On Dec. 20, 2019, the government of Samoa announced that 94 percent of the island nation’s population of about 200,000 people had been vaccinated against measles as part of a government-led mandatory, mass vaccination campaign. As of Dec. 20, the Samoan Ministry of Health (MOH) had confirmed 5,463 reported cases with 1,762 hospitalizations and 78 deaths associated with measles and the state of emergency will remain in effect for at least another week.1 2
The mandatory MMR vaccination campaign was initiated by the Samoan government on Nov. 20 in response to an outbreak that began in mid-October when the number of confirmed measles cases had surpassed 3,100, including 42 associated deaths. At the start of ( the outbreak in October only about 31 percent of Samoa’s population had received the MMR measles, mumps, rubella) vaccine. By the time the mandatory mass vaccination campaign began later in November, MMR coverage in Samoa was up to 66 percent of the population.1 2 3 4
International organizations such as UNICEF and the government of New Zealand have assisted Samoa in getting some 115,500 doses of measles vaccines donated and delivered to the island since Oct. 1. This enabled the MOH to vaccinate 89 percent of the population by Dec. 7.1 3 5 6 7
The MMR vaccine used in Samoa is produced by the Serum Institute of India. It has been approved and certified by the World Health Organization (WHO). It is an attenuated (weakened) live virus vaccine that is sold under the brand name Tresivac.8 9 10 11
Tresivac is contraindicated for people who are allergic to eggs, gelatin and neomycin or who have had a previous life-threatening reaction to any vaccine containing measles, mumps or rubella viruses. The Serum Institute’s MMR vaccine is also contraindicated for anyone who suffers from a chronic illness such as asthma or other breathing disorder, diabetes, kidney disease, or blood cell disorders such as anemia; or from severe immune suppression caused by disease (such as cancer, HIV, or AIDS), or who is receiving certain medicines such as steroids, chemotherapy or radiation. It is also contraindicated for pregnant women.12
According to the Serum Institute, there may be a problem with giving Tresivac to people with the following conditions: thrombocytopenia purpura (easy bruising or bleeding); active tuberculosis infection; a history of seizures; a neurologic disorder or disease affecting the brain (or if this was a reaction to a previous vaccine); and a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments. The vaccine might also cause problems for anyone who has received an immune globulin or other blood product within the past year or who has received a previous MMR vaccine within the previous 28 days.12
In October 2019, a one-year-old girl died two days after being administered Tresivac at a clinic in Cuba. The toddler began to have symptoms of severe adverse reactions within two hours after the vaccination.13 Four other children who received Tresivac at the same clinic at about the same time also suffered severe reactions being vaccinated.14 While the Cuban Ministry of Health investigated the Tresivac-related death in October, there was speculation that the MMR vaccine had not been kept properly refrigerated.15
In May 2002, a measles vaccine produced by the Serum Institute caused severe adverse reactions in 42 children in Cuba. Three of the children died of toxic shock syndrome. Eventually, health officials concluded that medical workers, who administered the MMR vaccine to children, had mistakenly used a “non-sterile dissolvent.”11 16
On May 13, 2008, a 17-year-old boy died of septic shock in Ukraine eight hours after being vaccinated with Tresivac. In 2009, the Associated Press reported that the Ukrainian Health Ministry and World Health Organization concluded that the boy died of “septic shock from a bacterial infection unrelated to the vaccine.” After childhood vaccination rates declined in the Ukraine in 2009, there was criticism of the Ukraine government’s decision in 2008 to temporarily suspend the MMR vaccination campaign after the boy’s death, and vaccine safety activists and “member of the homeopathic and alternative healing industries” were also blamed for publicizing the MMR-related death report.11 17
On Dec. 14, the Samoan government announced that the state of emergency declared on Nov. 15 due to the outbreak would be extended through Dec. 29. Among other restrictions, the state of emergency prohibits children 14 years of age and under from gathering in public and requires them to show proof of vaccination before boarding a ferryboat to travel from one island to another.2 18
2 Schnirring L. Samoa extends measles emergency. CIDRAP Dec. 16, 2019.
3 UNICEF. UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga. UNICEF.org Nov. 28, 2019.
4 USAID. Samoa. USAID.gov.
5 Cáceres M. Measles in Samoa: Why are So Many Dying? The Vaccine Reaction Dec. 15, 2019.
6 News Source. Royal New Zealand Airforce Arrives with 50,000 MMR Vaccines. Samoa Global News Dec. 3, 2019.
7 Zialcita P. Samoa Closes Schools And Mandates Vaccinations Amid Deadly Measles Epidemic. NPR Nov. 18, 2019.
8 Graue C, Walsh M. Samoa recalls vaccines, orders full investigation after two baby deaths. ABC July 10, 2018.
9 Kerr F. Lalomanu the village devastated by a tsunami prepares for the measles wave. Stuff Dec. 2,2019.
10 Tresivac. Serum Institute of India Pvt. Ltd.
11 TVR Staff. Baby Girl in Cuba Dies Two Days After Getting MMR Vaccine. The Vaccine Reaction Nov. 8, 2019.
12 Tresivac. Gmedication.com.
13 “They Killed My Daughter,” Denounces Mother of the Girl Who Died After a Vaccination in Cuba. Oct. 5, 2109.
14 OnCuba Staff. Baby girl dies in Cuba after vaccination; four other children were affected. OnCuba News Oct. 13, 2019.
15 Two Hypotheses About Baby’s Death After An MMR Vaccination. Translating Cuba Oct. 16, 2019.
16 Gámez Torres N, Pentón MJ. Child dies in Cuba after receiving vaccine made in India. It’s not the first time. Miami Herald Oct. 15, 2019.
17 Vaccine scare in Ukraine threatens health. Associated Press Mar. 25, 2019.
18 Lemieux M. Public Gatherings Banned as Samoa’s Measles Crisis Continues. Newsweek Nov. 22, 2019.