Primary healthcare news, information & resources


Measles - update and resources


Measles is a highly infectious disease that is easily spread from an infected person by saliva or mucous droplets when coughing, sneezing or talking. Just being in the same room as someone with measles can lead to infection for those who are not immunised.

If you cannot find an answer to your question on this page please contact our medical director Dr Jo Scott-Jones on
027 475 0488. 

On this page

  • Latest MMR vaccination advice
  • Vaccine stock levels 
  • Information for the public
  • Latest Ministry of Health national health advisory notice
  • Information for practices
  • Answering questions we've had from practices
  • Immunisation facilitator contact details

    Please encourage GP members of Pinnacle to join our Facebook group. We are hearing feedback that it is a useful resource. It's being updated at least daily - and whilst we are updating this page also, it allows interaction.


Immunisation advisory centre - MMR vaccination advice




MMR ordering process outside the Auckland region from 9 December

Please notify your providers of this change to ordering processes. There will be notification on the ProPharma website from Monday. We would appreciate if you could remind providers that the national priority groups for MMR vaccination remain unchanged:

  • ensure all children receive their vaccinations on time at 15 months (12 months in Auckland) and four years to maintain the national Childhood Immunisation Schedule
  • susceptible close contacts within 72 hours of first exposure to measles when possible
  • babies aged six months to 11 months who live in Auckland or who are travelling to Auckland or overseas to a country that has an active outbreak of measles
  • children and adolescents aged 15 and under who have not had a single dose of MMR
  • in accordance with the National Immunisation Schedule, all children under five who have not received either dose of MMR should be actively recalled. We consider active recall of this group to be in line with the priority groups.
  • unimmunised people under the age of 50 travelling from New Zealand to Samoa, Tonga, Philippines and Fiji.

Distribution levels of MMR will continue to be monitored daily. The Ministry of Health has worked with DHBs to gather a good understanding of expected usage until the end of 2019. Any significant increase in usage above expected levels will be investigated to ensure that all regions and priority groups continue to receive appropriate levels of vaccine.

Ordering the MMR vaccine through regional distribution centres outside of Auckland will begin on 9 December 2019.

Pharmacy

Pharmacies in the Auckland region that have a contract with their DHB to deliver MMR vaccines should continue to use the Auckland region process to order. Delivery to pharmacies has now been enabled and will commence on 9 December 2019.

Pharmacies outside of the Auckland region, that have a contract with their DHB to deliver MMR vaccines, will need to send their business name and address and any existing ProPharma account number or SAP code to yourselves and/or the Pharmacy Portfolio manager for your DHB, so that you are aware of which pharmacy are accessing MMR vaccines. Please then provide a list of pharmacies to brian.roulston@pharmac.govt.nz so that PHARMAC are able to work with the regional distribution centres to enable delivery of MMR vaccine.


Update 4 December - travelling to Samoa and Pacific

The question about eligibility for vaccination was raised and confirmed that:

  • children under the age of 18 are eligible for vaccination in New Zealand regardless of immigration status
  • un-immunised eligible people under the age of 50 travelling from New Zealand to Samoa, Tonga, Philippines and Fiji should get vaccinated at least two weeks prior to travel.

Eligibility criteria and claiming

The eligibility criteria for publicly funded vaccinations states:

Regardless of their citizenship or immigration status, children are eligible for publicly funded vaccinations on the Immunisation Schedule, and WellChild/Tamariki Ora services.

You can also find this information on the Ministry of Health website- vaccine eligibility.

Claiming for vaccinating children who are not New Zealand citizens follows the same process as claiming for those who are citizens. This includes claiming for the vaccine and administration. Information is available in the Immunisation Handbook page 12.

Those over the age of 18 and who are not residents or citizens are ineligible - eligibility criteria can be found here eligibility criteria.

Update 24 October - Waikato only

Further vaccine supply was made available for distribution on 10 October. This vaccine supply ensured Waikato practices could adequately cover all immunisation schedule requirements (15 month and 4 years). The MOH also granted approval for Waikato DHB to extend the priorities.  Please read the memo from Waikato DHB for full details.

Update 14 October

More vaccine stock has been secured, but at this stage the priority groups for vaccination have not changed.

The priority for MMR vaccinations

Outside of Auckland
  • Ensure all children receive their vaccinations on time at 15 months and 4 years to maintain the national Childhood Immunisation Schedule (actively recall children up to the age of 5 years).
  • Susceptible close contacts within 72 hours of first exposure to measles when possible.
  • babies aged six months to 11 months who live in Auckland or who are travelling to Auckland or overseas to a country that has an active outbreak of measles
  • in accordance with the National Immunisation Schedule, all children under five who have not received either dose of MMR should be actively recalled. We consider active recall of this group to be in line with the priority groups.
  • children and adolescents aged 15 and under who have not had a single dose of MMR
  • un-immunised eligible people under the age of 50 travelling from New Zealand to Samoa, Tonga, Philippines and Fiji.

You can help to ensure MMR vaccine is used to protect the most vulnerable populations by only vaccinating people from the groups listed above.

Non-priority groups

For patients booked-in to receive MMR or who are eligible but don't meet the above priorities, we recommend 
  • include them on a recall list for when vaccine distribution returns to normal. 
It's very important for all of the population to be protected and we don't want to lose the opportunity to offer MMR to all who are eligible. 

District specific information / public health alerts

Some districts have patient specific resources on their websites. For those without we have attached to the bottom of this page a series of resources developed from the Auckland Regional Public Health information (thank you Dave Maplesden). 


Vaccine stock levels - distribution is still problematic

Each area has a process for collection of stock levels in each practice. Thanks you for keeping this information up to date, it really helps with distribution of vaccine. For more information your local contact person is Taranaki: Awhina Mattock, Lakes: Helen Thomas, Tairawhiti: Matt Tong and Waikato: your practice support person.

Please keep filling in the stock and demand updates as accurately as possible, these are very helpful in our advocacy on your behalf, and our DHBs are using them to help them decided on stock allocation. 

  • Consider referring to NIR for outreach immunisation referrals for your 15 month and 4 year olds - this increases the options for your patients getting access to vaccination, it doesn't mean you can't do these immunisations yourselves if you can, it's just another option for access.

  • Please be mindful when speaking to concerned members of the public that if you are out of stock the message is clear they are eligible to be vaccinated - confusion is evident on Facebook where patients have been turned away due to stock issues. 

We will continue to work closely with our DHB colleagues and to advocate on your behalf, please let Jo Scott-Jones know if you have any concerns - particularly if you have high risk patients and no vaccine to give them.

Waikato - 2pm, 23 September

We will collect "stock on hand" data using this form on Monday and Thursday each week.

On Thursday 26 September (this week) we will also ask practices to tell us how many CHILDREN you are going to recall for MMR vaccination in the next two weeks.

This data will be sent to the Ministry of Health and used to:

  1. allocate the number of MMR vaccine doses to the Waikato district
  2. inform how many vaccines practices receive.

Supplies are at such a low level (240 doses every 2 weeks for 92 practices across the district) that practices may well be sent just enough vaccines to cover the number of children they have booked in.

The DHB will be using NIR data to check the doses required and doses actually given at a practice level.

The DHB is getting reports of practice still giving vaccine to people for occupational purposes (including adult DHB employees). Practices are reminded that ONLY children who are not fully immunised should be getting MMR vaccines, and we are encouraged to actively recall all children up to the age of 5 years.  

Unimmunised contacts of proven measles cases may be advised to have an MMR vaccine, but they will have been asked to do so by public health, and children travelling to measles prone areas may be vaccinated out of scheduled times. 

The key contact for vaccine distribution concerns in the Waikato is David Wilson

Taranaki

Taranaki DHB are using the Pinnacle spreadsheet as the source of truth - practices are encouraged to update that daily so the practice support team in Taranaki can communicate this to the DHB. The Taranaki locality office are part of the allocation team. 

Lakes

This is being coordinated by Helen Thomas

Taranaki

This is being coordinated by Matt Tong.


Information for the public

If you have patients with concerns who require general information you may wish to point them towards the HealthNavigator information on measles. This is prepared with the general public in mind.

There have recently been new cases in Waikato with multiple contacts - we have attached information sheets for patients (and practices) that can be used to address enquiries.


Information for practices

Resources and advice

The Immunisation Advisory Centre (IMAC) web page "Measles overseas and in New Zealand" is an excellent source of up to date information. It contains:

  • advice on measles overseas
  • advice for health professionals in New Zealand
  • measles within New Zealand - including numbers of confirmed cases by DHB area
  • MMR vaccination advice
  • advice for primary care - funding/eligibility, immunisation records and precall information
  • further resources - including MMR fact sheets, measles fact sheets, MOH information and releases and other useful websites.

Also see the Ministry of Health information for health professionals web page for a range of downloadable/printable resources and advice.

Taranaki Public Health Measles clinical fact sheet and flow chart is also a useful resource.

Answering questions we've had from practices

  • Loading 6-11 months MMR Vaccine into the NIR
We had a query regarding entering vaccine into the NIR for children 6-11 months and have been informed the only way the MMR vaccine can be entered into the NIR, is to enter it under the Standard Programme as MMR-Primary Course. The 15 month and 4 years still stay scheduled, If you are unsure how to do this in your PMS speak with your vendor or contact practice support.

The immunisation authority guidelines say that if a patient with a case of confirmed measles happened to have been sitting in the waiting room then we need to get a record of everyone who was in the room, this could be up to 40 people for us at times...

Measles is one of the most contagious of all infectious diseases - up to 9 out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. It survives in the air for up to two hours after the person has left the room. There is a risk of contracting measles after only 15 minutes in a room with a contagious patient.

  • Practices need to be prepared to implement infection prevention and control. IMAC advice includes keeping an accurate record of walk-in patients and other visitors in case contact tracing is required, and identifying suitable triage and isolation areas for suspected measles cases. 
  • Allow only immune staff to have contact with the patient.
  • User appropriate personal protective equipment (e.g. N95 masks).
  • Place signs, hand gels and surgical masks at waiting room entrances and reception desks.
  • Notify the medical officer of health as soon as you suspect measles - do not wait for a laboratory confirmation.


What about infection control procedures - for example how do we clean the isolation room after use?

After the triage and isolation area has been vacated surfaces should be washed down with a disinfectant following the instructions on the product. The New Zealand Ministry of Health recommend that a when a person with a high suspicion of measles has been in  a room it is left vacant for ONE hour after their departure. Staff dealing with patients in the triage and isolation areas should wash their hands before and after contact with the patient. 

I have a patient who had chemotherapy for cancer a few years ago - do they need an MMR vaccine if they are over 60 years of age? 

It's complicated. There is a comprehensive re-vaccination schedule that details the vaccinations that could be needed depending on the particular case. 

The inclusion of funded vaccines for "revaccination post-chemotherapy" on the Pharmaceutical Schedule provides an indication of what can be given when required rather than an instruction of what must be given regardless of the individual's age and documented vaccination records. As per the Handbook, "Oncology patients - this section provides general guidelines for vaccination after cancer treatment. Specific vaccination questions should be discussed with an expert paediatrician, infectious diseases physician or oncologist." Use of the word "revaccination" may be causing some confusion. Best practice is that individuals who have a complete documented primary course of vaccines prior to chemotherapy do not need to repeat a primary course of the vaccines post-chemotherapy. Starship guidelines do not to follow this evidence but the advice for those aged 18 years or older does.

In the case of MMR vaccination for adults post-chemotherapy, the first criteria is that the adult is non-immune to measles, mumps and rubella. If they were considered immune before chemotherapy, they are still considered immune to measles, mumps and rubella after.

Adults born prior to 1969 are considered immune to measles therefore vaccinating these adults post-chemotherapy is not indicated.

Adults born 1969 or later

  • Those who have two documented doses of MMR are considered immune. No more MMR vaccinations are required.
  • Adults born 1969 or later who have one documented dose of MMR prior to chemotherapy have completed their primary dose of MMR and would receive a second documented dose of MMR because this is the standard schedule, i.e. the second dose of MMR is for the 5-10% who didn't become immune after their first dose and is not about boosting the response to the first dose.
  • Adults born 1969 or later who do not have any documented doses of MMR vaccine receive two documented doses of MMR vaccine six months post-chemotherapy and when their lymphocyte count is >1.0 x 109/L.

If a patient has had one vaccine as a child, and is now 49 years of age, should they have another vaccine?

Yes, but there is no urgency about this - a single vaccine will provide cover for 95 per cent of the population, the second vaccine "booster" can pick up another 3 per cent or so.


Immunisation facilitators - contact details

Waikato

Helen Ride, Pinnacle Midlands Health Network
Phone 021 683 977 or email helen.ride@pinnacle.health.nz

Taranaki

Mel Hurliman, Taranaki DHB
Phone (06) 753 7702 extn 8680 / 027 211 6357 or email melanie.hurliman@tdhb.org.nz

Lakes

Kim Winckel, Lakes DHB - available Thursday, Friday and alternate Wednesdays, 8am-4.30pm
Phone (07) 343 7759 / 027 513 0931 or email immunisation.facilitator@lakesdhb.govt.nz

Tairawhiti

Janine Brown, Hauora Tairawhiti 
Phone (06) 869 2092 extn 8765 or email janine.brown@tdh.org.nz


Measles - Travel PDF 362.25 kB Attention - You could have measles PDF 373.25 kB Measles for patients (Auckland Regional Public Health information) DOCX 129.17 kB Think Measles PDF 283.98 kB Do you have measles symptoms? (Editable practice sign - PowerPoint) MISC 60.46 kB Auckland measles whanau pack GPs and EDs (Auckland Regional Public Health information) DOCX 560.34 kB Waikato DHB measles notification form DOCX 20.86 kB Waikato DHB measles flowchart for notifiers DOCX 46.32 kB Suspected measles for patients 2 (Auckland Regional Public Health information) DOCX 178.13 kB Waikato DHB measles poster PDF 172.8 kB Suspected measles for patients 1 (Auckland Regional Public Health information) DOCX 137.52 kB Measles for close contacts of cases 1 (Auckland Regional Public Health information) DOCX 146.33 kB Measles for close contacts of cases 2 (Auckland Regional Public Health information) DOCX 145.55 kB

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