Measles alert

Measles alert

On 18 February 2017 MidCentral Public Health confirmed seven measles cases in students attending the Institute of the Pacific United in Palmerston North. Contacts of the most recent case have been identified and placed into isolation.

Both public health units are asking other people who haven't been immunised and who may have been in contact with a measles case to keep a close eye out for these symptoms. If you develop symptoms, stay home and phone your general practice or Healthline (0800 611 116) and let them know that you have potentially been in contact with a confirmed measles case. Measles is easily spread, please do not attend a medical centre or hospital before organising how you can be seen without being around other people who could catch the disease.

It usually takes 10-14 days for someone who has caught measles to develop symptoms. The illness begins with fever, cough, runny nose and conjunctivitis (inflammation in the eyes).  It may be possible to see small white spots (Koplik spots) inside the mouth. A rash appears 2–4 days after the first symptoms. Anyone with measles needs to be isolated from the time they become ill until 5 days after the rash has appeared. Isolation means staying at home and missing out on things like school, work, sporting competitions and social events. 

MMR fact sheet

 Click on the link to download our Quick answers to frequent MMR questions fact sheet.

Here's a brief video outlining some key messages around measles

 

MMR immunisation

For parents calling about giving MMR to children aged 12 months to under 15 months

  • Children can have their first MMR vaccine as early as the day they have their first birthday and their second MMR as early as 28 days later. They only need two doses of MMR in total, if they have their second dose early they don’t need any MMR when they are 4 years old.

For parents calling about children who have had one MMR vaccination given at 12 months of age or older

  • The children can have their second MMR anytime, as long as it is 28 days or more since their first MMR. Like the younger children, if these children have their second MMR before they are 4 years old, they don’t need another MMR when they are 4 years old.

There is flexibility to vary the timing of the second MMR vaccination because it is administered to give the 5–10 people out of 100 who do not become fully protected from measles after one MMR vaccination a second opportunity to become fully protected. It was put on the Schedule to be given at 4 years old so parents did not have to manage getting their child to their family doctor for a second MMR at say 16 months old and then again at 4 years old for the DTaP-IPV (diphtheria/tetanus/pertussis/polio booster) vaccination recommended before starting school. There is a paragraph in Section 11.5.1 in the Immunisation Handbook 2014 covering early administration of MMR vaccinations.

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.
  • In the absence of documented doses of MMR vaccine administered from 12 months of age and a minimum of 28 days apart people born 1969 or later are recommended to receive MMR vaccinations
    • if they don't have any documented MMR doses – give two doses of MMR vaccine 28 days apart;
    • if they have one MMR dose documented (administered at 12 months of age or older) – give one further MMR at least 28 days after the previous dose.
  • Individuals 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.

The Ministry of Health requests that primary care:

  • Continue standard immunisation precalls for children approaching a Schedule immunisation event, i.e. practices do not need to precall children early for the MMR immunisation due at 15 months or 4 years.
  • Administer two doses of MMR vaccine, at least 28 days apart, from 12 months of age if parents request this.
  • Actively recall enrolled patients aged 5–47 years (but particularly those aged 10–29 years) who do not have two documented doses of MMR vaccine, i.e. their MMR doses are considered overdue.
  • 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).

Be prepared to implement infection prevention and control

  • 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.

Immunisation records

Children, adolescents and adults born before 2005 will not have immunisation records on the NIR, except Gardasil® (HPV) and more recently influenza and Boostrix® (Tdap) vaccines 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.

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.