Bulletin

TOKELAU NATIONAL SURVEILLANCE AND PREVENTATIVE APPROACHES TOWARDS MEASLES

BACKGROUND

Measles is a highly contagious viral disease that occurs in children and adults.
Symptoms include fever, rash, runny nose, and inflamed eyes, while further health
complications are quite common.

People who have already had measles develop immunity (meaning that their immune
system is able to fight off subsequent exposure) and cannot get measles again.

CAUSES
Measles is a highly infectious disease that can spread rapidly. Nine out of 10 people
around a person with measles will become infected if they are not immune. Outbreaks
occur mainly in communities where the number of people vaccinated against measles is
low.

Measles outbreaks usually involve unvaccinated older children, adolescents, and adults.
Measles can be transmitted from an infected person to another person for a period of
about eight days – from four days before until four days after the appearance of the
rash.

For the four days before appearance of the rash, a person with measles will not know
that they have the disease and that they are likely to be spreading it to other people.
Measles is spread through the air by infectious droplets that are produced when
someone with measles talks, coughs, or sneezes. Infected droplets may land on
surfaces where they can remain contagious for several hours.

SYMPTOMS

It takes an average of 7–14 days from exposure to the measles virus until the
appearance of the first symptom.

The initial signs and symptoms of measles include:
 Mild to moderate fever
 Runny nose
 Dry cough
 Sore throat
 Earache
 Inflamed eyes (conjunctivitis) or "pink eye" Skin rash, with a red motley appearance
 Small bluish-white spots (known as Koplik’s spots) inside the mouth.
 Sensitivity to light (photophobia).
 Loss of appetite
 Tiredness

Contact your local hospital if you have any of these signs/symptoms
 The measles rash appears as small red spots, and usually appears
approximately 14 days after exposure and 3–5 days after the fever begins. It first
appears along the hairline and behind the ears, spreads to the face and upper
neck, and then proceeds down the body. The rash usually lasts 4–6 days.


PREVENTATIVE APPROACHES

1. MMR / MR Vaccination
Tokelau has a 100% MMR immunization coverage rate for our new born with first
dose at 12 months and second dose at 15 months. As such, most of our people
are immunized.

In the current measles preventative approach, we have introduced the MR at
6months and then MMR at 12 and 15 months respectively as per usual Tokelau
schedule

However, we still have risks especially for those that were not born in Tokelau so
we have ordered MR vaccines and all hospitals are providing vaccines for
o For all health workers
o 14-21 years age group
o For those travelling out of Tokelau
o those who not sure if vaccinated already
o For those who are 60+ above
o Post-natal mothers (immediately after delivery)

Samoa has MR vaccines available in all hospitals and private clinics in Apia that
Tokelau staffs in Apia can access for their vaccination if unsure of their
vaccination status or contact Liza Kele at our office in Apia for assistance.

Travelling population
Passengers travelling to Tokelau are advised to make sure they have vaccination
before they travel to Tokelau at least 14 days prior to travelling to Tokelau as
vaccination will be effective after 2 weeks from date of vaccination.
Travelling passengers from outside of Samoa needs to be vaccinated 2 weeks
prior to travelling to Apia to avoid picking up the virus in Apia. While in Apia,
avoid being around crowded places to reduce risk of picking up the virus.

As part of International Health Regulations to protect the people of Tokelau from
imported measles to Tokelau, travelling passengers need to show proof of
vaccination to the transport officer prior to traveling to Tokelau and if not,
passenger will not be allowed to travel to Tokelau. If passenger show proof of
vaccination done but it was less than 2 weeks ago, then passenger will remain
back in Apia until completion of the 2 weeks before travelling to Tokelau. This
border restriction will be enforced on the 26th November 2019 and will be in effect
until further advice.

Tokelau nationals travelling to Tokelau and affected by this border restrictions
need to contact Liza Kele at the Health Office in Apia for assistance.

All hospitals in Tokelau are providing vaccination for those travelling out of
Tokelau to boost immunity and this needs to be done 2 weeks prior to travelling
out to Apia

2. Border control Screening
In Apia
Health team in Apia do screening of all passengers in Apia before passengers
depart on the boat and any person having three or more of the signs and
symptoms of measles will be asked to stay back in Apia under the TPRS
scheme.
On each atoll
Screening will be done for all passengers upon arrival in each atoll by the local
health teams and follow through for the first 2 weeks to ensure these passengers
do not import the virus to Tokelau.

Passengers from Apia bound for the atolls only get off on the designated atoll,
which means, passengers from Apia to Atafu do not go ashore in Fakaofo and
Nukunonu. Transport team in the respective villages to enforce this restriction in
each atoll.

Passengers from the other atolls travelling to another atoll within Tokelau does
not need to be screened at the moment. We will closely monitor the situation and
provide further advice if these inter-atoll passengers need to be screened

3. Health education and Awareness
In the villages
The health team in each atoll continues the ongoing awareness for the whole
community on preventative measures are ongoing and pamphlets are available
for everyone in the atolls with advice on preventative approaches

Outside of Tokelau
Use the Tokelau Health facebook page and Government of Tokelau website to
share information on the preventative approaches for measles in Tokelau
especially for those outside of Tokelau planning to travel to Tokelau.
Work closely with the Department of Transport with regards to travelling
passengers to Tokelau

Any person needing further information to contact the respective hospitals or the
department Head office in Nukunonu or Health staffs in Apia for further
information (further details of contacts below)

4. Hospital preparedness for any suspected case
All hospitals are prepared to manage any suspected cases with sufficient
resources.
Infection control and Universal precaution strengthened in all hospitals.

All hospitals have been advised on preparations for isolation units when there is
a suspected case including PPE and management guidelines with check list for
all hospitals.

The laboratory services at the National hospital is prepared for testing and
confirmation of cases if need be with the support of WHO.


ONGOING MONITORING AND EVALUATION

The National PH disease surveillance committee meets once a week (Every
Friday) through teleconference to discuss on the progress of the preventative
approaches and improve where necessary

There is a designated reporting and follow up template that each hospital needs
to fill and submit on a weekly basis to assist the National PHDSC and if there is
any suspicious case to report once they pick up in any of the hospital

Work closely with the WHO and Pacific Disease Surveillance Network in closely
monitoring outbreak around the Pacific and the risk for Tokelau with technical
support to strengthen preventative approaches in Tokelau.

Contact details:

Dr. Silivia Tavite
Director of Health
Phone (690) 2421; 24212
Email: stdrtavite@gmail.com

Nukunonu
Dr. Alani Tangitau
Chief Clinical Advisor/Chief Medical Officer
St. Joseph Hospital
Phone (690) 24111
Email: alanitangitau@yahoo.com

Mr. Alapati Tavite
Chief Public Health Advisor
Health Head Office
Phone (690) 24211; 24212
Email: alapatitavite@gmail.com

Atafu
Dr. Susana Leitu
Medical Officer
Lomaloma Hospital
Phone (690) 22112
Email: leihana@gmail.com

Fakaofo
Dr. Hla Thein
Medical officer
Fanuafala Hospital
Phone (690) 23114
Email: nickygolf913@gmail.com

Lolo Tuumuli
Public Health Officer
Phone (690) 23114
Email: lolo.tuumuli@tokelau.org.nz

Samoa:
Liza Kele
Health Manager, Apia
Phone (685) 20822
Email: liza.lui@tokelau.org.nz