2019 Samoa measles outbreak

Measles epidemic in Samoa in late 2019

2019 Samoa measles outbreak

Disease| Measles
Virus strain| D8 strain (genotype) of measles virus[1]
Index case| 30 September 2019
Dates| 30 September 2019 –
22 December 2019[2]
Confirmed cases| 5,707[3]

Deaths

| 83[4]
Government website
http://www.samoagovt.ws/

The 2019 Samoa measles outbreak began in September 2019.[5] By 6 January 2020, over 5,700 cases of measles and 83 deaths had been reported, out of a population of 200,874,[4][6] an infection rate of over three per cent.[7] The cause of the outbreak was decreased vaccination rates among newborns, from 74% in 2017 to 31–34% in 2018. Nearby islands had rates near 99%.

On 17 November, a state of emergency was declared, closing all schools, keeping children under 17 away from public events, and mandatory vaccination. On 2 December, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings. Families seeking MMR vaccination were asked by the government to display a red cloth in front of their homes to alert mobile medical teams traveling the island during the lockdown.[8] Some added messages like "Help!" or "I want to live!"[9]

On 5 and 6 December, the government shut down everything, and reposted civil servants to the vaccination campaign. On 7 December, the curfew was lifted when the government estimated that the vaccination program had reached 90% of the population. On 14 December, the state of emergency was extended to 29 December.[10] Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order". By 22 December 2019, an estimated 94% of the eligible population had been vaccinated.[7]

## Background

[edit]

A hypothetical measles timeline from exposure to illness

Measles arrived in Samoa in 1893, carried by a steamer from New Zealand. By the end of 1893, over 1,000 people, of a population of 34,500, had died from measles.[11] Measles is much more contagious than other infectious diseases such as polio, which only requires an 80% vaccination rate for the population to attain herd immunity.[12]

In 2019, measles broke out across the Pacific region, including in Tonga, Fiji, the Philippines and New Zealand,[13][14][15] but only Samoa suffered casualties, due to its low vaccination rate.[16]

### Vaccine hesitancy

[edit]

The outbreak is attributed to Samoa's sharp drop in measles vaccination from the previous year.[17]

In 2013, 90% of babies in Samoa received the measles-mumps-rubella vaccination (MMR) at one year of age.[9]

On 6 July 2018, on the east coast of Savaiʻi, two 12-month-old children died after receiving MMR vaccinations.[8] The cause of death was incorrect preparation of the vaccine by two nurses, who mixed vaccine powder with expired atracurium instead of the appropriate diluent (sterile water).[18] These deaths were used by anti-vaccine groups to incite vaccination fear on social media. This caused the government to suspend its measles vaccination programme for ten months, despite contrary advice from the World Health Organization (WHO).[19][17] The incident cost many Samoan residents their trust in the healthcare system.[20]

From October 1, 2018, to late November 2018, UNICEF provided 115,500 measles vaccines doses to Samoa, including the diluent, syringes and safety boxes, and shipped Vitamin A supplies.[21][22] UNICEF and WHO estimate that the newborn measles vaccination rate fell from 74% in 2017 to 34% in 2018.[23][24] Vaccination rates dropped to 31% in Samoa, compared to 99% in nearby Nauru, Niue, Cook Islands,[16] and American Samoa.[25] In March 2019, the WHO and UN children's agency UNICEF warned the Pacific to take proactive measures and improve immunisation rates.[26]

In June 2019, American anti-vaccination activist Robert F. Kennedy Jr. visited Samoa to meet with local anti-vaccination activists including Taylor Winterstein and Edwin Tamanese, whom he called a "medical freedom hero". Kennedy also discussed vaccines with then-Prime Minister Tuilaʻepa Saʻilele Malielegaoi,[27][28] and campaigned against the vaccine on social media.[29][30]

## 2019 outbreak

[edit]

In August 2019, an infected passenger on one of the more than 8,000 annual flights between New Zealand and Samoa probably brought the disease from Auckland to Upolu.[8] An outbreak began in October 2019 and continued for four months. Before seeking proper medical treatment, some parents first took their children to 'traditional healers' who used machines purchased that claimed to produce "immune-protective" water.[9]

As of 22 December, there were 79 deaths. This was 0.4 deaths per 1,000 people, based on a population of 200,874,[7][6] an infection fatality rate of 1.43%. There were 5,520 cases, representing 2.75% of the population.[2][7][6] 61 of the first 70 deaths were aged four and under. All but seven of the deaths were from people aged under 15.[31][32]

At least 20% of babies aged six to 11 months contracted measles. One in 150 babies died.[33]

By 20 December 2019, 94% of the population had been vaccinated,[33][34] versus the 95% required for herd immunity.[33]

After the outbreak started, anti-vaxxers, including Kennedy,[35] attributed the dozens of measles deaths to poverty and malnutrition or to the vaccine, but cited no evidence for these claims. Clinicians reported that Vitamin A deficiency or immunodeficiency did not appear to be a substantial contributing factor to the outbreak.[8]

### Government response

[edit]

Initially, schools remained open after the outbreak was declared. The Samoan government initially did not accept humanitarian support.[17]

On 17 November, a state of emergency was declared, ordering the closure of all schools, keeping children under 17 away from public events, and making vaccination mandatory.[36] UNICEF sent 110,500 vaccine doses. Tonga and Fiji also declared states of emergency.[37] Tonga closed all schools for several days. American Samoa required all travelers from Tonga and Samoa to present proof of vaccination.[38] In Fiji, vaccines were prioritised for young children and overseas travellers.[39]

On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings.[40][41] All unvaccinated families were ordered to display a red flag or red cloth in front of their homes to warn others and to aid mass vaccination efforts.[42] The Royal New Zealand Air Force transported medical supplies and equipment to Samoa. Medical teams from New Zealand, Australia, the United Kingdom, France and its overseas territory of French Polynesia assisted Samoan medical authorities.[43]

On 5 and 6 December, the government shut down everything other than public utilities, and assigned all available civil servants to the vaccination campaign.[44]

Edwin Tamasese, a Samoan anti-vaccination activist with no medical training who was also the chair of a coconut farmers' collective,[8] was charged with "incitement against a government order".[44] He had posted online comments like "Enjoy your killing spree."[8] He encouraged people to refuse immunisation, as he believed the vaccine caused measles,[45] and even discouraged life-saving antibiotics.[8] Tamasese faced up to two years in prison.[8]

On 7 December, the curfew was lifted when the government estimated that 90% of the population had been reached by the vaccination program.[46] On 19 December, Parliament passed a bill to make measles vaccinations mandatory in 2020.[47]

As of 29 December, a public inquiry into the government's role in suspending vaccinations had not been announced. Deputy director of health Gaualofa Matalavea Saaga stated, "Having our case blasted out to the world is the last thing we want."[8] Samoa's political opposition called for the health minister to be removed.[8]

On 31 December, Prime Minister Tuilaʻepa Saʻilele Malielegaoi addressed the nation about the measles outbreak. He acknowledged the support of the Samoan diaspora and 49 medical teams from across the world.[48]

### International response

[edit]

Many organisations and countries responded:

* American Samoa declared a measles outbreak and closed public schools and park gatherings[49] and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa.[50]
* Australian Medical Assistance Teams (AUSMAT) sent a team of nurses, doctors, and public health experts, and medical equipment and supplies to Samoa. They left on 3 January 2020, after eight weeks in Samoa in one of its longest-ever missions.[51][52]
* Fiji through UNFPA
* French Polynesia sent a team of paediatric nurses.
* Israel sent Intensive Care teams.[53] along with a team of two paediatricians, six nurses and one physiotherapist trained in disaster medicine from the Israel Center for Disaster Medicine and Humanitarian Response.[54]
* New Zealand sent three rotations of the New Zealand Medical Assistance Team (NZMAT) of doctors, nurses and logistics specialists who supported Leulumoega Hospital and Faleolo Clinic for six weeks. New Zealand also sent a team of nurse vaccinators, 3,000 vaccination doses and vaccine fridges in mid-November,[55] and a small number of Intensive Care Clinicians. Residents of Rotorua, New Zealand sent two dozen infant-size coffins decorated with flowers and butterflies to Samoan families.[56] On 14 December 2019, New Zealand Foreign Minister Winston Peters announced $1 million in funds towards preventive efforts in the Pacific.[57]
* United Kingdom EMT sent two rotations of doctors, nurses, physiotherapists, an anaesthetist, and an epidemiologist for four weeks of support from the end of November to December 2019.[58] UK Save the Children helped out.
* United States: Hawaii sent 75 doctors and nurses for two days at the beginning of December to assist with vaccination.

#### Organisations

[edit]

* UNICEF sent 200,000 vaccines.[37][59]
* WHO deployed 128 medical teams to assist in vaccination. The UN Central Emergency Response Fund (CERF) allocated $2.7 million to support the response in Samoa, Tonga, and Fiji.[59]
* The World Bank gave a US$3.5 million grant to support the response to the outbreak and another US$9.3m grant over the next five years to improve the health system.[53]

### Others

[edit]

As of January 2020, the following other countries had sent aid:[60][48]

* American Samoa
* China
* Japan
* Kiribati
* Norway
* Papua New Guinea
* Solomon Islands

Various organisations

* Save the Children
* PACMAT
* Blacktown Doctors Medical Centre
* Samoa mo Samoa Doctors Worldwide
* Counties Manuka District Health Board
* ADRA
* Pacific Community (SPC)
* Médecins Sans Frontières

## Aftermath

[edit]

In November 2019, Tuilaepa said he would propose legislation to penalise parents who refused to vaccinate their children.[61] The Samoan government allocated US$2.5 million for relief work.[61]

In December 2019, immunology experts questioned the role of social media, primarily Facebook, and how social media facilitated the spread of vaccination hesitancy during the outbreak. The Immunisation Advisory Centre in New Zealand said that the Samoan crisis was a sign that social media needs to deal with dangerous misinformation.[62]

By 25 January 2020, Tuilaepa had resisted calls for an inquiry.[63] Opposition MP Olo Fiti Vaʻai continued to call for an inquiry and was "apologising on behalf of Parliament and telling the people of Samoa that the government had failed miserably."[64][17]

In August 2021, following the ousting of the HRPP in the 2021 Samoan general election, new Health Minister Valasi Toogamaga Tafito announced he was considering an inquiry into the outbreak.[65][needs update]

## See also

[edit]

* Taylor Winterstein, Samoan anti-vaccination campaigner
* Robert F. Kennedy Jr., American anti-vaccination campaigner
* 2019 Tonga measles outbreak
* 2019 New Zealand measles outbreak
* 2019 Philippines measles outbreak
* Chemophobia
* Measles resurgence in the United States
* Vaccination
* Vaccine hesitancy
* 2019 in Oceania
* 2025 Southwest United States measles outbreak

## References

[edit]

1. ^ "WHO/UNICEF Secretariat Supporting Measles Outbreak Preparedness And Response In The Pacific" (PDF). who.int. World Health Organization. 22 November 2019. Archived (PDF) from the original on 13 December 2019.
2. ^ a b "Samoa, Fiji and Tonga - Measles outbreak (DG ECHO, WHO, UNICEF and media) (ECHO Daily Flash of 25 November 2019) - Samoa". ReliefWeb. UN Office for the Coordination of Humanitarian Affairs (OCHA). 25 November 2019. Archived from the original on 2 December 2019.
3. ^ "Health Emergency Operation Centre: Update on the measles outbreak" (Press release). Government of Samoa. 20 January 2020.
4. ^ a b "Two more deaths from measles in samoa over new year period". Radio New Zealand. 7 January 2020. Archived from the original on 7 January 2020.
5. ^ "Ministry of Health Press Release 1 - Measles Epidemic - Samoa". ReliefWeb. Government of Samoa. 16 November 2019. Archived from the original on 1 December 2019.
6. ^ a b c "Population & Demography Indicator Summary". Samoa Bureau of Statistics. 22 December 2019. Archived from the original on 8 December 2019.
7. ^ a b c d Government of Samoa (22 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 36) 22 December, 2019". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
8. ^ a b c d e f g h i j Deer, Brian (20 December 2019). "Samoa's perfect storm: How a collapse in vaccination rates killed more than 70 children". The Telegraph. London, UK. ISSN 0307-1235. Archived from the original on 21 December 2019.
9. ^ a b c Kwai, Isabella (19 December 2019). "'Why My Baby?' How Measles Robbed Samoa of Its Young". The New York Times. US. Archived from the original on 31 December 2019.
10. ^ "Samoa measles state of emergency extended". Radio New Zealand. 14 December 2019. Archived from the original on 14 December 2019.
11. ^ Davies, Samuel H. (1894). "Epidemic Measles at Samoa". The British Medical Journal. 1 (1742): 1077. doi:10.1136/bmj.1.1742.1077. PMC 2404975. PMID 20754822.
12. ^ Belluz, Julia (18 December 2019). "Tiny Samoa has had nearly 5,000 measles cases. Here's how it got so bad". Vox. US: Vox Media LLC. Archived from the original on 8 January 2020.
13. ^ Aguilar, Krissy (7 February 2019). "Failure of health system leads to measles outbreak – UNICEF". Philippine Daily Inquirer. Retrieved 9 February 2019.
14. ^ "Tonga Measles Outbreak 2019 – Situation Report #8". 4 December 2019. Archived from the original on 8 December 2019. Retrieved 8 December 2019.
15. ^ Small, Zane; Lynch, Jenna. "'This is serious': National Health Coordination Centre activated over measles outbreak". Newshub. Archived from the original on 31 August 2019.
16. ^ a b "The wrong jab that helped cause a measles crisis". BBC News. UK. 2 December 2019. Archived from the original on 5 December 2019.
17. ^ a b c d Jackson, Lagipoiva Cherelle; Lyons, Kate (17 December 2019). "'These babies should not have died': How the measles outbreak took hold in Samoa". The Guardian. UK. ISSN 0261-3077. Archived from the original on 18 December 2019.
18. ^ Dreaver, Barbara (2 August 2019). "Nurses sentenced to five years in prison for incorrectly administering MMR vaccine that led to deaths of two infants in Samoa". 1News.
19. ^ Agence France-Presse (28 November 2019). "Samoa measles outbreak: WHO blames anti-vaccine scare as death toll hits 39". The Guardian. UK. Archived from the original on 29 November 2019.
20. ^ Clarke, Melissa (8 December 2019). "Anatomy of an epidemic: How measles took hold of Samoa". ABC News. Australian Broadcasting Corp. Archived from the original on 10 December 2019.
21. ^ "SAMOA MEASLES UPDATE: Death toll rises to 42". www.samoanews.com. 29 November 2019. Retrieved 13 February 2024.
22. ^ "WHO/UNICEF Secretariat Supporting Measles Outbreak Preparedness and Response in the Pacific – Measles Outbreak in the Pacific – Situation Report No 5" (PDF). WHO.int. 6 December 2019. Archived (PDF) from the original on 13 February 2024. Retrieved 12 February 2023.
23. ^ Whyte, Chelsea (6 December 2019). "Samoan government takes drastic measures to fight measles outbreak". New Scientist. Archived from the original on 10 December 2019. Retrieved 8 December 2019.
24. ^ "Samoa: WHO and UNICEF estimates of immunization coverage: 2018 revision" (PDF). World Health Organization. 2018. Archived (PDF) from the original on 8 December 2019.
25. ^ "American Samoa declares measles outbreak". SBS News. Australia. 8 December 2019. Archived from the original on 9 December 2019.
26. ^ Duckor-Jones, Avi (5 February 2020). "Tragedy in paradise: How Samoa is faring after the measles epidemic". The Listener. NZ: Bauer Media Pty Ltd. Archived from the original on 23 February 2020.
27. ^ Corn, David. "How RFK Jr. Falsely Denied His Connection to a Deadly Measles Outbreak in Samoa". Mother Jones. Retrieved 19 November 2024.
28. ^ Weiland, Noah (18 November 2024). "Robert F. Kennedy Jr.'s Views on Vaccination 'Dangerous,' Says His Ambassador Cousin". New York Times.
29. ^ "RFK Jr. appears before Congress as his comments spreading misinformation draw scrutiny". PBS News. 20 July 2023. Retrieved 19 November 2024.
30. ^ Yang, Maya (14 November 2024). "RFK Jr condemned as 'clear and present danger' after Trump nomination". The Guardian. ISSN 0261-3077. Retrieved 19 November 2024.
31. ^ Government of Samoa (9 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 23) 9 December". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
32. ^ Barrett, Jonathan (9 December 2019). "Decorated with butterflies, infant-sized coffins sent to measles-ravaged Samoa". Reuters. New York, NY, US. Archived from the original on 10 December 2019.
33. ^ a b c Gibney, Katherine (12 December 2019). "Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster". The Conversation. Melbourne, Australia: The Conversation Media Trust. Archived from the original on 12 December 2019.
34. ^ Kerr, Florence (20 December 2019). "Samoa measles outbreak: Death toll continues to rise, 39 new cases". Stuff. NZ: Stuff Ltd. Archived from the original on 20 December 2019.
35. ^ Hagan, Joe (2 July 2024). "RFK Jr.'s Family Doesn't Want Him to Run. Even They May Not Know His Darkest Secrets". Vanity Fair. Retrieved 19 November 2024.
36. ^ "Samoa declares state of emergency over deadly measles outbreak". ABC News. Australian Broadcasting Corp. 17 November 2019. Archived from the original on 2 December 2019.
37. ^ a b "Samoa measles outbreak worsens". BBC News. UK. 23 November 2019. Archived from the original on 5 December 2019.
38. ^ Wibawa, Tasha (19 November 2019). "'Deaths keep climbing': How did a measles outbreak become deadly in Samoa?". ABC News. Archived from the original on 2 December 2019.
39. ^ "Authorities in Fiji urge public to respect quarantine". Radio New Zealand. 25 November 2019. Archived from the original on 2 December 2019.
40. ^ "Children stay home, Christmas gatherings cancelled in Samoa". Radio New Zealand. 2 December 2019. Archived from the original on 26 February 2020.
41. ^ "Samoa measles outbreak: Police urge public to keep to curfew". Radio New Zealand. 2 December 2019. Archived from the original on 21 December 2019.
42. ^ Silk, John; AFP (4 December 2019). "Samoan measles epidemic: Unvaccinated advised to display red flags in front of their homes". Deutsche Welle. Germany. Archived from the original on 5 December 2019.
43. ^ "NZDF supporting Samoa measles epidemic response". Radio New Zealand. 3 December 2019. Archived from the original on 3 December 2019.
44. ^ a b Kennedy, Merrit (6 December 2019). "Samoa Arrests Anti-Vaccination Activist As Measles Death Toll Rises". NPR. US. Archived from the original on 31 January 2020.
45. ^ Purtill, James (5 December 2019). "Samoan measles anti-vaxxer with links to Australia arrested after spreading conspiracy theories". triple j - Hack. Australian Broadcasting Corp. Archived from the original on 7 December 2019.
46. ^ "Samoa measles vaccination hits target but new cases still rising". Al Jazeera English. 7 December 2019. Archived from the original on 9 December 2019.
47. ^ "Samoa's measles death toll rises to 78". Radio New Zealand. 20 December 2019. Archived from the original on 20 December 2019.
48. ^ a b Feagaimaali'i, Joyetter (1 January 2020). "Prime Minister addresses nation at start of 2020". Samoa Observer. Archived from the original on 1 January 2020.
49. ^ Hofschneider, Anita (9 December 2019). "Hawaii Lt Gov Says Samoa Medical Mission Won't Be The Last". Honolulu Civil Beat. HI, US. Archived from the original on 10 December 2019.
50. ^ "American Samoa tightens entry as measles fears grow". Radio New Zealand. 10 December 2019. Archived from the original on 10 December 2019.
51. ^ "Statement on Samoa measles outbreak". ReliefWeb. Government of Australia. 21 November 2019. Archived from the original on 22 November 2019.
52. ^ Wilson, Soli (5 January 2020). "Australia's emergency measles mission ends". Samoa Observer. Archived from the original on 16 March 2020.
53. ^ a b Meyer, Jenny (10 December 2019). "Jabs could knock out kid-killing measles epidemic in Samoa". New Zealand Herald. Archived from the original on 10 December 2019.
54. ^ Leichman, Abigail Klein (8 December 2019). "Israeli medical experts fly to help Samoan measles victims". Israel21c news. San Francisco, US. Archived from the original on 8 January 2020.
55. ^ "Measles outbreak: Samoa declares state of emergency after 6 fatalities". Deutsche Welle. Germany. 18 November 2019. Archived from the original on 19 November 2019.
56. ^ Gerson, Michael (10 December 2019). "Samoa has become a case study for 'anti-vax' success". Washington Post. US. Archived from the original on 10 December 2019.
57. ^ "Samoa measles outbreak: New Zealand gives $1m for preventive action in Pacific". Stuff. New Zealand: Stuff Limited. 14 December 2019. Archived from the original on 14 December 2019.
58. ^ Department for International Development (29 November 2019). "UK medics fight deadly measles outbreak in Samoa - Press release". UK Government. Archived from the original on 30 November 2019.
59. ^ a b "UN team aids Samoa response to deadly measles epidemic". UN News. 5 December 2019. Archived from the original on 6 December 2019. Retrieved 21 April 2021.
60. ^ Govt Press Release (25 December 2019). "Emergency Medical Teams Work Through Christmas". Samoa Global News. Archived from the original on 16 January 2020.
61. ^ a b "Samoa govt allocates more funds for measles epidemic". Radio New Zealand. 30 November 2019. Archived from the original on 30 November 2019.
62. ^ Hendrie, Doug (11 December 2019). "Facebook challenged over spread of anti-vaccine content in measles-stricken Samoa". newsGP. The Royal Australian College of General Practitioners. Archived from the original on 18 December 2019.
63. ^ "Samoa's measles crisis wanes, but questions remain unanswered". Radio New Zealand. 24 January 2020. Archived from the original on 25 January 2020.
64. ^ "MP calls for inquiry into Samoa's measles epidemic". Radio New Zealand. 21 January 2020. Archived from the original on 25 January 2020.
65. ^ Joyetter Feagaimaali'i (18 August 2021). "Government considers measles inquiry". Samoa Observer. Archived from the original on 18 August 2021. Retrieved 29 August 2021.

## Further reading

[edit]

* "'Her body was turning black': Samoan nurses jailed for infant vaccination deaths". ABC News. 2 August 2019.
* "Australia - Oceania :: Samoa — The World Factbook - Central Intelligence Agency (July 2018 est.)". www.cia.gov. Retrieved 6 December 2019.
* "Measles death toll rises to 68 in Samoa". Radio New Zealand. 8 December 2019.
* @samoagovt (5 December 2019). "Latest update: 4,357 measles cases have been reported since the outbreak with 140 recorded in the last 24 hours. To date, 63 measles related deaths have been recorded" (Tweet) - via Twitter.
* "Samoa makes measles vaccinations compulsory after outbreak kills 32". ABC News. 26 November 2019.
* Russell, Emma (30 November 2019). "Samoan measles outbreak: 70 deaths projected and 6500 infected". The New Zealand Herald.
* "Further support for Samoan measles outbreak". New Zealand Government (Press release). 18 November 2019.
* McNamara, Audrey (14 December 2019). "Measles outbreak in Samoa kills 72, most of them children". CBS News.
* Prasad, Vinay (24 December 2024). "The true story of the Samoa measles outbreak".

* v
* t
* e

2019–2020 measles outbreaks

>10,000 confirmed cases|

* Democratic Republic of the Congo (380,766, 7,018 deaths)
* Philippines (31,056, 415 deaths)

1,000 to 10,000 confirmed cases|

* Samoa (5,700, 83 deaths)
* New Zealand (2,194, 2 deaths)

<1,000 confirmed cases|

* Tonga (612)
* New York (423)
* Pacific Northwest (73)
* Kuala Koh (43, 15 deaths) (113 suspected)
* Freewinds (1)

Related: Measles resurgence in the United States

* v
* t
* e

Pandemics, epidemics and notable disease outbreaks

* List of epidemics and pandemics

Local|

| Ancient|

* Hittite plague (c. 1330 BC)
* Plague of Athens (429–426 BC)
* Antonine Plague (165–180 AD)
* Plague of Cyprian (250–266)

|

Post-
classical|

* Plague of Justinian (541–542)
* Roman Plague (590)
* Plague of Sheroe (627–628)
* Plague of Amwas (638–639)
* Plague of 664 (664–689)
* Japanese smallpox (735–737)
* Black Death (1346–1353)
* Sweating sickness (1485–1551)

Early
modern|

| 16th century|

* Influenza pandemic (1510)
* Mexican smallpox (1520)
* "Cocoliztli" epidemics in colonial Mexico (1545, 1576)
* Influenza pandemic (1557–1559)
* London plague (1563–1564)
* Maltese plague (1592–1593)
* London plague (1592–1593)

|

17th century|

* London plague (1603)
* Maltese plague (1623)
* Italian plague (1629–1631)
* Massachusetts smallpox (1633)
* Great Plague in the late Ming dynasty (1633–1644)
* Great Plague of Seville (1647–1652)
* Maltese plague (1655)
* Naples Plague (1656)
* Great Plague of London (1665–1666)
* Maltese plague (1675–1676)
* Great Plague of Vienna (1679)

18th century|

* Iceland smallpox epidemic (1707–1708)
* Great Northern War plague (1710–1712)
* Great Plague of Marseille (1720–1722)
* Great Plague of 1738 (1738)
* Russian plague (1770–1772)
* Persian Plague (1772)
* North American smallpox (1780–1782)
* Philadelphia yellow fever (1793–1798)

Modern|

| 19th century|

* Ottoman plague (1812–1819)
* Maltese plague (1813–1814)
* Caragea's plague (1813)
* Groningen epidemic (1829)
* Great Plains smallpox (1837–1838)
* Typhus (1847–1848)
* Copenhagen cholera (1853)
* Stockholm cholera (1853)
* Broad Street cholera (1854)
* Guam smallpox (1856)
* Pacific Northwest smallpox (1862–1863)
* Barcelona yellow fever (1870)
* Buenos Aires yellow fever (1871)
* Australia scarlet fever (1875–1876)
* Hong Kong plague (1894)

|

20th century|

* San Francisco plague (1900–1904)
* Manchurian plague (1910–1911)
* LA pneumonic plague (1924)
* Croydon typhoid (1937)
* NYC smallpox (1947)
* Wrocław smallpox (1963)
* Yugoslav smallpox (1972)
* London flu (1972–1973)
* Indian smallpox (1974)
* Surat plague (1994)
* Malaysian Nipah virus (1998–1999)

21st century|

* SARS (2002–2004)
* Midwest monkeypox (2003)
* Bird flu (2003–2005)
* Singaporean dengue (2005)
* Indian dengue (2006)
* Chikungunya outbreaks (2006)
* Pakistani dengue (2006)
* Iraqi cholera (2007)
* Zimbabwean cholera (2008–2009)
* Madagascar plague (2008–2017)
* Bolivian dengue (2009)
* Gujarat hepatitis (2009)
* Western African meningitis (2009–2010)
* Haiti cholera (2010–2019)
* Pakistani dengue (2011)
* Darfur yellow fever (2012)
* MERS (2012)
* Singaporean dengue (2013)
* Swansea measles (2013)
* Chikungunya (2013–2014)
* Western African Ebola (2013–2016)
* DR Congo Ebola (2014)
* Madagascar plague (2014)
* Odisha hepatitis (2014)
* Polio declaration (2014)
* Indian swine flu (2015)
* South Korean MERS (2015)
* Zika (2015–2016)
* Angolan yellow fever (2016)
* Yemeni cholera (2016–2022)
* Gorakhpur Japanese encephalitis (2017)
* Saudi Arabian MERS (2018)
* Kerala Nipah virus (2018)
* Équateur province Ebola (2018)
* Kivu Ebola (2018–2020)
* Madagascar measles (2018)
* Samoa measles (2019)
* Philippine measles (2019)
* Pacific NW measles (2019)
* New York measles (2019)
* Kuala Koh measles (2019)
* Tonga measles (2019)
* DRC measles (2019–2020)
* New Zealand measles (2019–2020)
* Singaporean dengue (2020)
* Uganda Ebola (2022–2023)
* Jamaica dengue (2023)
* Bangsamoro measles (2023–present)
* 2024 Latin American dengue
* Argentina (2024)

Global|

* First plague pandemic (541–767)
* Second plague pandemic (1348–19th century)
* Influenza pandemic (1510)
* Influenza pandemic (1557–1559)
* First cholera pandemic (1816–1826)
* Second cholera pandemic (1829–1851)
* Third cholera pandemic (1852–1860)
* Third plague pandemic (1855–1860)
* Fourth cholera pandemic (1863–1879)
* Fifth cholera pandemic (1881–1896)
* Russian flu (1889–1890)
* Sixth cholera pandemic (1899–1923)
* Spanish flu (1918–1920)
* encephalitis lethargica epidemic (1919–1930)
* Asian flu (1957–1958)
* Seventh cholera pandemic (1961–1975)
* Hong Kong flu (1968–1970)
* Russian flu pandemic (1977–1979)
* HIV/AIDS (1981–present)
* Swine flu (2009–2010)
* COVID-19 (2019–present)
* Mpox (clade II) outbreak (2022–2023)
* Mpox (clade Ib) epidemic (2023–2025)

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