Measles Outbreak Information January 2020

30 Aug, 2019 | Uncategorised

There are just over 1700 cases in Auckland as of January 2020. The peak of this outbreak was at the end of August 2019 and is now well past. The number of new cases is now less than one a day, as compared to several weeks ago when there were about 20 new cases every day. The number of cases is not expected to rise in the near future.The majority of cases are still occurring in South Auckland. Current detailed information here. If you are interested in national data, the Public Health Surveillance publishes a weekly list of confirmed cases nationally. This data tells an accurate story of the outbreak.

IF YOU THINK YOU HAVE MEASLES OR HAVE BEEN IN CONTACT WITH A CONFIRMED CASE OF MEASLES, PLEASE CALL US FIRST BEFORE COMING IN. WHEN YOU ARRIVE FOR A CONSULTATION, PLEASE STAY IN YOUR CAR AND COMMUNICATE WITH US BY PHONE UNTIL A DOCTOR OR NURSE CALLS YOU IN. IF YOU ARE COUGHING WE WILL ASK YOU TO WEAR A MASK WHEN YOU COME INSIDE.

We are also introducing online video consultations with Dr Catherine Chan, which is a good option if you wish to reduce your exposure to sick patients.

There is now enough MMR stock to widen access, as 100,000 doses has arrived in NZ ahead of schedule. We are now allowed to vaccinate the following

  • SCHEDULED MMR AT 12 MONTHS AND 4 YEARS. The 15 months MMR has been brought forward to 12 months.
  • CHILDREN 6-11 MONTHS AT RISK especially Pacific and Maori babies, babies in contact with a known case, traveling overseas to a country with an active measles outbreak (see FAQs). Children who start their MMR jabs at 6-11 months will require a total of 3 jabs in total ie an extra dose.
  • ONE DOSE TO THOSE ADULTS UP TO 49 YEARS OLD WITH NO PREVIOUS MMR AND AT HIGHER RISK eg Pacific and Maori patients (who have been disproportionately affected during this outbreak), new parents, teachers, early childhood educators, health care workers, students, prison workers etc

WE ARE NOT ABLE TO IMMUNISE THE FOLLOWING:

  • Adults 50 years old and older.
  • Those who are not our enrolled patients need to go to their own registered doctors. We are able to immunize only our enrolled patients as Ministry has allocated us very few doses – only enough MMRs for children and high risk youth in our enrolled population. Our books are open for new enrollments. 

 

Please note that those who are over 50 years old are considered immune, as they have most likely developed natural immunity during their childhoods, when the vaccine was not yet developed.

Please note also that the MMR vaccine is only partially effective in children under 12 months of age, thus unless the child is at higher risk, it is recommended to wait until they are 12 months old so we can maximise its effectiveness.

For those under 50, they have usually been immunised depending on which country they grew up in. There was an earlier vaccine available from 1963. It was improved and the current measles vaccine was developed in 1968. Measles vaccines were introduced in NZ in 1969, in the UK in 1968, in South Africa in 1975, USA in 1968, Canada in 1970,  in Australia in 1969, Ireland in 1985, China in 1963. Korea in 1965, Hong Kong in 1967, Singapore 1976, Fiji 1982, India 1985.

One dose of the vaccine in those over 12 months of age protects 95 people out of a 100 ie 95%. We are not able to give booster doses at this time to anyone except for 4 year old children (first dose at 12 months and second dose 4 years as per the schedule). If you are concerned about your immunity – please see FAQs below re accessing a blood test at a Labtests fee of about $50. We are unable to access a funded blood test for you unless you have been exposed to a confirmed case during their infectious period (see FAQs below)

 

FAQs:

Why is there an outbreak?

There are a few reasons:

  • Measles is a highly infectious disease, one of the most infectious known. It is estimated that each person with measles will infect 15 others who are not immunised.
  • If someone gets measles, they are infectious 5 days before they even realise it is measles. The first 5 days it looks like an ordinary bad case of flu. The rash only comes out after day 5. So they can infect many people during this period
  • Those they infect only get sick 10 to 14 days later, so there is a lag where many cases develop unseen and in turn each person will infect others before they develop a rash.
  • A country needs 95% coverage to stop measles from spreading. This is called “herd immunity”. In some areas of New Zealand only 60% of people are immunised.
  • There are several reasons why the immunisation rate is so low in some areas such as access issues (time off work, transport), poverty, inequities, health literacy, and fear of side effects of vaccines
  • There is a prominent internet presence of those who believe vaccines are dangerous, fueled by information that is just plain wrong.
  • In 2001 the Ministry Of Health MMR vaccine schedule changed from the second dose being given at 11 years, to being given at 4 years. A school-based catchup programme from 5-10 years was held but an unknown number of children did not receive this school based dose, so this cohort is not fully immunized.
  • Immunisation rates have dropped in many other countries, because of the anti-vaccine movement and other complex factors, and visitors from overseas can arrive by plane carrying the virus.
  • Those under 40 or 50 years old mostly grew up in a world where measles was very rare (post vaccinations) and have had no experience of the devastating effects of infection.

My baby is less than a year old. What can I do to protect her/him?

Keep your baby away from un-vaccinated people and those who are coughing or sniffy as much as possible. Immunise her/him promptly at 12 months, and call us to discuss options if baby is 6-12 months as Ministry is now recommending that all babies 6-12 months in Auckland have an extra jab. The immunisations do not work in babies less than 6 months old, and are only about 60-70% effective in babies 6-12 months. If your baby has been in contact with a known case of measles during their infectious period (5 days before and 5 days after the rash came out) please call us for advice.

I have a newborn at home. Can I get a jab/booster jab to protect baby?

From 21st October, yes we are allowed to jab non-immune parents (less than 50 years old) of a new-born.  IF BABY OR NON-IMMUNE PARENTS/WHANAU HAVE BEEN IN CONTACT WITH A KNOWN CASE PLEASE CALL US TO DISCUSS.

Can my baby have their MMR at 6 months?

Ministry is now recommending that babies 6-11 months can start their MMR jabs from 6 months. They will require a total of 3 doses – 2 boosters at 12 months and 4 years.

Currently countries with known outbreaks

  • Africa: DRC, Madagascar, Nigeria
  • South America: Argentina , Brazil, Chile, Columbia Peru, Uruguay and Venezuela
  • USA: all states
  • Europe: France, Poland, Ukraine
  • Israel, Syria
  • Pacific: Japan, Hong Kong, Phillipines
  • European countries – Austria, Bulgaria, Czech Republic, France, Finland, Germany, Greece, Hungary, Ireland, Italy, Poland, Portugal, Romania, and the United Kingdom
  • Neighbouring countries in the European region have also been affected: Albania, Belarus, Georgia, Russia, Serbia, Turkey and Ukraine

Will breastfeeding protect my baby from measles?

If mum is immune to measles, when she is pregnant her own measles IgG antibodies will pass across the placenta to baby and give up a a year’s protection after baby is born. This is why the MMR doesn’t work in the first 6 months of baby’s life – the anti-measles antibodies that baby received from mum inactivate the MMR vaccine before it can work. Generally speaking, without doubt breastfeeding is the best way to give baby natural immunity to many illnesses and many antibodies from Mum’s own immunity can pass through the breastmilk and help protect baby from many illnesses. Unfortunately this is not very effective for measles, as the measles antibodies are very low level and are of the wrong kind (IgA not IgG). There may be some protection, but it is not dependable. Here is a journal article with research details.

Is the measles vaccine (MMR) free?

Measles vaccine (MMR) immunisations are funded for NZ residents and those eligible for funded medical treatments. Unfortunately it is not available for those who do not qualify, as Ministry controls the MMR stock. see bottom of this page for details of eligibility for Ministry of Health funding. 

I am an adult and I don’t know if I had a measles vaccine as a child. What do I do?

  • 50 years or older ie born before 1969: If you were born before 1969 (over 50 years old) you are considered immune as there was lots of measles in the population until then. Because measles is highly infectious, it is very unlikely that anyone over 50 years old would have escaped infection and consequent lifelong immunity.
  • Younger than 50 years ie born after 1969: The measles vaccine was introduced into most first world countries in 1968-1969 – this includes NZ, Australia, UK, USA. So if you had any jabs as a child and were born after 1969, you would have definitely got the measles vaccine with all your immunisations. One dose of the vaccine protects 95 people out of a 100 ie 95%. A second dose adds another 3-4 people out of 100. 
  • Details of some countries: The current measles vaccine was developed in 1968 and introduced in NZ in 1969, in the UK in 1968, in South Africa in 1975, USA in 1968, Canada in 1970, in Australia in 1969, Ireland in 1985, China 1965, Korea 1965, Hong Kong 1967, Singapore 1976, Fiji 1982, India 1985
  • If this information hasn’t helped and you are under 30 years old, please call nurse to discuss. You  also might want to consider having a blood test to check if you are immune, see below. We have limited stock, so we may not be allowed to give you an MMR if you are at low risk.

I want a blood test to check if I am immune to measles

We are only allowed to order a funded blood test to check immunity if you have been closely exposed to a notified case of measles during their infectious period (5 days before the rash came out, and 5 days afterwards) and the result will impact on school or work attendance. If you haven’t had a close exposure to an infectious case during their infectious period, we are not allowed to order a funded blood test for you. However you can access this test by  paying at Labtests to have a measles immunity blood test (about $50-55). You don’t need a lab form from the doctor, you can just go and request it and pay for it. Please ask for a copy of the results to be sent to us.

How long does measles immunity (natural or from a vaccine) last?

Immunity is lifelong regardless if it is naturally acquired in those older than 50, or by immunization in those younger than 50

My child/I am sniffly and have a cough and want to be checked in case this is early measles

Please call us before you arrive if you think you have any signs or symptoms of measles and let us know. When you arrive, please call us from your car and let us know you are here. A doctor or nurse will come to fetch you from your car, or see you in your car. We need to keep our waiting room and consulting rooms safe for small babies and others at risk.

My child/I have a rash and are very worried this is measles

Please call us before you arrive if you think you have any signs or symptoms of measles and let us know. When you arrive, please call us from your car and let us know you are here. A doctor or nurse will come to fetch you from your car, or see you in your car. We need to keep our waiting room and consulting rooms safe for small babies and others at risk.

I/my child have been told I have been in contact with an active case of measles during their infectious period (5 days before the rash came out, and 5 days afterwards)

  • If you are NOT immunized: You need to enter into quarantine from 7 days after the first day you were in contact with the case, and stay in quarantine for 14 days after your last contact with the infected person ie a full two weeks. Here is the quarantine calculator, and here is more information for contacts. We are happy to give you a doctors note for work/school, but please do not come into the practice during this period. We will email you the note. After your quarantine period is over and you remain well, please book in for an immunisation if you are under 50 years old..
  • IF YOUR CHILD THAT HAS HAD A MEASLES CONTACT DURING THE INFECTIOUS PERIOD IS LESS THAN ONE YEAR OLD OR IS IMMUNOCOMPROMISED (have a weak immune system eg have cancer, on immunosupressant treatment such as chemotherapy, oral steroids etc) PLEASE CALL US FOR ADVICE.
  • If you ARE immunized: you are safe, you cannot spread the illness to others, and do not need to enter into quarantine.

I/my child have been told I have been in contact with an active case of measles, but this was NOT during their infectious period (5 days before the rash came out, and 5 days afterwards)

You will not be infected by that case.

My doctor has said I may have measles. What do I do?

Here is the information about  quarantine and keeping others safe. If you have a health concern whilst you are unwell, please call the practice before arriving.  Unfortunately there is no specific treatment for measles. Here is some more information about this illness. Things that can help are bed rest in a quiet dark room, paracetamol or ibuprofen for pain/fever, drinking lots of fluids, wiping the eyes gently with wet cotton wool or a soft facecloth. If you have concerns about these symptoms please call us, do not break quarantine:

  • trouble breathing
  • stiff neck
  • feeling drowsy or you cannot wake them up
  • coughing up green or yellow thick mucous
  • back pain 
  • sore ears
  • having a fit (seizure)
  • not passing urine for 10 hours.

How dangerous is measles? Has anyone died in Auckland?

Thankfully nobody has died yet during this outbreak. Measles has a mortality rate of 1-2/1000 people infected. About one third of people infected during this outbreak are needing hospital admission for complications such as pneumonia and encephalitis. Babies, small children with lowered immunity, and adults who are immunosupressed (eg organ transplants} have a 50% mortality from measles. In the 1991 outbreak of measles in NZ, there were around 7000 cases of measles and 7 deaths.

I have been in contact with a family member of a confirmed case of measles. I am not immunized against measles. What do I do?

  • If the family member has followed full quarantine instructions, you do not have to go into quarantine.
  • If they have not followed quarantine instructions, and you have been exposed to them during the quarantine period, you need to go into quarantine from 7 days after you first saw them and 7 days after ie a full two weeks. If you are a child, youth or adult less than 50 years old, please call nurse to discuss getting an MMR within 72 hours of exposure, which could possibly prevent you getting measles. The MMR does not prevent measles if given more than 72 hours after exposure. If you become unwell in your quarantine period, please phone us and we will advise what to do. Please do not come into the practice without a doctor or nurse fetching you from your car.

I have heard that the MMR contains egg and I am allergic to egg:

The modern MMR vaccine does not contain egg albumin

I am allergic to antibiotics and I have heard that the MMR contains antibiotics

The MMR contains a tiny amount of neomycin in order to keep it sterile. If you are allergic to neomycin please discuss with us.

I have heard that the MMR causes seizures in children

Children commonly get febrile seizures during childhood, These are commonly not dangerous and there is an extra 1/1000 of these seizures after MMR.  Measles disease is particularly dangerous to the brain. 1 in 1000 people with measles develop inflammation of the brain (encephalitis) – 15 in 100 of these people die and approximately 30 in 100 are left with permanent brain damage. 1 in 100,000 people who have had measles will, years later, develop a serious brain inflammation called subacute sclerosing panencephalitis (SSPE). This serious complication always results in death.

I have heard that the MMR can cause my baby to get a cough

The MMR vaccine can cause your child to have a bit of a runny nose and cough as it teaches your child’s immune system to learn to recognise and kill the measles virus. This does not turn to pneumonia. As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.

I have heard that the MMR vaccine can cause my baby to get measles

The vaccine is a very weak virus and cannot give your baby measles. Also, those who have received the vaccine cannot give measles to anyone else.

My nanna has cancer and is on chemotherapy and I am worried I will give her measles if I have the MMR

You cannot give measles to anyone when you have your MMR vaccine.

I have heard that the measles vaccine (MMR) causes autism

There was a paper published in  claiming the MMR caused autism, which has since been found to be untrue and withdrawn, and the author Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct and his medical license was cancelled. Additional studies showed that the data presented were fraudulent. There is no evidence that this vaccine causes autism

I have heard that the measles vaccine (MMR) contains mercury

The MMR does not contain mercury.

I am pregnant/trying to get pregnant. Can I have the measles vaccine (MMR)?

Unfortunately it is not safe to have this vaccine whilst you are pregnant, or if you are not using contraception and may be pregnant. This is because the vaccine is a weakened live virus and will pass to the fetus and may cause harm by giving the baby congenital rubella (German measles). We recommend that you use contraception for a month and have a negative pregnancy test before we give you this vaccine. In addition, we recommend that you do not fall pregnant for one month after this vaccine is given.

I am on immunosupressant medication. Can I have the vaccine?

No this virus is a weakened live virus and may harm you if you are on any of these medications.

I would like more information about vaccines

Immunisation Advisory Centre of New Zealand

 

 

Links to full resources from ARPHS

Doctors Resources

 

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