measles

Measles in Wellington, Taupo/Turangi, Auckland

Monday, 13 January 2014

Measles in New Zealand confirmed over the Christmas/New Year period.

Lakes District Health Board identified 10 cases of measles over the Christmas/new year period. Three of the 10 people had travelled to Sydney for the 2013 World Supremacy Battlegrounds hip-hop competition with teams from Hamilton and Huntly. Auckland Regional Public Health identified one case of measles, this person had also attended to the hip-hop competition. As of 13 January 2014, five further cases of measles have been confirmed - two cases in Wellington and three in Turangi/Taupo. The most recent cases are contacts of the earlier cases.

The total of confirmed measles cases in this outbreak in now 16.

Measles is easily spread to people who have not had the disease in the past or previously been immunised. Travel over the holiday period means measles cases could occur anywhere in New Zealand.

Anyone with symptoms of measles should stay at home and telephone their doctor or after hours clinic BEFORE visiting them so you don't have to wait for your appointment around other people. Healthline (0800 611 116) can also be contacted for advice. Our Measles webpage has more information about measles symptoms.

People born in 1969 or later should check that they have received two MMR (measles, mumps, rubella) immunisations. Those born before 1969 are expected to have had measles before immunisation against the disease was introduced in New Zealand.

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Have a Measles-Free Summer

Wednesday, 18 January 2012

Visit the Measles-Free Summer campaign on Facebook.

The Ministry of Health launched a Measles-Free Summer social media campaign in partnership with Auckland Regional Public Health Service, Auckland DHBs and the Immunisation Advisory Centre on 18 January 2012. The message is that there's an easy way to avoid letting measles ruin summer and the fun it brings.

 

Visit the Measles-Free Summer page, click 'Like' and recommend the page to your friends. As new material is posted you'll get a message on your Facebook page.

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Personal stories about measles

Thursday, 9 August 2012

The impact of a recent measles outbreak on children with cancer was highlighted at a launch of two Ministry of Health publications at Starship Hospital on Thursday 9th August 2012.

The booklets are accompanied by videos and can be viewed/downloaded from the Ministry's website.

 Immunisation – Making a Choice for Your Children

 Provides information for parents and others about how children and young people were affected by the measles outbreak in 2011. The booklet features stories about young people who had measles and includes interviews with Medical Officers of Health Richard Hoskins from Auckland and Ramon Pink from Christchurch.

 In the accompanying video Felicity Lyme, who caught measles during the 2011 outbreaks, talks about what the disease is like.

 Protecting Children with Cancer from Measles 

 Provides information for parents and others about how children and young people with cancer were affected by the measles outbreak in 2011. The booklet includes interviews with parents of children with cancer and Paediatric oncologists Scott Macfarlane from Starship Hospital and Rob Corbett from Christchurch Hospital who share their experiences of the disease.

 In the accompanying video Leroy Beckett, who was undergoing cancer treatment during the 2011 outbreak, talks about his fears about measles and how others being immunised is important to keep people like him safe.

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Measles case alert

Wednesday, 12 September 2012

Measles arrived in Auckland on a flight from Niue on 8 September 2012 and the person visited Middlemore Emergency Department on 9 September 2012.

Auckland Regional Public Health Service (ARPHS) is currently tracing contacts of a person with confirmed measles who arrived in Auckland from Niue on 8 September 2012 and spent some time at Middlemore Emergency Department on 9 September 2012.  We are in the process of writing to all potential contacts.

Health professionals are asked to consider any person reporting measles like symptoms up to 23 Sept 2012 as a suspected case of measles and isolate as appropriate. They will have received letters and the factsheets from ARPHS.

Further information on measles can be found on the ARPHS website and in the Immunisation Advisory Centre measles fact sheet.

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M-M-R® II

MMR

M-M-R® II is used for primary vaccination and revaccination of children and adults to protect against measles, mumps and rubella.

Rubella

Common Name: 
German measles
Parents & Caregivers
Introduction: 

Rubella, also known as German measles, is caused by a virus. It is usually a mild disease, but when it occurs in pregnant women during pregnancy it can result in severe damage to the developing baby.

A brief history: 

The number of rubella cases has fallen dramatically since the vaccine became available in 1970. Prior to this, extensive outbreaks of rubella occurred every 6-9 years. The last such outbreak started in Europe in 1962/1963 and spread to the USA and other countries including New Zealand in 1964/1965 causing many cases of Congenital Rubella Syndrome.

The current New Zealand situation: 

Outbreaks of rubella continue to occur both in New Zealand and in nearby Pacific Island countries.

Symptoms: 

Rubella infection without symptoms is common. When symptoms are present they include a brief widespread rash, swollen lymph glands and painful joints, the latter mainly occurring in adults.

The rubella rash looks similar to other rashes and the only way to diagnose rubella is by a blood test.

How do you get it?: 

Rubella is spread from person to person by airborne respiratory secretions (coughing and sneezing). The incubation period varies from 14 to 23 days. Infants with Congenital Rubella Syndrome should be considered infectious until they are one year old.

What are the risks?: 

Rubella is usually a mild disease in children. Adults tend to have more complications, including temporary painful or swollen joints. Rubella may also occasionally present as a more severe illness, indistinguishable from measles.

  • About 5 in 10 cases of rubella develop a rash and painful swollen glands.
  • Nearly 5 in 10 adolescents and adults have painful joints (temporary).
  • Encephalitis (inflammation of the brain) occurs in 1 out of 6,000 cases.

Rubella is of serious concern if contracted in the early stages of pregnancy, as it is highly likely to cause severe abnormalities in the developing baby. These include cataracts, deafness, heart abnormalities, mental retardation and behavioural problems. These abnormalities are referred to as Congenital Rubella Syndrome.

Who is most at risk?: 
  • The unborn baby is most at risk.
  • Those without a prior history of rubella immunisation or confirmed rubella disease and women born in New Zealand between 1965 and 1967 are at an increased risk.
  • Immigrant women of child bearing age who have not received rubella or MMR (measles, mumps, rubella) vaccine are also at risk.
Treating the symptoms: 

There is no specific treatment for infection.

Preventing Disease Spread: 

Rubella vaccine, as part of the MMR (measles, mumps, rubella) vaccine is the best method of prevention.

Cases of rubella must be kept away from early childhood services or school for 7 days after the rash appears.

Health Professionals
Causative organism: 

The rubella virus is from the togavirus family. It is easily killed by heat and UV light.

Clinical signs, symptoms and complications: 

Symptoms may be absent or mild and in 30%-50% of cases.

Usually a mild disease in children. Adults tend to have more complications.

  • A discrete macular rash appears on the forehead about 7 days following infection and spreads down the trunk and limbs.
  • Mild conjunctivitis, cervical lymphadenopathy and arthralgia may occur.
  • Small petechial lesions (Focheimer spots) may be seen on the palate.
  • Splenomegaly may occur.

The most serious complication of rubella infection is Congenital Rubella Syndrome (CRS), which results when the rubella virus attacks a developing fetus. When infection occurs during the first trimester of pregnancy up to 85% of infants will be born with some type of birth defect, including deafness, eye defects, heart defects, mental retardation and more.

The risk of damage reduces to 10-20% by about 16 weeks gestation and has rarely been reported when infection occurred after 16 weeks gestation.

The rubella rash looks similar to other rashes. The only way to diagnose rubella is by a blood test.

Method of transmission: 

Spread is from person to person through the air (by coughing, sneezing) and is moderately contagious.
The incubation period varies from 14 to 23 days.
The disease is most contagious when the rash is erupting, but the virus can be spread from seven days before, to seven days after the rash appears.

Public health significance: 

German physicians first described rubella; hence, it is commonly known as German measles.

In 1941 an ophthalmologist reported a link between maternal rubella and congenital cataracts. A pandemic of rubella in 1964 led to recognition of an expanded congenital rubella syndrome (CRS), which includes hepatitis, splenomegaly, encephalitis, mental retardation as well as the more familiar association with deafness, cataracts and heart disease.

Rubella has a very similar pattern to measles, epidemiologically. It has respiratory spread that is greater in crowded societies, and periodically may disappear from a geographic area only to reappear in epidemic form.

The seriousness of CRS can be seen when reviewing the latest major American epidemic in 1964-65. There were 30,000 pregnancies affected out of 12.5 million rubella cases, including 2,000 cases of encephalitis. Of these pregnancies, 5000 women had surgical abortions, over 6000 women had spontaneous abortions and among the 20,000 infants who survived pregnancy, 11,600 were deaf, 3,580 were blind and 1,800 with mental retardation.

Not every country can offer free rubella immunisation and regional epidemics do occur periodically. In 2003 there were large epidemics in several Pacific Island nations.

New Zealand epidemiology: 

Outbreaks of rubella continue to occur in New Zealand. Although rubella immunisation was offered from 1979 to all girls in year 7 (form 1), it was not offered to boys until 1992, allowing spread in the community. There were 100 cases 232 reported between August 1989 and February 1990, some among pregnant women, and there were three cases of CRS reported. The outbreaks of rubella in 1993 and a larger one in 1995 have mostly involved young adult males, who would not have been offered immunisation. These outbreaks emphasise the need to immunise both boys and girls to reduce the risk of exposure in pregnant women, as well as to reduce illness in men. Rubella has been a notifiable disease since 1996. In 2003 there were 26 cases of rubella notified, of which three cases were laboratory confirmed; and in 2004 there were 25 cases notified, of which three were laboratory confirmed. It is important that suspected cases are notified and are laboratory confirmed so that public health control programmes can limit spread. No cases of CRS in New Zealand newborns reported to the New Zealand Paediatric Surveillance Unit between 1998 and 2010. 

Prevention: 

Respiratory diseases are difficult to control in large populations. People who are infectious with rubella should always avoid coming into contact with pregnant women.

Post-exposure prophylaxis with immunoglobulin and vaccination in pregnant women has not been established as effective and is not recommended.

The major prevention method is by national immunisation programmes.
MMR (measles, mumps, rubella) vaccines are widely available and recommended by the World Health Organization.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Rubella is a viral disease that causes a rash and swollen glands. It causes severe damage to unborn babies if acquired during pregnancy.

Effects of disease: 
About 5 in 10 cases of rubella develop a rash and painful swollen glands.
Nearly 5 in 10 adolescents and adults have painful joints (temporary).
About 1 in 6,000 develops inflammation of the brain.
For women in early pregnancy, 85% of babies infected during the first eight weeks after conception will have a major congenital abnormality such as deafness, blindness, brain damage, or a heart defect. This risk decreases to 10-20% by about 16 weeks gestation. After 16 weeks fetal abnormalities are rare.
Common side effects of vaccine: 
Measles component:
Fever over 39.5˚C and/or rash 6–12 days after immunisation.
Mumps component:
Parotid and/or submaxillary swelling 10–14 days after immunisation.
Rubella component:
Mild rash, fever and/or lymphadenopathy between two and four weeks after immunisation.
Joint symptoms may occur after the vaccine, the incidence of which is age related. More adult women than children get joint symptoms about two to four weeks after immunisation.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Temporary thrombocytopenia.
Encephalitis occurs once in one million doses. There may be some long-term effects from this.
Aseptic mumps meningitis.
Convulsion associated with fever.
Vaccines: 

Measles

Parents & Caregivers
Introduction: 

Measles is one of the most infectious diseases in humans. It is also known by the names English measles, morbilli and rubeola. Measles is now the third most common vaccine-preventable cause of death among children throughout the world.

A brief history: 

Before a measles vaccine was developed most people had measles by the age of 20. Universal vaccination was introduced in 1969 into New Zealand although the coverage of the vaccine has been poor until recent years. The last two major measles epidemics in NZ  occurred in the 1990s with thousands of cases, hundreds of hospitalisations and seven deaths. Smaller outbreaks continue to occur, mainly in communities where vaccine uptake has been low. Outbreaks tend to start when someone brings the disease back from an overseas trip.  As measles is extremely infectious it can spread very quickly.

The current New Zealand situation: 

New Zealand continues to have outbreaks of measles, although at lower rates than previously. Due to higher immunisation rates in children by the age of two years outbreaks particularly affect unvaccinated older children, teenagers and adults.

Symptoms: 

The illness begins with fever, cough, runny nose and conjunctivitis (inflammation in the eyes), which lasts for 2-4 days. It may be possible to see small white spots (Koplik spots) inside the mouth. A rash appears 2-4 days after the first symptoms, beginning at the hairline and gradually spreading down the body to the arms and legs. The rash lasts for up to one week. It usually takes 10-12 days from exposure to the first symptom.

How do you get it?: 

Measles is spread through the air by infectious droplets or direct contact with secretions from the nose or throat of infected persons, for example by touching items or surfaces contaminated with secretions. The person with measles is most infectious during the first 2-4 days of symptoms and stays infectious until 3-4 days after the rash appears.

What are the risks?: 

Complications from measles are common. The measles virus suppresses the immune system, lowering the body’s ability to fight other infections.

Common complications include ear infections, diarrhoea, and pneumonia. In New Zealand more thatn 15 per 100 cases are hospitaised. Pneumonia accounts for nearly two thirds of measles deaths.

Approximately 1 per 1000 cases develop encephalitis (inflammation of the brain), of these 15% die and approximately one third are left with permanent brain damage.

One in 100,000 cases will,  years later, develop subacute sclerosing panencephalitis (SSPE, a degenerative brain disease). This condition is always fatal.

Other complications include immune thrombocytopenic purpura (ITP, affecting the blood clotting) and inflammation of the small airways in the lungs, heart, kidneys or liver.

The risk of complications and death are higher in children under 5 years and adults over 20 years of age.

Measles during pregnancy increases the risk of miscarriage and premature labour.

Anyone who has a weakness of their immune system is at greater risk of very serious disease. These people are often unable to be immunised and rely on protection from those around them being immunised.

Death occurs in approximately 1 per 1,000 reported cases of measles overall in western countries.

Who is most at risk?: 

Anyone who has not received at least one dose of a measles containing vaccine e.g., the combined measles, mumps, rubella (MMR) vaccine or who has not already had the disease.

Treating the symptoms: 

There is no cure for measles infection.

Acute cases are treated with Vitamin A.

Preventing Disease Spread: 

Immunisation given on time is the best way to prevent measles. Two doses of the MMR (measles, mumps, rubella) vaccine is 99% effective in preventing measles. MMR vaccine, if given within 72 hours of exposure to measles virus, may provide protection to the unimmunised and thus limit the spread of measles.
In the event of a measles outbreak unimmunised children (with no history of prior measles infection) who have contact with infected cases are advised NOT to attend school or early childhood services until notified.

Health Professionals
Causative organism: 

Measles is a paramyxovirus, genus Morbillus. It is an RNA virus. Measles virus can survive for up to 2 hours in air, but is sensitive to heat, light and acidic pH.

Clinical signs, symptoms and complications: 

Early symptoms include fever, runny nose, cough, loss of appetite, and conjunctivitis or "pink eye." Characteristic white Koplik’s spots may occur in the oral mucosa.

After 3 to 5 days the 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:

  • Diarrhoea (8%), ear infections (7-9%) and pneumonia (1-6%), which accounts for nearly two thirds of measles-related deaths.
  • 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). This serious complication can lead to permanent brain damage.

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. Immunisation for household contacts is important to protect those who are immunocpmpromised.

The measles, mumps and rubella vaccine viruses are considered non-transmissable meaning they are not passed from the vaccine recipient to their contacts.

Method of transmission: 

Measles is one of the most contagious viral diseases and can be transmitted from four days before until four days after the appearance of the rash.

  • It is spread through the air by infectious droplets and is highly contagious.
  • It takes an average of 10-12 days from exposure to the first symptom, which is usually fever.
  • The measles rash doesn't usually appear until approximately 14 days after exposure, 3-5 days after the fever begins.
Public health significance: 

Measles is endemic globally, although a few countries with developed economies and high immunisation coverage have virtually eliminated wild measles virus.

  • Regular epidemics still persist in many countries.
  • Developing countries have a higher burden on morbidity and mortality from measles.
  • Measles has been earmarked as a candidate for elimination through the implementation of global mass immunisation programmes.
New Zealand epidemiology: 

Large scale measles epidemics occur when the number in the susceptible population increases and the immunisation coverage is low. It has been estimated that to prevent recurrent outbreaks of measles, 95 percent of the population must be immune. Since measles vaccine efficacy is 90–95 percent and not all children receive the first scheduled dose, the only way to achieve this level of immunity is by implementing a two dose immunisation strategy, as is now recommended. In 2000 a mathematical model was developed to estimate the future timing of measles epidemics in New Zealand. The results suggested that if no changes were made to the MMR schedule of 15 months and 11 years, the next measles epidemic would be between 2002 and 2004. Therefore from January 2001 the National Immunisation Schedule was changed to give the first dose of MMR at 15 months and the second dose at four years of age, prior to school entry. In 2005 the measles mathematical model was updated to calculate the effect of the measles catch-up in 2001 and to estimate the effect of changing the National Immunisation Schedule to give MMR at age 15 months and at age four years before school entry. As the incidence of measles decreases in New Zealand, it is important to continue high MMR immunisation coverage to lower the risk of imported measles causing outbreaks. Every suspected case of measles will need laboratory confirmation and characterisation to inform the local medical officer of health, so that public health control measures can be put in place.

Prevention: 

Measles is so highly infectious that immunisation is the only effective prevention.

Exclusion of cases from daycare, school and work, as well as exclusion of unimmunised individuals during an outbreak may reduce but not eliminate transmission.

If a child is exposed and has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure.

Immune globulin (0.6 mL/kg IM, to a maximum dose of 15 mL) may prevent or lessen the severity of measles if given within six days of exposure.

Measles vaccine is produced from a live attenuated (weakened) strain (Edmonston or Schwarz strains) of measles virus prepared in chick fibroblasts (embryo cell culture).

The attenuated measles vaccine virus undergoes the infectious cycle in the host, triggering an immune response and the development immunity.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Measles is a highly infectious viral disease that can often have serious complications.

Effects of disease: 
Otitis media (ear infection): approximately 7-9 in 100.
Diarrhoea: approximately 8 in 100.
Pneumonia: approximately 6 per 100
Acute encephalitis (brain inflammation): approximately 1 per 1000
Subacute sclerosing panencephalitis (SSPE, a degenerative brain disease that is always fatal): 1 in 100,000.
The risk of complications and death are higher in children under 5 years and adults over 20 years of age and chronically ill.
Maternal measles increases risk for miscarriage and premature labour.
Overall death rate approximately 1 per 1000.
Common side effects of vaccine: 
Approximately 6 per 100 have a mild to moderate fever
Approximately 2 per 100 have a rash or runny eyes
Uncommon side effects of vaccine: 
Fever over 39.5 degrees Celsius less that 2 per 100.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Temporary thrombocytopenia, approximately 1 per 30,000
Encephalitis may occur once in one million doses
Aseptic mumps meningitis in approximately 1 per 100,000
Vaccines: 
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