UPDATED 24 FEBRUARY 2020 (4.30PM)
What has changed?
- Measles cases have tapered off significantly (9 cases in January and 1 case in February as at 21 February 2020)
- Outbreak national priorities for MMR vaccination are removed
- Ordering MMR vaccine has reverted to the normal ordering process from ProPharma
- In Auckland metropolitan DHBs only: MMR0 ceases but MMR1 remains at 12 months of age
Travelling overseas
When travelling outside of New Zealand, many countries still have active measles outbreaks. Others require arriving visitors to have written evidence of measles immunity.
Proof of vaccination may include an immunisation record summary showing one measles or MMR vaccination administered at least 14 days prior to travel to the country or serological evidence of immunity to measles.
The World Health Organization notes that countries with measles outbreaks are not the only places where infection is a risk, however. There are many countries where measles spreads routinely; some of them may have more measles cases than countries experiencing outbreaks. Airports, public transportation, and tourist attractions are also places where measles can spread. It is critical, therefore, for all international travellers to be protected against measles, regardless of their destination.
Anyone intending to travel overseas should plan well ahead and ensure their vaccination status is appropriately updated or documented prior to departure.
Health professionals should use their own clinical judgement on a case by case basis to determine if MMR vaccination is required for patients wishing to travel. This is irrespective of the patient’s usual eligibility for health services or age, as long as they are over 6 months of age.
MMR vaccination
MMR vaccine supplies are now restored.
Under PHARMAC’s Pharmaceutical Schedule, a maximum of two doses can be given to any person meeting the following criteria:
1. For primary vaccination in children
2. Revaccination following immunosuppression
3. Any eligible individual susceptible to measles, mumps or rubella (which includes unvaccinated adults under age 50)
4. A maximum of three doses for children who have had their first dose prior to 12 months.
All of New Zealand
- Infants aged 6–11 months can receive one dose of MMR if they are travelling to a country with an active measles outbreak.
- Ensure all children receive their Schedule vaccines on time at 15 months (12 months in Auckland) and 4 years.
- Actively recall children aged under 5 years who need catch-up vaccination.
- Actively recall children aged 5–14 years who do not have two documented MMR vaccinations.
- People aged 15 years to under 50 years can receive up to two documented doses of MMR vaccine a minimum of 28 days apart.
- Please ensure that all MMR doses administered are recorded on the National Immunisation Register (NIR), unless the person specifically requests it not to be recorded.
Auckland DHBs – Additional information
- MMR vaccine orders are via ProPharma following the usual process.
- Infants aged 6–11 months are no longer being recalled for MMR0.
- Ensure all children receive MMR1 and MMR2 vaccinations on time at 12 months and 4 years.
- Infants who received an MMR0 dose need to receive MMR1 from 12 months of age.
- A minimum of 4 weeks after the MMR0 dose is required.
- The other vaccines due at 15 months of age can be given with MMR1.
Ordering MMR vaccines
Nationally, ordering MMR vaccine has reverted to the normal ordering process from ProPharma along with other Schedule vaccines. Distribution levels of MMR will continue to be monitored by the Ministry of Health and PHARMAC.
PMS entry and claiming catch-up doses of MMR vaccine
In the PMS immunisation section, go to 'Schedule selection tab 3' and select 'MMR schedule – Adult eligible', then go to 'Immunisation tab 1' and select MMR1 to enter the first catch-up dose of MMR vaccine. Ensure 'Autobill' is selected as an Immunisation Subsidy can be claimed.
Adults aged 50 years or older (born in New Zealand or overseas before 1969)
- Not recommended to receive MMR vaccination. They are considered to be immune to measles.
- No measles vaccine was available in New Zealand until 1969 and measles is so infectious that people born before this were highly likely to be exposed.
- For those born overseas, it is fairly similar as most countries introduced a measles vaccine in the late 1960s, 1970s or later.
Administration of MMR vaccines in infants under 12 months of age
Priorix®: The administration of Priorix to infants aged 6–11 months is off-label. There are no safety concerns. Every dose needs to be individually prescribed. Priorix cannot be administered to infants aged 6–11 months under a standing order.
M-M-R® II: Authorised vaccinators in primary care will be able to administer the M-M-R II vaccine to infants aged 6–11 months without an individual prescription when stock has been distributed to primary care. M-M-R II can be administered to infants aged 6–11 months under a standing order in any community based targeted immunisation programmes.
Pacific temporary migrant workers including those enrolled in the Recognised Seasonal Employee (RSE) Scheme.
- Providers can administer one MMR vaccination for unimmunised Pacific temporary migrant workers, including those on the RSE scheme.
- Providers will not be able to claim the Immunisation Benefit for any vaccine given to Pacific temporary migrant workers. The Ministry of Business, Innovation and Employment (MBIE) will notify employers that they will be expected to pay for any administration fee. The vaccine itself can be provided free of charge to the workers.
- Providers and employers are required to keep records of any vaccine administered to Pacific temporary migrant workers and share this with District Health Boards (DHBs). The Ministry of Health ask that DHBs send the number of completed Pacific temporary migrant worker vaccinations to [email protected] by 31 March 2020.
- Providers need to supply a signed record of vaccination for the person to keep and, where possible, should record the vaccination on the National Immunisation Register. We also encourage employers to know and keep a record of the immunity of measles for their workforce.
- Vaccinators in the following areas may be requested to provide Pacific temporary migrant worker MMR vaccinations:
- Bay of Plenty
- Hawkes Bay
- Horowhenua-Manawatu Districts (MidCentral and Whanganui DHBs)
- Nelson
- Marlborough
- Otago (Southern DHB)
Other resources
IMAC
Measles fact sheet
Diseases and medications when live vaccines may be contraindicated fact sheet
Measles – Why immunise video
Websites
Auckland Regional Public Health Service measles webpage
Northland DHB measles webpage.
Ministry of Health – 2019/20 measles outbreak information
Measles weekly report, ESR
SafeTravel, a New Zealand website for New Zealanders living and travelling overseas
Centers for Disease Control and Prevention – Destinations, travel updates about non-USA countries with measles outbreaks. On the CDC Destinations webpage, choose the country for intended travel from the list of destinations.