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Measles outbreak: Spread of disease could be catastrophic for Pacific Islands
11:40 pm GMT+12, 04/09/2019, New Zealand

Opinion by Fergus Aitcheson  
 
I've had measles. Naked and delirious, I staggered into my parents' dinner party one evening in 1966 to solemnly proclaim "Christ I'm crook", provoking gales of laughter and a quick shooing back to bed. It has become the stuff of family legend.
 
Like most Kiwi kids of the 1960s, I recovered. But I was crook. Half a century later, I have two enduring memories. The first was what's loosely called conjunctivitis, but it's really an orbitopathy: everything in my eye sockets was inflamed, and the slightest sideways glance sent paroxysms of pain coursing through my skull.  
 
The second is from when I got better and jumped out of bed. The afternoon sun was slanting through my bedroom window, and as I threw off the covers, a cloud of shimmering shed skin – the aftermath of the rash – exploded across the room.  
 
Now, having briefly obtained eradication status, New Zealand finds itself in the midst of another measles outbreak. The issues raised are complex and nuanced: autonomy versus collective responsibility, parental rights versus the state's duty of care, and understanding barriers to accessing a free healthcare intervention.
 
In Te Tairawhiti, where I practise, we are isolated. We like to think of it as secluded. But we got syphilis, another disease from history which is currently doing the rounds of the country. Now, we are expecting measles.
 
On the weekend, a young adult from Bay of Plenty who now has confirmed measles visited Gisborne's CBD. In our clinic today the phones went down from too much traffic. A family of seven unimmunised kids aged from infancy to 15 presented, requesting vaccination. Kids were seen in the carpark.  
 
Depending on how you measure it, measles isn't the most contagious disease – that honour belongs to rotavirus, against which we also immunise. It's not the most lethal infectious disease either: Rabies wins that prize, but fortunately rabies is reasonably hard to get.
 
The problem with measles is that it occupies a unique spot: it's extremely contagious and moderately lethal. Epidemiology has a ruthless logic. The more cases, the more likely it is that someone will die.
 
Middlemore's Kidz First Children's Hospital has established a measles ward to cope with the number of sick children that are coming in.  
 
Médecins sans Frontières, the international organisation of doctors without borders, recognises this. Its first priority in humanitarian disasters, before securing water, food or shelter for a refugee population, is to immunise against measles.
 
I have a number of concerns about New Zealand's current measles outbreak, but two spring to mind.  
 
First, if enough cases occur here, then someone will die. We have a well-developed healthcare infrastructure and world-class intensive care facilities. But Auckland, the epicentre of the current outbreak, is the largest Polynesian city in the world. If we export measles to the Pacific Islands, the result could be catastrophic. In 1911, measles was introduced to the remote Pacific island of Rotuma. Half of the island's children died.  
 
Second is the descent into tribalism on social media. People who opt not to immunise their kids have their reasons. Let's not vilify them, but rather identify shared values and try to nudge the vaccine-hesitant towards vaccine uptake.
 
Our society's response to a serious health threat should bring out the best in us, not the worst – because we all love our kids.
 
Fergus Aitcheson is a GP at 3Rivers Medical in Gisborne.

SOURCE: STUFF NZ/PACNEWS


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