A visiting cruise ship made international headlines last week when it was quarantined in Port Castries. Medical officials confirmed on Monday that local health authorities monitored the single case of measles reported from the vessel and no passengers were allowed to disembark. The ship’s staff requested and received from Saint Lucia 100 measles vaccinations “in the interest of good public health practice,” according to the Chief Medical Officer, Merlene Fredericks-James. A common misconception is that the measles virus was completely eradicated worldwide. However, the virus has had a recent upsurge: 22 American states have reported over 700 cases of measles so far this year, more than in any other full year since 1994. The CMO announced on Monday: “In the event of these outbreaks going on in the rest of the world, it is quite possible that the disease can enter the island whether by air, sea or other route. We know we are not adequately covered when it comes to our measles vaccination.” Now that the cruise ship has left, the CMO points out it’s time to refocus on protection from the disease. She said those who have been vaccinated against measles have nothing to fear. “But if, for one reason or the other, you have decided not to immunize your child with the measles vaccine, we would like you to know that you or your child are at risk. It can also be seen as negligence if we decide not to protect our children and place them at risk.”
Since 2016 the measles, mumps and rubella (MMR) vaccine has been given to children in Saint Lucia in two doses: at 12 months of age and then 18 months. As of 2018, the vaccination coverage for the first vaccine, MMR1, was 86% and for the booster, MMR2, only 68% according to immunization manager, Julietta Frederick-Cassius. The vaccine is ineffective if the booster shot is not administered.
While other countries struggle with groups that purposely decline vaccination, the CMO says: “We would like to think in Saint Lucia it’s because parents are forgetting. But we also know there are a few who deliberately make a decision not to immunize their children.”
Measles can cause blindness, meningitis, pneumonia and even fatality in children and people over 70 years of age. Most measles-related deaths are reported to be among children.
According to the Saint Lucia Public Health Act, there are vaccination exemptions for children with compromised immune systems and those who suffer from cancer, HIV or a similar disease. The standard 95% vaccination coverage of the population will enable the herd immunization effect—immunized people will protect those who cannot be vaccinated, since the virus would be significantly less likely to spread within the population.
The Public Health Act also has an exemption for religious beliefs. “Some countries are actually reviewing their Acts and they are removing this exit clause for religious beliefs,” warned the CMO on Monday. “It’s something we have to consider and we’ve been reviewing our Public Health Act for a while. It’s certainly something the Ministry of Health is considering, in terms of strengthening these laws.”
In April, New York’s mayor declared a public health emergency and threatened a $1,000 fine for families not vaccinated. The city’s measles outbreak counted most of its cases in close-knit Orthodox Jewish communities, which refuse vaccinations because of safety concerns. Other “anti-vaxxers” include people who believe the treatments have serious side-effects, including autism, and they prefer to either let the virus run its course or use natural remedies.
The autism claims have been debunked by numerous scientific research studies on vaccines, and vaccination side-effects have been reported to be minimal, according to Frederick-Cassius.
Said the CMO: “We have to know the websites we go to for information on vaccination are credible.”
However, unlike in New York, fines are not on the table in Saint Lucia. “The fees [sic] under our Public Health Act are very minimal but we are working. It’s at an advanced stage right now and I think we’re going to use this opportunity to reiterate to our cabinet of ministers the importance of passing the changes to strengthen the Act,” said the CMO.
Meanwhile Saint Lucia boasted over 1.2 million tourist arrivals in 2018 and many citizens frequently travel to and from the US. Keeping in mind the cruise ship incident, local authorities are considering protective measures. For aircraft, passengers sitting in the same row and two rows in front of and behind an infected person will be screened before entering the country. And if a Saint Lucian contracts measles at home, he or she will be quarantined at home unless they need to be hospitalized.
The CMO assured that during events such as Saint Lucia Jazz and Carnival, the screening process is more rigid to keep up with the influx of visitors. However, there is no requirement for tourists to carry their health or immunization records when visiting. Also, the island has no resources to test for measles; samples are sent to Trinidad. Added the CMO: “Saint Lucia is still measles-free. We had our last case in 1990. The measles vaccine is free and available at all public health facilities.”
Parents are encouraged to review their children’s immunization cards and bear in mind that Section 28 (1) (d) of the Education Act states: “No child shall be admitted to a primary school unless at the time of such admission — a certificate issued by a registered medical practitioner or the Public Health authorities is produced indicating that the child has been immunised as may be prescribed by regulations made under this Act.”
