Dept of Health staff actively looking for origin of measles infection

Pago Pago, AMERICAN SAMOA — With the territory under an emergency declaration due to the measles outbreak, Gov. Lemanu P. S. Mauga has urged his cabinet members to help and support ongoing efforts by the Health Department and the LBJ Medical Center to prevent the further spread of the virus.

And with schools closed, with no classroom instruction Lemanu also called on cabinet members to assist and support the work of the Department of Education, ensuring that students still get their lessons through online learning as they head towards the end of the current school year. 

The governor made the public calls during a cabinet meeting Monday afternoon, streamed on KVZK-TV, saying that cabinet members have gone through this similar type of emergency situation with the COVID-19 pandemic. He stressed the importance of everyone working together to protect the community.

The cabinet briefing focused on the measles outbreak with a DoH presentation, where Epidemiologist Dr. Scott Anesi announced that as of 2p.m. that day, the territory still has only one-laboratory confirmed case and a new update — that there are 31 probable cases identified through symptomatic diagnosis and referred for evaluation and confirmation at their nearest health center.

Health Department chart shows the break-down of probable measles cases by villages as of 2p.m. on Monday. The chart was presented during a cabinet meeting. [screen shot]

And the age range is 2 months to 13-years old; 53% male; 47% female.

Dr. Anesi informed the meeting that on Mar. 23, the first case was presented to the health center and this is the laboratory confirmed case of the 8-year old female student from Kanana Fou Elementary School. 

He explained that the other probable cases all reported back had links to the original case, the “Iliili range” [sic], pertaining to the student. 

“The outbreak started as we saw cases into Fagaalu as well as Pago Pago range that are all linked to the Ilili case,” he said. “We were then able to activate our active surveillance and investigation team and have been able to find spread cases from Fagalii to Onenoa.”

And by that Monday afternoon, the probable case count had reached 31.

Dr. Anesi shared a chart of village breakdown of suspected cases and they are linked back to the original case in Iliili. According to the chart, Ilili has six probable cases.

“Iliili is predominantly high as its related to the [original] index case,” he said and noted the number of “cases shows that we have active community transmission in the territory which is part of the advice that was given to the governor because we are showing there is widespread community transmission in all the districts on Tutuila.”

 “The advice was to stem the community transmission through the closure of schools and the targeted population,” he added.

Lemanu asked as to how DoH identified the cases and Dr. Anesi explained that the “recommendation from the medical team is that when we identify a case in the community, they are first assessed to the pediatric unit or the on-call attending physician.

“At such time that the physician deems that this case warrants an investigation or be part of the probable case definition, the lab team is then dispatched to collect the sample and the nursing team is then charged with follow-up for that individual case,” he continued.

“Isolation of the case as well as recommendation for home treatment is then done by the nursing team with follow-ups and advice from the medical team,” he said and noted that there’s a roster of “physicians as well as nurses that are operating on a 24-hour basis through our hotline and through our field teams that go out and make sure that the care for that individual is done.”

“At this time, there is no recommendation from the medical team for quarantine of the [whole] family that’s associated with the case but self-isolation of the case is worth it,” Dr. Anesi said.

Another question — which is also being asked by many in the community as well as those residing off island, including Hawai’i — came from Attorney General, Fainuulelei Falefatu Alailima Utu on whether DoH conducted contact-tracking for all 31 probable cases.

Dr. Anesi responded yes and Fainuulelei followed up with a query if any of that contact tracing shows that the infection originated — or cause — from Hawaii, the U.S mainland or Samoa.

“At this point in the investigation, we’ve been able to backtrack it for two incubation periods. So we’re at about a month before the presentation of symptoms,” was Dr. Anesi’s response.

As such, “we are not able to definitively say whether this is where the link is, in terms of travel associations. The investigation is still ongoing. There is a team that’s associated with that. But the primary concern here from the medical team is to go out and actively seek cases that are active and symptomatic,” he explained.

However, he did note that there’s a “team that is continuing to do the investigating just to establish where the point of reference is for our initial index case.”

On the issue of whether there’s a confirmed outbreak in the U.S or Samoa, Dr. Anesi said DoH remains in contact with the U.S Centers for Diseases Control and Prevention (CDC); and there are no outbreak reports from U.S regions.

DoH has also been in contact with the World Health Organization (WHO) and that “no South Pacific countries in our immediate jurisdiction are reporting cases,” he said.

However, WHO mentioned that they are starting to ramp up testing in neighboring countries “and so we should know a lot more as their tests come back.”

He said Samoa and Tonga are spending specimens to New Zealand and “they’re using case profiles similar to ours and we’ll know a lot more as they rank up their testing.”

“Right now, we’re in active phase. We’re actively testing,” he added.

On Monday this week, the Hawaii Department of Heath confirmed the second case of measles on the island of Oahu. The Oahu resident who was exposed to the previously confirmed case in an international traveler, reported on April 10, 2023. 

“Healthcare providers and the public are encouraged to be more aware and vigilant for a possible measles infection due to recent cases in our community,” said Immunization Program Branch Chief, Ronald Balajadia in a news release. “We are seeing increases in measles outbreaks globally, including recent cases reported in American Samoa.”

Balajadia noted the two recent cases in Hawai‘i are not related to any cases in American Samoa.

Meanwhile, the CDC website (www.cdc.gov) provides a link on global measles outbreak.