Fighting measles in Samoa
As a huge measles outbreak swept through Samoa in late 2019, a Médecins Sans Frontières (MSF) team travelled to the Pacific island nation to support the local response. MSF’s work focused on supporting local health workers to provide treatment for people with uncomplicated measles, who comprise the majority of cases.
MSF regularly monitors the Pacific region for medical and humanitarian needs, providing assessments and offering support as required. In this instance, MSF responded to the World Health Organization’s call for additional support to fight the outbreak.
Focusing on smaller hospitals
Melissa Hozjan, MSF’s paediatric nursing advisor, based in Sydney, was part of the team that travelled to Samoa.
After meeting with other medical teams and assessing the needs, MSF identified that many resources focused on the two main referral hospitals in the country, which were treating the sickest patients, with insufficient focus on smaller hospitals.
“We quickly determined that the key gap in the response was at the district hospital level, which was often the first point of contact with patients, and where uncomplicated cases were presenting,” says Melissa.
The initial government protocol to respond to the outbreak was developed by WHO with the use of the MSF Measles Guidelines. The team further developed the protocol for managing uncomplicated cases, in collaboration with the Samoan Ministry of Health and the Australian Medical Assistance Team (AUSMAT).
The importance of Vitamin A
The protocol ensured systematic use of vitamin A for all measles cases; a key part of measles outbreak response that had not been previously implemented. Vitamin A is crucial to reducing the severity of complications of measles, especially in children under-5.
“From MSF’s experience responding to measles outbreaks globally, we know the importance of vitamin A. Children with pre-existing low vitamin A stores are more vulnerable to severe complications of measles such as blindness, and respiratory disease. Evidence shows vitamin A supplementation reduces severity of these complications.”
After developing the protocol, the team visited the district hospitals to train staff in using it, and ensure they had the relevant medications.
The team also strengthened routine infection prevention and control practices in the district and referral hospitals.
“Some of the kids were so unwell, they required high level respiratory support in intensive care which, unlike in many other places MSF works, was available. Hence, many of these children survived but may have longer term respiratory and neurological complications.”
A preventable outbreak
The Samoan measles outbreak infected more than 5,700 people and killed 83, many of them children under age 5, among a national population of just 200,000.
Measles is vaccine-preventable, but vaccination rates in Samoa had plummeted after two children died due to a vaccine administration error, leading to the government temporarily suspending the immunisation program.
With measles cases increasing, the Samoan Government launched a mass vaccination campaign and declared a state of emergency, closing schools and restricting travel and public gatherings.
Melissa says the outbreak affected every part of Samoan society, particularly as the country shut down during the vaccination campaign.
“There was no one outside or on the roads. It was silent, with red flags or pieces of material outside people’s homes to indicate that they needed vaccination. There had been a perception of anti-vaxxer fear, but people put out those red flags [to get the vaccine]. They knew that their cousins were sick, their friends were sick… so they really wanted the vaccine.”
Although the state of emergency has finished, Melissa warns that some children will face ongoing health issues as a result of measles infection.
“Some of the kids were so unwell, they required high level respiratory support in intensive care which, unlike in many other places MSF works, was available. Hence, many of these children survived but may have longer term respiratory and neurological complications.”
The outbreak occurred against a backdrop of growing numbers of measles cases globally, including in Australia in recent years. MSF is also responding to an ongoing outbreak in the Democratic Republic of Congo, which has infected more than 288,000 people and killed more than 5,700 since January 2019.