Fiji and measles: from devastation to elimination

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The graves are still there, silent, beneath century-old trees. In 1875 Fijians buried one-third of their population – all dead as a result of measles. At the time “death drums sounded incessantly in seemingly deserted villages,” and “graves were only half dug because no one had the strength to dig.”

Dr. David Morens’ classic 1998 article in Pacific Health Dialogue is a study of the measles epidemic which spread “with astonishing speed”, and explains how infected passengers traveling from Australia sparked a nationwide, devastating epidemic.  An estimated 40,000 people died.

Dr. Lisi Tikoduadua, one of Fiji’s most respected senior paediatricians, says that even a century later “measles complications were still keeping our hospital beds full of children with pneumonia and diarrhoea.”

Then Fiji introduced the measles vaccine in 1982, sparking the first step to a dramatic change.

Today, Fiji and all of the Pacific Islands are completely free of measles.

“The older doctors appreciate the absence of measles, prevented by immunisation,” says Dr. Tikoduadua. “However many of the young doctors have not even seen a child with measles.”

Public health poster featuring Fiji’s senior paediatrician Dr. Lisi Tikoduadua. Photo: WHO/M&RI

Fiji’s success is due to a combination of progressively higher coverage with the first dose, wide-age range supplementary campaigns in 1998 and in 2001 targeting under fives, introduction of the 2nd  dose combined with rubella 2003;  and additional supplementary campaigns in 2003 and 2004.

“It is indeed a tremendous achievement to be able to say that we are free from measles considering the devastating effect it had on Fiji in the 1875 epidemic,” says Dr Tikoduadua. She adds that for health workers  “joy will come when Fiji is certified measles-free because it will mean they are doing their work well.”

The threat of a measles importation to Fiji and other Pacific Islands is ever-present. As Dr. Morens wrote: “In the 1870s, modern travel could allow a virus to go half way around the world, from port to port, in three years. Today a virus can circle the globe in a day.”

“I remember the face of measles very well and I say, measles is not welcome on our Fiji Islands, says Dr. Tikoduadua. “I hope other countries feel the same about measles. We can’t rest until the whole world is measles-free.”

Last week, Dr. Margaret Chan, Director-General of WHO lauded the progress in measles elimination in the WHO Western Pacific Region. “The drop in measles has been breath-taking: only two measles deaths reported this year, representing a 99% decline since 2003. The measles initiative is also being used to accelerate the control of rubella and the prevention of congenital rubella syndrome.” 

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