Primary healthcare news, information & resources


Measles - update and resources


Measles is a highly infectious disease that is easily spread from an infected person by saliva or mucous droplets when coughing, sneezing or talking. Just being in the same room as someone with measles can lead to infection for those who are not immunised.

This page was updated at 9.40am on 16 September 2019 - and we will continue to update it as often as necessary.
If you cannot find an answer to your question on this page please contact our medical director Dr Jo Scott-Jones on
027 475 0488. 

On this page

  • Latest MMR vaccination advice from IMAC
  • Vaccine stock levels 
  • Information for the public
  • Latest Ministry of Health national health advisory notice
  • Information for practices
  • Answering questions we've had from practices
  • Immunisation facilitator contact details

    Please encourage GP members of Pinnacle to join our Facebook group. We are hearing feedback that it is a useful resource, it being updated at least daily - and whilst we are updating this page also, it allows interaction.


Immune advisory centre - MMR vaccination advice




Ministry of Health update - midday 12 September

With 1,172 cased of measles in New Zealand, 970 of which are in Auckland, the Ministry of Health is continuing to work closely with DHBs and other stakeholders to respond to the outbreak. On the advice of an immunisation Expert Advisory Group, we need to ensure we are protecting our most vulnerable. As a result the Ministry of Health is providing guidance to general practices and PHOs to target measles vaccinations to priority groups. This means the first priority for vaccinations should be on:

  • ensuring all children across NZ receive their vaccines on time at 15 months (12 months of age in Auckland) and 4 years to maintain the national childhood immunisation schedule.
  • vaccinating groups who are most affected by the outbreak in the Auckland area, namely children under 4 years of age, those aged 15-29 years with a focus on Pacific peoples within those groups.
  • proactively contacting children aged up to 14 years who have not had a single dose of vaccine to get vaccinated.

You can help ensure measles vaccine is used to protect the most vulnerable populations by only vaccinating people from the groups listed above. We also ask staff at general practices and other clinics to keep vigilant about measles supplies at their clinics, for example in fridges, before ordering new stock. Over 54,000 doses of measles vaccine were distributed last week. This is great news as it means the vaccine is out in communities where it is needed. Given the amount of orders last week, we expect most areas have supplies of vaccines they can call upon. We appreciate your continued support - kia mihi. More information is available on the Ministry of Health website.

District specific information / public health alerts


In the absence of any specific information from our DHBs at this point, we have attached to the bottom of this page a series of resources developed from the Auckland Regional Public Health information (thank you Dave Maplesden) along with a Waikato flowchart for notifiers on suspicion, and Waikato notification form that practices may find helpful to hand out to patients who they suspect as having measles, and to be distributed to the possible contacts of those patients. We have also attached the Auckland whanau pack as the best source resource we can find.

Please feel free to distribute these widely, with the caveat that district specific information MAY be forthcoming in the event of an epidemic being proclaimed. 


Vaccine stock levels - distribution is still problematic

Each area has a process for daily collection of stock levels in each practice. Thanks you for keeping this information up to date, it really helps with distribution of vaccine. For more information your local contact person is Taranaki: Awhina Mattock, Lakes: Helen Thomas, Tairawhiti: Matt Tong and Waikato: your practice support person.

  • Consider referring to NIR for outreach immunisation referrals for your 15 month and 4 year olds - this increases the options for your patients getting access to vaccination, it doesn't mean you can't do these immunisations yourselves if you can, it's just another option for access.

  • Please be mindful when speaking to concerned members of the public that if you are out of stock the message is clear they are eligible to be vaccinated - confusion is evident on Facebook where patients have been turned away due to stock issues. 

Update 9.30am, Monday 16 September

We have been informed the stocks allocated by the DHBs at the end of last week are all that there is at this point in time.

As things stand this morning, a national meeting will be held on Wednesday in which regions will negotiate stock and distribution of anything that comes into the country.

IT IS REALLY IMPORTANT WE GET THE DAILY REPORT FROM PRACTICES ON STOCK AND DEMAND LEVELS please.

It is likely stock would then arrive in practices starting Friday this week.

This means what you have now is what you have for the week.

The priorities remain:

  1. Children with no previous MMR vaccine (15 months) and those needing boosters at 4 years.
  2. We are enocuraged to proactively recall children up to 14 years of age with no previous MMR record.
  3. Contact management on a case by case basis as directed by public health.

If there is a practice with spare stock that could help practices with none - that would be awesome, but we appreciate this is unlikely in this environment.

We will continue to work closely with our DHB colleagues and to advocate on your behalf, please let Jo Scott-Jones know if you have any concerns - particularly if you have high risk patients and no vaccine to give them.

DHBs are now starting to "localise" the resources we have provided through this page for patients with confirmed / suspected / contact of measles (that we in turn took from the Auckland DHB) and we'll attach these to this page as they become available.

Waikato

The key contact for the Waikato is David Wilson. We are keen to advocate on your behalf, so keep us in the loop through the daily update form but David is the person in charge of supply and distribution issues. 


Taranaki

(Updated Friday 13 September) Currently we do not have an outbreak in Taranaki. Three of the cases there, caught measles in Auckland and then there was limited secondary transmission in Taranaki. All six cases were unvaccinated.

In future allocations (if the same process is used) the Taranaki DHB will be using the Pinnacle spreadsheet as the source of truth - practices are encouraged to update that daily so the practice support team in Taranaki can communicate this to the DHB.


Information for the public

If you have patients with concerns who require general information you may wish to point them towards the HealthNavigator information on measles. This is prepared with the general public in mind.

There have recently been new cases in Waikato with multiple contacts - we have attached information sheets for patients (and practices) that can be used to address enquiries.


Information for practices

Resources and advice

The Immunisation Advisory Centre (IMAC) web page "Measles overseas and in New Zealand" is an excellent source of up to date information. It contains:

  • advice on measles overseas
  • advice for health professionals in New Zealand
  • measles within New Zealand - including numbers of confirmed cases by DHB area
  • MMR vaccination advice
  • advice for primary care - funding/eligibility, immunisation records and precall information
  • further resources - including MMR fact sheets, measles fact sheets, MOH information and releases and other useful websites.

Also see the Ministry of Health information for health professionals web page for a range of downloadable/printable resources and advice.

Taranaki Public Health Measles clinical fact sheet and flow chart is also a useful resource.

Answering questions we've had from practices

  • Loading 6-11 months MMR Vaccine into the NIR
We had a query regarding entering vaccine into the NIR for children 6-11 months and have been informed the only way the MMR vaccine can be entered into the NIR, is to enter it under the Standard Programme as MMR-Primary Course. The 15 month and 4 years still stay scheduled, If you are unsure how to do this in your PMS speak with your vendor or contact practice support.

The immunisation authority guidelines say that if a patient with a case of confirmed measles happened to have been sitting in the waiting room then we need to get a record of everyone who was in the room, this could be up to 40 people for us at times...

Measles is one of the most contagious of all infectious diseases - up to 9 out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. It survives in the air for up to two hours after the person has left the room. There is a risk of contracting measles after only 15 minutes in a room with a contagious patient.

  • Practices need to be prepared to implement infection prevention and control. IMAC advice includes keeping an accurate record of walk-in patients and other visitors in case contact tracing is required, and identifying suitable triage and isolation areas for suspected measles cases. 
  • Allow only immune staff to have contact with the patient.
  • User appropriate personal protective equipment (e.g. N95 masks).
  • Place signs, hand gels and surgical masks at waiting room entrances and reception desks.
  • Notify the medical officer of health as soon as you suspect measles - do not wait for a laboratory confirmation.


What about infection control procedures - for example how do we clean the isolation room after use?

After the triage and isolation area has been vacated surfaces should be washed down with a disinfectant following the instructions on the product. The New Zealand Ministry of Health recommend that a when a person with a high suspicion of measles has been in  a room it is left vacant for ONE hour after their departure. Staff dealing with patients in the triage and isolation areas should wash their hands before and after contact with the patient. 

I have a patient who had chemotherapy for cancer a few years ago - do they need an MMR vaccine if they are over 60 years of age? 

It's complicated. There is a comprehensive re-vaccination schedule that details the vaccinations that could be needed depending on the particular case. 

The inclusion of funded vaccines for "revaccination post-chemotherapy" on the Pharmaceutical Schedule provides an indication of what can be given when required rather than an instruction of what must be given regardless of the individual's age and documented vaccination records. As per the Handbook, "Oncology patients - this section provides general guidelines for vaccination after cancer treatment. Specific vaccination questions should be discussed with an expert paediatrician, infectious diseases physician or oncologist." Use of the word "revaccination" may be causing some confusion. Best practice is that individuals who have a complete documented primary course of vaccines prior to chemotherapy do not need to repeat a primary course of the vaccines post-chemotherapy. Starship guidelines do not to follow this evidence but the advice for those aged 18 years or older does.

In the case of MMR vaccination for adults post-chemotherapy, the first criteria is that the adult is non-immune to measles, mumps and rubella. If they were considered immune before chemotherapy, they are still considered immune to measles, mumps and rubella after.

Adults born prior to 1969 are considered immune to measles therefore vaccinating these adults post-chemotherapy is not indicated.

Adults born 1969 or later

  • Those who have two documented doses of MMR are considered immune. No more MMR vaccinations are required.
  • Adults born 1969 or later who have one documented dose of MMR prior to chemotherapy have completed their primary dose of MMR and would receive a second documented dose of MMR because this is the standard schedule, i.e. the second dose of MMR is for the 5-10% who didn't become immune after their first dose and is not about boosting the response to the first dose.
  • Adults born 1969 or later who do not have any documented doses of MMR vaccine receive two documented doses of MMR vaccine six months post-chemotherapy and when their lymphocyte count is >1.0 x 109/L.

If a patient has had one vaccine as a child, and is now 49 years of age, should they have another vaccine?

Yes, but there is no urgency about this - a single vaccine will provide cover for 95 per cent of the population, the second vaccine "booster" can pick up another 3 per cent or so.


Immunisation facilitators - contact details

Waikato

Helen Ride, Pinnacle Midlands Health Network
Phone 021 683 977 or email helen.ride@pinnacle.health.nz

Taranaki

Mel Hurliman, Taranaki DHB
Phone (06) 753 7702 extn 8680 / 027 211 6357 or email melanie.hurliman@tdhb.org.nz

Lakes

Kim Winckel, Lakes DHB - available Thursday, Friday and alternate Wednesdays, 8am-4.30pm
Phone (07) 343 7759 / 027 513 0931 or email immunisation.facilitator@lakesdhb.govt.nz

Tairawhiti

Janine Brown, Hauora Tairawhiti 
Phone (06) 869 2092 extn 8765 or email janine.brown@tdh.org.nz


Measles - Travel PDF 362.25 kB Attention - You could have measles PDF 373.25 kB Waikato DHB measles notification form DOCX 20.86 kB Waikato DHB measles flowchart for notifiers DOCX 46.32 kB Suspected measles for patients 2 (Auckland Regional Public Health information) DOCX 178.13 kB Waikato DHB measles poster PDF 172.8 kB Suspected measles for patients 1 (Auckland Regional Public Health information) DOCX 137.52 kB Measles for close contacts of cases 1 (Auckland Regional Public Health information) DOCX 146.33 kB Measles for close contacts of cases 2 (Auckland Regional Public Health information) DOCX 145.55 kB Measles for patients (Auckland Regional Public Health information) DOCX 129.17 kB Think Measles PDF 283.98 kB Do you have measles symptoms? (Editable practice sign - PowerPoint) MISC 60.46 kB Auckland measles whanau pack GPs and EDs (Auckland Regional Public Health information) DOCX 560.34 kB

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