2019 Tonga measles outbreak

Measles epidemic in Tonga in late 2019

2019 Tonga measles outbreak

Disease| Measles
Virus strain| D8 strain (genotype) of measles virus [1]
Index case| October, 2019
Dates| 22 October 2019 –
present[2]
Confirmed cases| 612[3]

Deaths

| 0
Government website
https://reliefweb.int/report/tonga/tonga-measles-outbreak-2019-situation-report-8

The 2019 Tonga measles outbreak began in October 2019 after a squad of Tongan rugby players came back from New Zealand.[4] By 5 January 2020, there had been 612 cases of measles.[citation needed]

## Background

[edit]

A hypothetical measles timeline exposure to illness

Beginning in 2017, the WHO began tracking measles outbreaks in the Asia Pacific Region. Measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, Australia, Cambodia, Japan, the Republic of Korea, Malaysia, Thailand, Vietnam, Samoa, the Philippines and New Zealand.[5][6] Previously, measles had been believed to be eradicated in the Asia Pacific Region, with the last reported case in 2014, prior to the outbreak.[6]

Samoa, Tonga and Fiji all declared states of emergency to tackle their 2019 measles outbreaks. When contrasting the scores of deaths in Samoa to the lack of fatalities in Tonga and Fiji, this is put down to the far higher vaccination rates in Tonga and Fiji compared to the 31% in Samoa.[7]

Most of the cases have been on the island of Tongatapu where the first cases started, with 88% of all cases located on Tongatapu and 10% located on the neighboring island of Vava'u.[8][9]

## Vaccine hesitancy

[edit]

The outbreak has been attributed to a sharp drop in measles vaccination in Samoa from the previous year, following an incident in 2018 when two infants died in Samoa shortly after receiving measles vaccinations, which led the country to suspend its measles vaccination program.[10] The reason for the two infants' deaths was incorrect preparation of the vaccine by two nurses who mixed vaccine powder with expired anaesthetic.[11] The nurses responsible were sentenced to 5 years in prison with manslaughter charges and Samoa began arresting anti-vaccination advocates.[12] The United States' Centers of Disease Control sent representatives to Samoa, Tonga, and Fiji to coordinate vaccine efforts and combate vaccine misinformation.[12]

## Government response

[edit]

Ministry of Health chief executive, Siale ‘Akau’ola, said more than 12,000 people had been re-vaccinated. This vaccination program targeted school children and 6-11 month-old infants. A second vaccination program was conducted in February 2020, targeting children ages 1–9 years old.[13] The vaccination rate in Tonga was over 90% which might stem the infection rates seen in Samoa and New Zealand.[14] In November, 2019, the Tongan Minister of Education shut down all primary schools until the beginning of 2020.[15]

## International response

[edit]

UNICEF sent almost 300,000 vaccines to Vanuatu, Cook Islands, Nauru, Niue, Tokelau and Tuvalu, Samoa, Tonga, and Fiji.[16] Samoa, Tonga, and Fiji have also declared states of emergency.[17] The WHO and UNICEF have developed a toolkit for Pacific island nations following the outbreak to aid in further measles prevention.[16] Tonga closed all schools for several days while American Samoa required all travelers from Tonga and Samoa to present proof of vaccination.[18] The United States' Center for Disease control placed a Level 1 travel ban to the Kingdom of Tonga following the outbreak.[15]

Since 1 October, UNICEF delivered 12,000 measles vaccines to Tonga.[19] UNICEF later provided 6,000 additional doses of the vaccine cold chain following the success of the first administration.[15] Through domestic and internationally coordinated efforts, 44,605 individuals under the age of 24 were vaccinated by January 2020. This included administration of supplementary vaccines for previously vaccinated individuals in conjunction with routine childhood vaccination.[20]

On 10 December, American Samoa declared a measle outbreak and closed public schools and park gatherings[21] and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa.[22]

## See also

[edit]

* Taylor Winterstein, Samoan Anti-vaxxer
* 2019 Samoa measles outbreak
* 2019 New Zealand measles outbreak
* 2019 Philippines measles outbreak
* Chemophobia
* Measles resurgence in the United States
* Vaccination
* Vaccine hesitancy

## References

[edit]

1. ^ "WHO/UNICEF Secretariat Supporting Measles Outbreak Preparedness and Response in the Pacific" (PDF). WHO. Retrieved 16 December 2019.
2. ^ "Samoa, Fiji and Tonga – Measles outbreak (DG ECHO, WHO, UNICEF and media) (ECHO Daily Flash of 25 November 2019) – Samoa". ReliefWeb. 25 November 2019. Retrieved 26 November 2019.
3. ^ "It's okay to vaccinate, Minister Aupito spreads the message". Samoa Observer. Retrieved 5 January 2020.
4. ^ "Tonga Measles Outbreak 2019 – Situation Report #8". 4 December 2019. Archived from the original on 8 December 2019. Retrieved 8 December 2019.
5. ^ Whyte, Chelsea (6 December 2019). "Samoan government takes drastic measures to fight measles outbreak". New Scientist. Retrieved 8 December 2019.
6. ^ a b "WHO | Measles – Pacific Island Countries and Areas". WHO. Archived from the original on 10 June 2020. Retrieved 23 September 2020.
7. ^ "The wrong jab that helped cause a measles crisis". BBC News. UK. 2 December 2019. Archived from the original on 5 December 2019.
8. ^ "440 measles cases reported in outbreak". Matangi Tonga. 9 December 2019. Archived from the original on 11 December 2019. Retrieved 11 December 2019.
9. ^ "Tonga measles outbreak 2019–2020 update". Outbreak News Today. 13 January 2020. Retrieved 23 September 2020.
10. ^ "Samoa measles outbreak: WHO blames anti-vaccine scare as death toll hits 39". The Guardian. Agence France-Presse. 28 November 2019. Retrieved 30 November 2019.
11. ^ Beat, Pacific (2 August 2019). "'Her body was turning black': Samoan nurses jailed for infant vaccination deaths". ABC News. Retrieved 29 November 2019.
12. ^ a b Sun, Lena (11 December 2019). "CDC sends experts to fight measles outbreaks in Pacific islands neighboring Samoa". The Washington Post.
13. ^ "Tonga Measles Outbreak 2019–20 – Situation Report #17 – Tonga". ReliefWeb. 8 February 2020. Retrieved 23 September 2020.
14. ^ "Tonga close to achieving measles vaccination targets – Ministry". RNZ. 29 November 2019. Retrieved 8 December 2019.
15. ^ a b c "Pacific Island Measles Outbreak Gains Needed Support From UNICEF". www.vaxbeforetravel.com. Retrieved 24 September 2020.
16. ^ a b "UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga". www.unicef.org. Retrieved 24 September 2020.
17. ^ "Samoa measles outbreak worsens". BBC. 23 November 2019. Retrieved 26 November 2019.
18. ^ Samoa's measles crisis has claimed 15 lives but how did the outbreak start?, Tasha Wibawa, ABC, 18 November 2019
19. ^ "UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga". Retrieved 8 December 2019.
20. ^ "Tonga measles: Case tally now 659". Outbreak News Today. 17 February 2020. Retrieved 24 September 2020.
21. ^ "Hawaii Lt Gov Says Samoa Medical Mission Won't Be The Last". Honolulu Civil Beat. Retrieved 10 December 2019.
22. ^ "American Samoa tightens entry as measles fears grow". 10 December 2019. Retrieved 10 December 2019.

* 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)

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template
*[c.]: circa