News Item

Risk of measles importation to Pacific Islands

News 26 Sep 2019

Situational Update

Since 2017, there has been a global resurgence of measles cases. In proximity to Pacific Island countries and areas, outbreaks of measles have been reported in Australia, Cambodia, China (including Hong Kong and Macao), Japan, Lao People's Democratic Republic, Malaysia, New Zealand, Philippines, Republic of Korea, United States of America and Vietnam.

Measles risk to Pacific Island Countries and areas

In Pacific Island countries and areas (not inclusive of Australia, New Zealand or Papua New Guinea), the last recorded outbreak occurred in 2014 and the region is now in the measles elimination phase. A single laboratory confirmed case of measles therefore constitutes an outbreak in a Pacific Island country or area.

Given the recent large-scale measles outbreaks in neighbouring nations and the significant population movements between these countries and the Pacific, there is an increased risk of the virus being imported to the Pacific.

Vaccination is the best protection against vaccine-preventable diseases. For measles, at least 95% immunisation coverage is needed to achieve 'herd immunity', which helps protect communities by slowing or stopping the spread of the virus because the large majority of people are immune. Achieving and sustaining herd immunity reduces risk of large infants, pregnant women and people with certain medical conditions. Despite significant efforts, some Pacific island countries and areas have not reached the 95% immunisation coverage target for measles, making them more vulnerable to outbreaks.

Given recent outbreaks of measles in neighbouring countries, WHO and UNICEF have assessed that there is an increased likelihood of the measles virus being imported to Pacific island countries and areas. In response to this heightened risk, WHO and UNICEF are continuing to support Pacific health authorities and partners in country efforts to vaccinate all children and high risk groups, and strengthen their outbreak preparedness and response.

Vaccinate against measles

Measles can by prevented by vaccination with a measles-containing vaccine.

The two main types of vaccines utilised in the Pacific are Measles-Rubella (MR) and Measles-Mumps-Rubella (MMR). Following one dose of a measles containing vaccine about 95% of people are protected from measles. After two doses, more than 99% of people are protected. It is critical that children and adults ensure they are up-to-date with their immunisations, as per their national immunisation schedule.

Traveller advice

Travellers who are uncertain of their measles vaccination status should receive at least one dose of a measles-containing vaccine at least 15 days prior to travel.

If a person is unsure of whether they or their child have received a measles-containing vaccine or have natural immunity through infection, they should be vaccinated again. It is safe to have the vaccine more than twice.

We all have a responsibility to protect our communities, and those we are travelling to, by ensuring we are properly vaccinated.

Important information about measles

About measles virus

Measles is caused by a highly infectious virus that spreads easily from person to person though the air - via breathing, coughing and sneezing.

Signs and symptoms

Measles has a long incubation period (time from exposure to onset of symptoms) with a range of 7 to 18 days (most commonly 10-12 days), which means it is possible for international travellers to spread the virus to their travel destination before they have symptoms.

Initial (non-specific) signs and symptoms are:
- high fever (may spike to more than 40oC or 104oF)
- runny nose (coryza)
- coughing
- red, watery eyes (conjunctivitus)
- small, white spots on the inside of the cheeks (koplik spots)

Several days (3-5 days) after the initial symptoms, a rash will develop:
- the rash usually starts as flat red spots, at the hairline and behind the ears, spreading over the face and upper neck then down the body. The rash is not itchy.
- some infants and young children may also experience diarrhoea.

Who is most at risk?
Anyone who hasn't previously had measles or been immunised with MR or MMR vaccines can get measles. About 90 percent of susceptible people who are exposed to someone with the virus will be infected.

Unvaccinated young children and unvaccinated pregnant women are at highest risk of measles and its complications, including death.

What is the treatment for measles?

There is no specific treatment for measles and most people recover within 2 - 3 weeks. However, particularly in malnourished children and people with reduced immunity, measles can cause serious complications, including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia.

Severe complications from measles can be reduced through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with oral rehydration solution. Appropriate antibiotics should be prescribed to treat eye and ear infections, and pneumonia.

For further information about measles and immunisation services in your country, contact your national health authority.