Key messages from the Ministry of Health include:
• Immunisation is the only method available to prevent the spread of measles
• We currently do not have large enough vaccine supplies in the country to focus on a mass campaign, and recognizing the resource limitations for us all at the practice level –
• Prioritise: All children aged 12 months to 12 years who have not had a documented history of receiving one MMR: recall and offer MMR
• Continue with opportunistic catch ups for all others to check they have received age appropriate immunisations i.e. two doses of MMR by 4 years of age for all children, and at least one MMR for adults born after 1969 without a clear history of having had measles or received vaccination.
The MoH will continue to provide updates on priority approaches and vaccine supply.
• Myth busting - MMR does not cause autism. A very brief summary: In 1998 the lead author of an observational study on 12 children with inflammatory bowel diseases and autism hypothesized in the media that the MMR vaccine may cause autism. Since that time there have been over 20 large studies including millions of children in the US, UK and Europe comparing vaccinated and unvaccinated children, all of which consistently show no association between MMR and autism. Despite the abundance of scientific published data the myth is still around. For further information go to http://www.immune.org.nz/?t=719
Measles – some clarification of issues
• Immunisation Benefit Subsidy and claiming: All non-immune children and adults are eligible for the immunisation benefit subsidy for 2 doses of MMR.
• Changing the timing of giving MMR: For those who are contacts of cases or in areas at high risk, who have not had their full 2 doses of MMR, the first dose can be given as early as 12 months of age and the second dose can be given as early as a month after the first dose. For anyone who presents requesting MMR2 early, it is effective to give it at any time from a month after the first dose. NB As there are high measles rates in Canterbury this is the current Canterbury strategy
• Infants between 6 months and 12 months at high risk: These infants can be offered an extra MMR (called MMR0). There are no safety concerns however efficacy is lower in this age group therefore it is important that children are still recalled for the MMR1 and MMR2. The Immunisation Benefit Claim for the extra MMR (MMR0) for these infants will need to be a manual claim as this is outside of the standard schedule vaccines. NB As there are high measles rates in Canterbury this is the current Canterbury strategy
• Continue to deliver other schedule vaccines with MMR: Children given MMR at 12 – 15 months should also receive the other 15 month schedule vaccines (Hiberix and Prevenar) at the same time.
Background information on measles
Measles is an acute viral illness. Early symptoms include fever, runny nose, cough, loss of appetite, and conjunctivitis. Characteristic white Koplik’s spots may occur in the oral mucosa. After 3 to 5 days a rash appears at the hairline, moves to the face and upper neck, then proceeds down the body and usually lasts 4-6 days. Measles is often a serious disease, with up to 30% of reported cases experiencing one or more complications.
Complications include: Ear infections (7 %) and pneumonia (6%), Acute encephalitis may develop in 1 in 1000 cases, of whom 15% die and a further 25% - 35% are left with permanent neurological damage. Approximately 1 in 100,000 cases will develop subacute sclerosing panencephalitis (SSPE) which is always fatal. Measles during pregnancy increases the risk of premature labour, miscarriage, and low-birth-weight infants, although birth defects have not been linked to measles exposure. Measles can be especially severe in persons with compromised immune systems and immunisation for household contacts is important to protect them.
Each case of measles is likely to infect a further 12-18 non immune persons. The only method of prevention is vaccination. In order to prevent transmission of measles around 95% of the community must be immune.
Current situation
In NZ measles cases have increased during the first half of 2009. Cases for July indicate that an epidemic has begun. Current vaccine coverage varies depending on region and age group. Current NIR data indicates that around 84% of children receive at least one dose of MMR vaccine by their 5th birthday. The proportion of these children receiving the vaccine on time is much lower. In order to interrupt transmission and minimise this epidemic there are some changes to the timing of MMR vaccine delivery.
Vaccinating pregnant women
• Live vaccines (such as MMR) are contraindicated in pregnant women
• There is no evidence that vaccine virus is transmissible to fetus, it is theoretical only.
• Recommend ensuring those in contact with pregnant women are immunised.
Changes to timing of MMR administration in Christchurch:
Bring the 2 doses of MMR vaccine forward from 15 months and 4 years to 12 months and 13 months.
• Recall all children over 12 months for vaccination
• Recall all patients with questionable measles vaccine history, there is no increased risk in receiving extra doses
• The second MMR can be delivered one month after the first
• Children under 1 year can be offered MMR asap, but will still require 2 further doses over a year of age (3 doses in total). The Ministry of Health and the Immunisation Advisory Centre recommend that children in this age group receive this.
• High-risk individuals (e.g. significantly immuno-compromised) can receive immunoglobulin (on a case-by-case basis - this can be discussed with the local Medical Officer of Health)
Other DHBs:
• Follow advice from the local Medical Officer of Health
• If not fully immune (i.e. 2 doses of MMR vaccine), contacts of measles cases can be offered vaccine dose 1 from a year of age, and dose 2 a month after dose 1. An extra dose for infants 6 – 12 months can be offered, but note these children still need two doses over a year of age
o High risk people (e.g. immunocompromised) can be offered immunoglobulin (take local advice)
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