence is a factor. And if so, rest assured those processes will be implemented to the letter to ensure that such a tragedy will not be repeated and those responsible will be made to answer.”

Leausa Take Naseri, director general of health, said he has halted the vaccination program until the inquiry’s completion. He has also requested a forensic autopsy on the two babies, as the deaths are also being investigated by police.

Hospital staff involved have also been removed for their own safety, Radio New Zealand reported. “We’re also concerned for the safety of our workers especially the nurses who were involved because it’s now easily blamed — the finger is pointed towards the nurses,” Naseri said.”

What happened? The investigations revealed that one of the nurses did not use sterile water in preparing the vaccine. Instead, she used a muscle relaxant. Two other reported cases from a few months back were also investigated. In those cases, a genetic condition had triggered the bad reaction to the vaccine in two siblings. This is how the Immunisation Advisory Centre from the University of Auckland (New Zealand) explains it:

“The deaths of two infants on 6 July 2018 in Samoa shortly after receiving their MMR immunisations were under investigation by the Samoan Ministry of Health and Samoan Police. However, the inquest was put on hold until the trial of the two nurses who administered the MMR vaccines had been completed.

On 4 June 2019, both nurses pleaded guilty to negligence causing manslaughter. On 2 August, both nurses were sentenced to five years in prison. During the sentencing hearing, it was confirmed that one of the nurses mixed the MMR vaccine powder with expired muscle relaxant anaesthetic instead of water for injection supplied in a vial with the vaccine. Eight Samoan speaking New Zealand nurses visited Samoa in June to provide training for vaccinating nurses at district hospitals.

There have also been media reports of two other deaths of Samoan siblings on separate occasions more than a week after MMR vaccination – these deaths occurred in 2017 and April 2018. A very rare genetic immune disorder is expected to have contributed to the death of the second sibling, who died in New Zealand. It is suspected that the first sibling had the same disorder. The family are undergoing genetic testing.”

The explanation for what happened didn’t matter to many parents, and they hesitated to immunize their children as recommended. In a country where immunization rates are already low, this vaccine hesitancy led to numerous non-immune children being susceptible for infection with a virus that is among the most infectious out there. As of the writing of this blog post, Samoa has reported over 1,600 cases of measles and 20 deaths.

According to The Guardian:

“Suspected cases of measles have more than doubled over the past week to 1,644, the government added on Friday. Children under five accounted for all but one of the deaths.

Staff from the UN agency Unicef have delivered 110,500 doses of vaccines this week as they fanned out across Samoa to boost its mandatory immunisation effort, the agency said. It has also worked with governments of other tiny Pacific nations to run immunisation campaigns and develop preparedness plans to combat a regional outbreak, it added.

Australia is sending a specialist team of doctors, nurses and public health experts to Samoa, along with equipment and supplies, the foreign ministry said.”

Globally, 2019 has been a record year for measles. Countries that were previously classified as having eliminated measles are back to being classified as having endemic measles. (Eliminated means that the virus doesn’t circulate in the population and is only seen in outbreak situations. Endemic means that the virus circulates in the population.) The United States almost lost its eliminated status in October, avoiding the downgrade only because no cases from the New York outbreak were detected even as new cases have now appeared in Georgia.

Screenshot 2019-11-23 14.09.28

When you realize that the measles vaccine is highly effective, that it has a great track record of safety and that it has been around for over 50 years, one can’t help but wonder why we are still seeing measles around the world. No, the virus doesn’t mutate into something that the vaccine doesn’t protect from. No, the vaccine does not shed virus that causes measles. Yes, there are dangerous sequela from the infection. So why have we not eradicated measles like we did with smallpox?

It all boils down to vaccine hesitancy. Wakefield’s fraud gave legitimacy to a false theory that the measles vaccine causes autism. It does not. Anti-vaccine people and organizations share a tremendous number of lies and misinformation about vaccines via social media day in and day out. They also seize upon sad, tragic incidents like what happened in Samoa to promote their ideas and conspiracy theories. As a result, parents hesitate in vaccinating their children, and, in the end, those who end up paying the price for such hesitancy are those children. So far in Samoa, 20 children have paid the price.

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Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: https://www.linkedin.com/in/renenajera Feel free to follow me on Twitter: @EpiRen

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