Measles information for Health Professionals

Measles Update - 07 November

Dear Colleagues -

3,000 MMR vaccine doses have arrived at Propharma in Dunedin and are ready to be distributed to practices.

Ordering vaccines

• If your practice requires additional vaccine for current priority groups – that is, all unvaccinated or under-vaccinated children and young people under 18 – then you can order MMR vaccine via WellSouth at mmr.order@wellsouth.org.nz. This is a temporary measure which the Ministry of Health has asked us to put in place and normal protocols – ordering directly via Propharma – will resume in the near future.
• Please place your orders each Monday by 5pm and please include your current MMR stock levels as well.
• We will do our best to provide the quantity of vaccine your practice orders, but this may not always be possible.

Priority Groups

GPs are reminded to recall any patients, under 18 years of age, that need a booster in order to be fully vaccinated (with two MMR vaccines).

The normal Immunisation Schedule should continue to be followed: MMR 1 at 15 months and MMR 2 at 4 years old.

Babies younger than 15 months can have an MMR 0 from 6 months if they are travelling to Auckland or to overseas countries experiencing measles outbreaks.

 Nationally, DHBs are being asked to consider how an MMR vaccination service for people >16 years might be included in contracts with community pharmacies.

No decisions have been made yet. No pharmacies are currently contracted to provide MMR vaccination in SDHB region.

Dr Stephen Graham
Medical Director
WellSouth

ENDS

GP FAQs Updated 23 October 2019

Update on case numbers, suspect cases and contact tracing:

71 cases confirmed.

Total cases for each location to date is:

Dunedin: 2
Oamaru: 1
Wanaka: 3
Queenstown: 64
Gore: 1

Who should be prioritised for vaccinations?

The priority groups:

• Routine MMR vaccination at 15 months (MMR1) and 4 years (MMR2) as per the Immunisation Schedule
• MMR vaccination for unvaccinated (no MMR) or under vaccinated (one MMR) from >4 years to under the age of 18 years.

Under 18s who are unvaccinated, under-vaccinated or have no record of vaccination should be actively recalled to ensure all have full vaccination (two MMR vaccinations at least one month apart).

For children traveling to Auckland, or to a country where there is a measles outbreak, and who have not had two doses of MMR, the vaccine schedule can be brought forward, including for children as young as six months. (If under 12 months, the vaccine is MMR0.) Please note, to be effective, the vaccine must be given 14 days before travel.

Babies who have had an MMR vaccination before their first birthday will still need to receive their normal MMR1 (15 months) and MMR2 (4 years old) to be considered fully vaccinated.

Are vaccines being distributed fairly?

We are working with the MoH to increase vaccine supply to our region. They are aware of the need. WellSouth reviews vaccine need by practice and allocates according to that need.

Definitive source of measles information, resources?

https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/measles

Standard info for people calling GPs who have had one vaccine?

One MMR provides about 95% protection. Ideally patients would get a second MMR for 99% protection but during this outbreak if they are not in the above priority groups, GP practices will put names on a recall register for when vaccine becomes available.

Standard info about rules for isolation, contacting ACC, sick note needed?

Public Health South should issue sick notes to patients to cover their isolation period if they are an identified contact. Contacts of measles cases are asked to be isolated if they do not have documentary evidence of 2 measles-containing vaccinations or their measles serology indicates they are not immune.

From SDHB Measles FAQ page:

What does isolation mean?

It means staying home away from others. Do not go to work, school, group or social activities, sports, or public places like movie theatres, shopping malls, supermarkets and other food markets. Do not use public transport or visit friends or family. Avoid being in the same room as people who are not immune to measles.

Has there been a number of cases that are partially or fully vaccinated?

There have been some measles cases that are partially (1 MMR) or fully vaccinated (2 MMRs). With national case numbers so high there will be some unlucky people who get measles despite having had one or two MMRs. Even if someone has had one or two measles/MMR vaccinations, if they have clinically compatible symptoms of measles then please call Public Health to discuss and we will likely advise you to swab to check.

From SDHB Measles FAQ page:

Full vaccination means having had two MMR or other measles vaccines, according to New Zealand’s Immunisation Schedule.

Full vaccination provides 99% coverage for a population meaning that 1 in every 100 vaccinated people can still contract measles.

For that 1% of the population it is likely that their body didn’t create a sufficient immune response to the vaccine.

Vaccinated or partially vaccinated people who contract measles often get a milder form of the virus and are less contagious to others.

What do I do if a patient suspects measles and is calling from their car outside?

Go outside and assess them. Take the history and if clinically compatible with measles i.e. prodromal symptoms and a fever and rash, call Public health to discuss and get approval for swab. Then do PCR swab while the patient remains in the car. Ask the patient to stay isolated and tell them Public Health will be calling them. Please advise them to start getting a list together of people and places they have been in contact with or visited in the 5 days before the rash started (infectious period) for contact tracing. Please particularly ask them to think about if they have contact with any vulnerable people i.e. pregnant women, babies too young to be immunised, or people who might be immunosuppressed e.g. on cancer treatment.

How do we manage suspected contacts, do they have to go through Public Health South, can we vaccinate them ourselves within that 72 hour window?

Please discuss with Public Health South if you identify a close contact within 72 hours of first exposure to a measles case. If they fit the criteria then yes they should be vaccinated. If it is their second documented MMR they are then deemed immune. If it is their first MMR they will still need to be isolated (hence the discussion with Public Health)

Can we expect more vaccine supplies and when might they be offered to unvaccinated people on waiting lists?

We are still waiting for an update from MoH but hopefully in the next few weeks.

Can we offer blood tests to concerned people who don’t know if they are vaccinated?

Public Health South is organising measles serology for contacts of a confirmed measles case where the contact cannot provide documentary evidence of two measles/MMR vaccinations. This will be part of public health action and free for the contact. Other people can have measles serology through SCL and can even self-refer but will need to pay for it.

ENDS

Click here for the latest media releases about the measles from Southern DHB