Measles Outbreaks In The Pacific

Fever, rash, cough and congestion. These are the hallmarks of measles. Before the beginning of the measles vaccination program in the 1960s, there were 3-4 million cases of measles annually in the United States, almost 40,000 people were hospitalized, over 1000 people developed permanent disability from measles encephalopathy, and almost 500 people died. Every year. Most of these cases happened in children.

Now with vaccination rates falling, we are again seeing outbreaks of measles. Right now, there are measles outbreaks occurring in the South Pacific. It’s estimated that only 30% of the population of Samoa, for instance, have been vaccinated against measles, and they are in the midst of a terrible outbreak right now. Other countries are sending medical supplies, doses of vaccine and health care personnel to help deal with this outbreak.

Samoa is a country with about 200,000 people. 3,149 cases of measles have been reported, 197 people are hospitalized and 42 have died. To give some idea of the magnitude of this outbreak, we can compare to the United States, which has a population of 327.2 million people. This size of an outbreak in the US would result in 5.2 million cases, 322,000 people hospitalized, and 68,712 deaths. Most of Samoa’s deaths have been in children under 4 years of age.

Think about that. Imagine a United States in which almost 70,000 infants, toddlers and preschoolers were killed within a month’s time. Bearing in mind that those deaths are preventable, this outbreak in Samoa is a heartbreaking tragedy.

The good news for the USA is that vaccine coverage overall is still above 90%. However, there are 11 states in which coverage is under 90% and there are pockets where vaccine coverage is much, much lower. Amish people reject most modern medical innovations (including vaccines). Many California communities have vaccine coverage rates at about 50%. This is much lower than what is required to prevent outbreaks of measles.

Measles is the most contagious illness we know. It is a serious illness and potentially fatal. The vaccine is safe, so safe that in 1.5 million people vaccinated in Finland from 1982-1992 no deaths or serious permanent adverse reactions were reported.

If you are not immune to measles and are exposed, you have a 90% chance of getting sick. This is in comparison to influenza, which has about a 50% transmission rate. Parents who choose not to vaccinate their children are making a choice to leave them unprotected against a serious, possibly fatal, horribly contagious illness that is still endemic in parts of the world.

No vaccine is perfectly effective, but the MMR vaccine is pretty close. It eradicated measles, mumps and rubella in Finland in the 1980s with a 12-year, 2-dose vaccination schedule.

Measles is still present in the world. The MMR vaccine is the most effective weapon we have against this illness. Please be sure to vaccinate your children.


2 thoughts on “Measles Outbreaks In The Pacific

  1. For your consideration

    Samoa’s Measles Outbreak and Response


    There is some question about whether the high measles mortality in Samoa this year is solely due to the 66 percent vaccination rate among Samoans. While the fact that only two-thirds of Samoa’s population has been vaccinated for measles may explain the high incidence and spread of the disease, there may be other factors that account for the high mortality rate associated with Samoa’s current measles outbreak.10 11

    While measles is a highly contagious infection, it very rarely causes death or disability in the United States and other developed nations.11 12 The Centers for Disease Control and Prevention (CDC) estimates that there are one or two associated deaths for every 1,000 cases of measles.10 11 However, this year in the U.S. there have been 1,261 confirmed measles cases reported in 31 states as of Nov. 7, 2019 and no deaths.13

    Why such a disparity between the U.S. and Samoa in the number of deaths associated with measles? One reason might be the wide disparity in socio-economic conditions between the two countries. According to the World Health Organization (WHO):
    The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.14

    There is also the issue of the impact of diet on the susceptibility of people to become severely ill or die from infectious diseases like measles. Malnutrition, for example, is a significant and growing problem in Samoa, particularly among the country’s children.15 16 17

    • Susan I agree that all these things factor in. Samoa has a very different socioeconomic environment and health care system from the United States. However, you can’t possibly argue that the low measles vaccine coverage has no role. The WHO estimated in 2018 that only 31% of Samoan children had had even one measles vaccination and only 18% had had the full two-dose schedule. Measles cases in the US are fairly rare in the US but if vaccination rates fall much lower that will change. And it is not true that measles causes no death or disability in the US. Prior to the vaccination program it was the main cause of acquired deafness. In fact if you see an older adult who is using ASL due to profound hearing impairment the chances are good they are deaf due to measles. We see almost no measles in the US because of vaccination. If vaccine coverage rates fall lower we will see more measles. Measles kills children and leaves more with lifelong disability. Medical advances in the US are wonderful but our system would be overwhelmed by a full-scale outbreak the magnitude of what is happening in Samoa. And as a physician I would argue that we have a terrible problem with malnutrition in this country with adults and children habitually eating processed, nutrient-poor “food.” Every year I take care of people miserable with influenza, most of whom regret not having had the influenza vaccine. I have hundreds of patients receive the influenza vaccine every year and have never had a serious vaccine reaction other than the usual sore arm and feeling temporarily run-down and tired. I have never had a child have a serious reaction to a childhood vaccine (even the dreaded and evil Gardasil). Vaccines are safe, and they work. If an individual has had a serious vaccine reaction (and they happen, albeit rarely) that individual should definitely not receive vaccines in future. All the rest of us who have healthy and strong immune systems should get our vaccines to protect those who can’t have them.

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