Pago Pago, AMERICAN SAMOA — Department of Health (DoH) personnel were at all schools on Tutuila yesterday morning and they are expected to be back again today administering measles vaccinations to students who were not up to date with the vaccination for the highly infectious disease.

As of press time, there was no announcement that schools will be closed, other than the daycare centers and Kanana For Elementary and high school.

A public service announcement sent out by the Department of Public Health said unvaccinated students should attend their school with a parent/ caregiver to get vaccinated between 8:30am- 10am — both yesterday and today.

DoH pointed out during an emergency press conference Wednesday evening, Apr. 19 that they are planning on doing targeted mass vaccinations until they achieve 100% measles vaccination coverage in the territory.

In a DoH press conference held Wednesday evening, April 19, 2023, it was announced that they had received laboratory confirmation indicating evidence of a measles outbreak on Tutuila. This highly contagious disease can spread quickly and poses a serious health risk to individuals who are not vaccinated or who have weakened immune systems.

Present for the press conference were Epidemiologist Scott Anesi; Clinical Director at Tafuna Community Health Center, Dr. Saipale Fuimaono and DoH Deputy Director Talalelei Vesi Fautanu.

To prevent further spread of the disease, it has ordered that all daycare centers be closed until further notice. Kanana Fou Elementary and High school were also closed until further notice yesterday, Thursday April 20, 2023.

Dr. Fuimaono  explained, “Samples were sent off island to test for measles, and when it was received it was then we confirmed a positive case of measles. For our territory’s attention, measles is highly contagious and coughing and sneezing would be the main cause of spread for measles. Runny nose, cough, high fever, red and watery eyes, or conjunctivitis.

“Patients may get sick from 7 to 14 days, and on the 3rd to the 5th day, patients may start experiencing a rash that may start from the face and will spread to the rest of the body,” Dr. Fuimaono said.

He urged the public that the only safeguard we have against measles is by getting vaccinated and also disclosed “that the DoH and Immunization office has a vaccination program currently in place to update vaccines and to vaccinate those who have not received it, especially children aged 17 and under.

“Measles vaccines are administered with a first shot at the age of 1, and a second shot administered at the age of 4.”

Epidemiologist Anesi reiterated the announcement of the positive measles case.

 “We have been conducting our case investigations, and as a result, our mitigation and response plans include the promotion of vaccinations and immunization programs, and as such we will be ramping up these programs and want to make sure that all the parents of the territory evaluate their children’s immunization records and make sure it is complete for MMRs,” he said.

“We’re also confident in saying since we have the one case of measles, which is a very aggressive virus, that we have made the recommendation to signify that this would be a measles outbreak,” the doctor concluded.

According to diseases protocols, one measles case would signify an outbreak in the territory.

“We have made that recommendation and the Director of Health is reviewing and assessing the situation.

“There are individuals in the territory that we will be approaching for targeted immunization and vaccination, and those parents will be contacted for our campaigns and will be ramping up through the villages and different districts of the territory,” stated Anesi.

Anesi also explained that they will be “evaluating protocols for visits in each of the health centers to include the use of personal protection masks as well as the use of sanitizers.”

They will also be “evaluating the flow of patients in each of the health centers and would like to let the public know to be patient and to bear with them if they do visit any of the health centers that they may be redirected through traffic and will mention more of that in the coming days through their public service announcements,” he said.

TREATING YOUR INFECTED CHILD AT HOME

 “One of the best protections that you can do for your children at home is to keep them at home and isolate them from others, especially in households that have multiple children.

“If any of your children do develop a fever, rash or even red eyes, and you suspect they may have measles, please call out hotline 219 and you will be assessed over the phone and receive guidance to the next step for them. 

“The child that is sick will be the one that will be put in a mask and will be isolated.

“Infected patients must be isolated in a separate room and limit their contact with other members of the family.

“Make sure they have their own eating instruments, their own utensils, their own cups, and their own restroom if at all possible,” stated Dr. Anesi.

 “The best way that we can stop community transmission is through parents and community members staying vigilant.”

Anesi further disclosed that “there will be recommendations that will be coming from Public Health in consultation with the government as to the closure of all schools as well as daycare centers.”

The Department of Human & Social Services, in a press release Wednesday afternoon, announced that all daycare centers were to immediately close until further notice to prevent the spread of measles, according to DHSS director Muavaefa’atasi John E, Suisala after he had received an official communication from DoH director Motusa T. Nua confirming that a positive case of measles had been identified in the community.

All parents were advised to make sure that “their child’s immunizations are current and that the Child Care Office has a copy of their most current vaccination card,” the DHSS stated.

OTHER ANNOUNCEMENTS

One of the other announcements made at the press conference was “that during an outbreak, the Center for Disease Control recommends that the first dose should be administered at 6 months old, and the immunization program will be implementing that 6 months first dose range for children.”

As of right now, they have announced that all daycare centers will be closed until such time they are able to get that portion of the population vaccinated and immunized.

 “Newborns are not eligible to receive that vaccine and if that portion of the population contracts measles, the severity will be worse than the other age groups, and that is an unacceptable risk and will close daycare centers and limit community exposure as much as possible.”

MEDIA QUESTIONS

A member of the media asked, “How long ago was the case seen at the health center and how long ago did they receive confirmation of the positive case?”

Dr. Anese responded, “This positive case was seen on March 23rd at the health center, and the patient only showed symptoms of a rash and they decided to send out the test off-island for confirmation, and we received the positive indication test Wednesday morning.”

According to the doctors, the patient was reported to be 8 years old and had already been vaccinated and received the first and second dose of the MMR vaccine.

The percentage of children currently vaccinated is at 92%, but with the inclusion of the new age group, 6 months, the percentage is at 89.2%.

 “The goal is, with the recommendation of making sure we work with our partners to shut the schools down, especially the daycares is to give us enough time to do our targeted mass vaccination campaign and to raise that percentage, because once another portion of the population is added, the denominator raises while the percentage falls.

“And now that more of the population is included in the vaccination coverage, the percentage will be less.”

Dr. Anesi also reported that a shipment of MMR vaccines is on the way and started arriving yesterday, Thursday April 20, 2023 with more arriving throughout the weekend.

The media also asked whether all schools, or just Kanana Fou elementary and high school would be closed.

Although the doctors recommended closing down all schools, Dr. Fuimaono disclosed that only daycares and Kanana Fou elementary and high school would be closed for now, but they are planning to close all schools next week and to get all vaccines out as soon as possible.

The media also asked how long someone who was tested for MMR had to wait before receiving results, to which Anesi replied, “The serology testing was done in California, and what they’re trying to do is shorten the mechanism between the time that it takes them from when they get the sample and when they send it out, and currently the confirmatory testing for measles is done off island and the turnaround time could be anywhere between 1 week or longer.”

They are currently working on a mechanism right now with their partners to do testing locally and are in the process of working with some vendors to see if they can get rapid tests on island and deploy it locally, Anesi said.

The media also asked about the “long delay to get the word out when they received the confirmation of the positive case” and Anesi stated that “when the laboratory received the positive confirmation, the mechanism of their reporting changed and the actual lab report did not go to the personnel it should have.

“The positive case results were released by the lab on Saturday and the Department of Health was alerted to that case today [Wed April 19],” stated Anesi.

DoH Director Motusa said on Wednesday night that he would be meeting with the Governor Thursday morning to go over and review the recommendation of the Public Health doctors on whether they had come to a decision to close all schools, so the DoH can execute their targeted mass vaccination.

But as of this writing, the only schools reported to be closed are Kanana Fou elementary, reportedly the school the patient attends, and Kanana Fou high school — as well as all daycares on island.

BACKGROUND

On Mar. 15th, Samoa News reported that there were two new suspected cases of measles in Samoa, which was announced by Samoa's Director General of Health Aiono Dr Alec Ekeroma. The initial suspected case had been ruled out after tests were returned from New Zealand.

Government newspaper Savali reported the Health Ministry is maintaining its strict surveillance and monitoring duties for a potential outbreak of measles in the wake of alerts from New Zealand and Australia.

During the 2019 measles outbreak 83 lives were lost, mostly young children.