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Measles overseas and in New Zealand

National MMR vaccination advice modified in light of current vaccine supplies

The Ministry of Health has modified the standard MMR vaccination catch-up advice.

Advice for those outside Canterbury

Infants aged under 15 months

  • Infants living outside of Canterbury are recommended to receive their MMR vaccination at 15 months of age as per the Immunisation Schedule.
  • A Medical Officer of Health may recommend that an infant aged 6–14 months who is a close contact of a confirmed measles case receive an MMR vaccination within 72 hours of contact.

Children aged between 15 months and 4 years

  • Pre-school aged children living outside of Canterbury should receive their normal MMR vaccinations as per the Immunisation Schedule.

Click here for more information for children aged 12 months to under 5 years.

Older children, teenagers and adults aged under 29 years

  • In the short term vaccine supplies are limited. Vaccinators are recommended to prioritise those who do not have any documented measles-containing vaccine doses when aged 12 months or older and administer one catch-up MMR vaccination. This is because after one measles-containing vaccine (measles only, measles-rubella only or MMR vaccines) 90–95 people in 100 are protected from measles. The second MMR vaccine dose is to make sure the 5–10% who are still susceptible to measles have a second opportunity to become protected.
  • Subsequent MMR catch-up doses are recommended to be administered once MMR vaccine demand returns to normal (and a minimum of 4 weeks after the first MMR dose).

Adults aged between 29 and 50 years

  • Adults in this age group are expected to have received one measles-containing vaccination or had measles disease. However, if the person does not have any documented measles-containing vaccine doses when aged 12 months or older the vaccinator can administer one catch-up MMR vaccination. 
  • Subsequent MMR catch-up doses are recommended to be administered once MMR vaccine demand returns to normal (and a minimum of 4 weeks after the first MMR dose).

Click here for more information about children at primary, intermediate or high school, and adults born in 1969 or later.

Adults aged 50 years or older (born before 1969)

  • Adults born in New Zealand prior to 1969 are considered to be immune to measles as there was no measles containing vaccine until 1969 and the disease is so highly infectious. MMR vaccination is not generally indicated for adults born in New Zealand prior to 1969. 
  • Adults born overseas prior to 1969 may have received a measles-containing vaccination. If you are unsure whether an individual is likely to be susceptible to measles, please call us on 0800 IMMUNE (0800 466 863).

Advice for Canterbury

Canterbury is currently responding to a measles outbreak in their community. The advice for people in Canterbury is different to the rest of New Zealand.

  • Vaccinators are advised to prioritise those aged 12 months through 28 years (i.e. 12 months to under 29 years) who have never received a measles-containing vaccine (measles-only, measles-rubella only or MMR vaccines) when aged 12 months or older.
  • A Medical Officer of Health may recommend that an infant aged 6–11 months who is a close contact of a confirmed measles case receive an MMR vaccination within 72 hours of contact.

Travel overseas to a country with a measles outbreak

There are significant measles outbreaks overseas, including in the Philippines, the U.K., some U.S. states and some European countries. The Ministry of Health advises people travelling overseas to ensure they are fully immunised against measles before leaving New Zealand.

  • Infants aged 6–11 months can have an MMR vaccination prior to travel to a country with a measles outbreak.** Click here for more information.
    • Note: Travel to Canterbury is not currently considered to carry the same level of risk as travel to countries with serious measles outbreaks, MMR0 is not recommended or funded for these infants.
  • Children aged 12–14 months can have an MMR vaccination prior to travel to a country with a measles outbreak.** 
    • Note: Travel to Canterbury is not currently considered to carry the same level of risk as travel to countries with serious measles outbreaks.
  • Adults born in 1969 or later can have an MMR vaccination if they do not have any documented measles-containing vaccine doses.
  • Adults born in New Zealand before 1969 are considered immune to measles as the disease was prevalent and circulating widely prior to introduction of a measles vaccine in 1969.

**Refer to this website for travel updates about countries with measles outbreaks – Centers for Disease Control and Prevention – Measles for travellers

Advice for health professionals in New Zealand

All front line health care staff born on/after 1 January 1969

  • PLEASE check your measles immunisation status.
  • If you do not have any documented measles-containing vaccine doses it is important to obtain the first of two MMR vaccinations (and the second documented MMR vaccination once the demand for MMR vaccine returns to normal).
  • There are no safety concerns receiving an MMR vaccination oif you are already immune to measles, mumps or rubella.
  • If you come in contact with a measles case and do not have any documented measles-containing vaccine doses and your measles immunity is unknown, you will need to be stood down from work during the possible incubation period or until you are confirmed as being immune to measles.

Be prepared to implement infection prevention and control

  • Be alert for the possibility of measles among patients who have recently travelled overseas.
  • On suspicion of measles, notify your Regional Public Health Service.
  • Keep an accurate record of walk-in patients and other visitors in case contact tracing is required.
  • Identify suitable triage and isolation areas for suspect measles cases.
    • *Allow only immune staff to have contact with the patient, and
    • Use appropriate personal protective equipment (e.g. N95 masks).
  • Place signs, hand gels and surgical masks at waiting room entrances or reception desks.
  • Ask patients with suspected measles to isolate at home, and explain how important this is to prevent the spread of measles.
    • If the person needs to go to hospital or labs, make advance arrangements to avoid common waiting rooms etc.

Latest updates

  Ministry of Health – National MMR vaccination advice modified in light of current vaccine supplies, 18 March 2019

 IMAC – Quick update on measles and vaccination priorities, March 2019

  Ministry of Health – Measles (check out the 'Prevention' tab for MMR vaccination advice)

Measles within New Zealand

Since 2012, all cases of measles in New Zealand came from travellers bringing the disease from overseas. Individuals who have not been immunised against measles or had the disease, and individuals who are immune compromised due to an illness or treatment, may catch the disease next time an overseas traveller who has measles arrives in New Zealand. 

In 2019, a total of 54 measles cases were confirmed in New Zealand between 1 January and 25 March. Eighteen (18) people have been hospitalised due to the severity of their measles disease. The age of those infected with measles include an infant aged 27 weeks old (and too young to be vaccinated), children aged 1–5 years, adolescents 10–19 years, young adults 20–39 years, adults aged in their 40s and two adults aged in their 50s. The majority of cases have occurred in children, adolescents and young adults aged under 29 years.

Location by District Health Board Cumulative number of confirmed  measles cases in 2019
Auckland region 4 cases
Waikato 12 cases
Bay of Plenty 2 cases
Canterbury 35 cases
Southland 2 cases

 

Resources

IMAC

 Quick answers to frequent MMR questions fact sheet

 Measles fact sheet

 Diseases and medications when live vaccines may be contraindicated fact sheet

 Measles – Why immunise video

 Quick update on measles and vacicnation priorities, March 2019 video

Ministry of Health 

 Immunisation update – Measles update, 15 March 2019

 Immunisation update, 6 March 2019

 National Health Advisory – Nationwide MMR prioritisation advice, 14 March 2019

 National Health Advisory – Notification of measles outbreaks overseas, 28 February 2019

 Media Release – International measles outbreaks prompt renewed call for MMR vaccination

 Protecting children with cancer video

Websites

 Ministry of Health – National MMR vaccination advice modified in light of current vaccine supplies, 18 March 2019

 Ministry of Health Communicable Disease Control Manual – Measles chapter

 Ministry of Health – Measles (check out the 'Prevention' tab for MMR vaccination advice)

 SafeTravel, a New Zealander website with advice for New Zealanders living and travelling overseas

 Centers for Disease Control and Prevention – Measles for travellers, a U.S. website with travel updates about countries with measles outbreaks

MMR vaccination advice

MMR dose zero for infants aged 6 months to under 12 months

  • If a Medical Officer of Health recommends that an infant who is a close contact of a confirmed measles case receives an MMR vaccination within 72 hours of contact, or
  • The infant will be travelling to a country with a measles outbreak** 
    • One MMR vaccination can be given
      • Infants who receive an MMR vaccine before they are 12 months old need two more MMR vaccinations from 12 months old, given a minimum of 28 days apart.
      • This dose is called ‘Dose 0’, in case the baby still has maternal antibodies against measles circulating in their blood from before they were born and these antibodies help their immune system deal with the vaccine instead of their immune system doing all the responding and learning to recognise measles.
      • PMS entry and claiming
        • Enter the dose on the NIR using your PMS high risk MMR vaccine option.
        • Leave the Schedule 15 months and 4 years MMR vaccinations as to be given in the future.
        • The additional vaccination at 6–11 months of age is funded. An Immunisation Subsidy can be claimed.

**Note 1 – Travel to Canterbury is not currently considered to carry the same level of risk as travel to countries with serious measles outbreaks and MMR0 is not recommended or funded for these infants.
**Note 2 – Refer to this website for travel updates about countries with measles outbreaks – Centers for Disease Control and Prevention – Measles for travellers

MMR for children aged 12 months to under 5 years

First and second MMR for children aged 12 months to under 15 months

  • Children remaining in NZ or travelling overseas
    • Children who received an MMR vaccination aged 6–11 months need two further MMR doses when aged 12 months or older.
    • Outside Canterbury DHB:
      • Please do not precall children for early administration of the first MMR vaccination due at 15 months of age. 
      • The Ministry of Health recommends that the vaccines due at 15 months of age are not brought forward and are given on-time when the child is aged 15 months as per the Immunisation Schedule.
      • A Medical Officer of Health may recommend that a child aged 12–14 months who is a close contact of a confirmed measles case receive an MMR vaccination within 72 hours of contact.
    • Within Canterbury DHB only:
      • Prioritise MMR vaccination of people aged 12 months to 28 years who have never received a measles-containing vaccine (measles-only, measles-rubella only or MMR vaccines) when aged 12 months or older.

Second MMR for children aged 15 months to under 4 years

  • Children remaining in NZ or travelling overseas
    • Outside Canterbury DHB:
      • Please do not precall children for early administration of the second MMR vaccination due at 4 years of age.​
      • The Ministry of Health recommends that the second MMR vacicnation due at 4 years of age is not brought forward and is given on-time when the child is aged 4 years as per the Immunisation Schedule.
      • Children who have previously received their second MMR vaccination early do not need a third MMR vaccination when aged 4 years.
    • Within Canterbury DHB only:
      • Prioritise MMR vaccination of people aged 12 months to 28 years who have never received a measles or MMR vaccine.

After one measles-containing vaccine (measles only, measles-rubella only or MMR vaccines) 90–95 people in 100 are protected from measles. The second MMR vaccine dose is to make sure the 5–10% who are still susceptible to measles have a second opportunity to become protected.

    MMR catch-up for children at primary, intermediate or high school, and adults born in 1969 or later

    • We can only use documented immunisation records to determine what vaccines have been given.
      • No matter how well intentioned a parent or person is when they say they or I “would have had everything when I was young” we cannot use that as evidence of immunisation.
      • It is not necessary to do serology testing.
      • It is appropriate to vaccinate if you cannot easily locate immunsation records.
        • Vaccination is a safer option than possibly leaving a person susceptible to measles whilst they are searching for records.
    • Adults born in 1969 or later can have an MMR vaccination if they do not have any documented measles-containing vaccine doses when aged 12 months or older the vaccinator can administer one catch-up MMR vaccination. 
    • Subsequent MMR catch-up doses are recommended to be administered once MMR vaccine demand returns to normal (and a minimum of 4 weeks after the first MMR dose).

    Adults born prior to 1969

    • Adults born in New Zealand prior to 1969 are considered to be immune to measles as there was no measles containing vaccine until 1969 and the disease is so highly infectious. MMR vaccination is not generally indicated for adults born in New Zealand prior to 1969. 
    • Adults born overseas prior to 1969 may have received a measles-containing vaccination. If you are unsure whether an individual is likely to be susceptible to measles, please call us on 0800 IMMUNE (0800 466 863).

    Canterbury DHB MMR vaccination campaign

    Within Canterbury DHB only:

    • Prioritise MMR vaccination of people aged 12 months to 28 years who have never received a measles or MMR vaccine.

    Advice for primary care

    MMR eligibility, records and precalls

    Funding/Eligibility

    A maximum of two MMR vaccine doses for any patient meeting the following criteria:

    1. For primary vaccination in children; or
    2. For revaccination following immunosuppression; or
    3. For any individual susceptible to measles, mumps or rubella
    4. A maximum of three doses for children who have had their first dose prior to 12 months.

    Note: Everyone born from 1 January 1969 needs to have had two doses of the measles, mumps and rubella vaccine, given at least a month apart to be protected.  The vaccine is free for anyone who needs it.

    Immunisation records

    Children, adolescents and adults born before 2005 will not have immunisation records on the NIR, except Gardasil®/Garadsil®9 (HPV), Boostrix® (Tdap), influenza and more recently MMR vaccinations if they received them. The National Immunisation Register (NIR) was not rolled out across New Zealand until mid-2005. Prior to this, there was no central register and records would only have been in the person's Well Child Book and held by the doctor they went to as a baby or subsequent doctors if their old notes were transferred to them.

    It is appropriate to vaccinate if you cannot easily locate immunsation records. Vaccination is a safer option than possibly leaving a person susceptible to measles whilst they are searching for records.

    Precalls

    • Within Canterbury DHB only: Prioritise MMR vaccination of people aged 12 months to 28 years who have never received a measles or MMR vaccine.
    • Outside Canterbury DHB: Continue standard immunisation precalls for children approaching a Schedule immunisation event, i.e. please do not precall children early for the MMR immunisation due at 15 months or 4 years.
      • It is essential that all practices outside Canterbury DHB maintain the National Immunisation Programme of MMR vaccination at ages 15 months and 4 years.
      • Please order MMR vaccines according to actual usage not anticipated demand.
    • Administer two doses of MMR vaccine, at least 28 days apart, from 12 months of age if parents request this.
    • Proactively check the immunisation status of staff and vaccinate if necessary.
    • Provide requested immunisation documentation to patients free of charge whilst measles is circulating in the community.
    • Record all new MMR immunisations, including those given to people born before 2005, on the National Immunisation Register (NIR).

     

    Last updated: Mar 2019