Measles information for Health Professionals

Measles Update #13 - 23 September

WellSouth and Southern DHB have completed a stocktake of MMR vaccine requirements in the district.

MMR has been sent to practices today to ensure they have enough vaccines to meet Immunisation Schedule requirements.

15 month and four years of age continues to be the prioritised groups.

If practices have extra doses of vaccine on hand, they can use discretion to vaccinate other priority groups – catch up for any children that are overdue, or other vulnerable patients. But please bear in mind that the vaccine supply continues to be limited across the country.

Please see this IMAC info sheet for additional advice.

Thank you again for your support.

Measles Update #12 - 20 September

Three new cases were confirmed in Queenstown Friday, taking the total number of cases to 29 (28 of those being Queenstown residents.)

The following is the latest communications from the Southern DHB concerning the measles outbreak.

Immunisation Schedule prioritised until MMR vaccine stocks replenished

While vaccine supplies remain limited, the Ministry of Health has advised DHBs to prioritise MMR vaccinations for 15 month and 4 year olds.

Local MMR vaccine distribution is currently being managed by Southern DHB, who are in the process of getting stock to general practice.

Currently, ongoing vaccine supply will be allocated to match each practice’s Immunisation Schedule requirements only.

These groups will be prioritised until further notice:

Children 15 months and 4 years old getting their MMR as part of the Immunisation Schedule
Susceptible individuals who have had ‘close contact’ with a measles case, following discussion with public health.

Please refer patients to Healthline on 0800 611 116. The symptoms of measles include: high fever, cough, runny nose, sore watery red eyes and a rash starting on the head or neck.

For more information on measles please visit the Ministry of Health website https://www.southernhealth.nz/living-well/measles-what-you-need-know

Measles Update #11 - 19 September

I have been asked by the Measles EOC team to contact General Practices.

This communication is designed to

update you with the most recent information
inform you about the situation regarding MMR vaccine
try and help reduce the amount of extra work you are needing to do regarding the measles situation

We appreciate that this is a lot of extra, often stressful work for you in the practices, as it is for public health and the measles EOC.

As you are no doubt aware there have been additional measles cases including four confirmed this week - one patient visited Wanaka, Dunedin and Winton.

See details in this news release.

Vaccine supply

There is limited MMR vaccine stock currently in NZ and the Ministry of Health has been prioritising how it is distributed.

Local MMR vaccine distribution is now being managed by Southern DHB as per the National Health Coordination Centre guidance and the supply in the Southern district is limited.

Existing MMR vaccine orders through Propharma have been cancelled, as of yesterday and no further orders for now will be accepted through Propharma.

The DHB are in the process of getting stock to all practices that have none or very little on hand. You do not need to place an order. After this, the ongoing supply will be allocated to match your Immunisation Schedule requirements only.

Priority for vaccination

While the current vaccine supply is limited, the following groups should be prioritised.

Children 15 months and 4 years old getting their MMR as part of the Immunisation Schedule
Susceptible individuals who have had ‘close contact’ with a measles case, following discussion with public health. This is only given if it is within 72 hours of contact. Susceptible individuals are those who are unvaccinated or who have only had one MMR.
Contacts who were quarantined/isolated under written instructions from Public Health South (as they were susceptible and in contact with a confirmed measles case) coming out of isolation and therefore needing vaccination. These contacts will make an appointment with relevant practices and bring their quarantine letter. Additional vaccines will be supplied for these contacts.

What is the definition of a 'close contact'?\

A close contact is someone who was in a confined setting with a measles case during their infectious period.

What is a confined setting?

A confined setting may include:

early childhood service or classroom.
household.
transportation.
indoor occupational or social setting.
medical waiting room, reception area or consultation room.

When should I contact Public Health?

Public Health have been receiving a lot of enquiries around suspected close contacts. They have identified that a lot of the enquiries do not qualify as “close contacts” based on the above definition which is why this has been included to help you understand who Public Health will be including as a close contact. Please note that Public Health South will follow up these people.

Please continue to use HealthPathways for the latest measles information and advice. Every attempt is being made to update the HealthPathways site so this can be consulted with confidence.

At this time the EOC is operating at least for another week.

For any queries your contact remains Dunedin.reception@wellsouth.org.nz

Measles #10 – 17 September

Two new cases of measles confirmed on Tuesday 17 September in Queenstown, bringing to 23 the total number of confirmed cases in the district - 22 are Queenstown residents and one a visitor from Auckland.

One of those confirmed today travelled to Wanaka on 8-10 September, was at a number of locations in Dunedin on 11 – 13 September and in Winton on 13 September.

Please media release for more details.

Vaccines:

While additional supplies of vaccines arrived in New Zealand yesterday, and the MOH is working with DHBs across the country to managed the distribution of these vaccines, supplies are still limited and prioritisation remains as previously advised.

Prioritisation:

Ensuring ongoing provision and uptake of MMR at 15 months and 4years.Susceptible (unimmunised) close contacts within 72 hours of first exposure to measles where possible
Southern DHB is managing allocation of vaccines to general practices
Public Health South is focusing on contact tracing and isolation of contacts and infected persons
Public Health EOC remains open, but at a reduced capacity. 03 470-9910.

Ministry of Health - Measles Response Update:

Attached is the National Health Advisory updates providing directives regarding vaccines. Please read carefully, including info on non-priority groups.

Non-priority groups:

For patients booked-in to receive MMR or who are eligible but don’t meet the above priorities, we recommend that general practice include them on a recall list for when vaccine stock is sufficient. 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. When stocks are secure, general practices should be offering two documented doses of MMR vaccine to those who need it at no cost, as per the New Zealand Pharmaceutical Schedule.

Fact Sheet

The Immunisation Advisory Centre has provided up-to-date information – including a printable fact sheet - about measles immunity and the MMR vaccine on their website: https://www.immune.org.nz/hot-topic/measles-overseas-and-new-zealand

Thank you again for your support. Please continue to check HealthPathways for information and updates.

Measles Update #9 - 17 September

Another Queenstown measles case was confirmed over the weekend. There are 21 cases in Queenstown: 20 local residents and one visitor from Auckland.

Prioritisation:

The goal is to contain the spread of measles in the Southern district by ensuring ongoing provision and uptake of MMR at 15 months and 4years.
Public Health South is focusing on contact tracing and isolation of contacts and infected persons.
Southern DHB is managing allocation vaccines to general practices. General practices should continue to order as per usual and will be notified of vaccines being allocated.
The key messages to the public from Medical Officer of Health Dr Susan Jack is to remain vigilant for the symptoms of the disease and for those with symptoms to isolate themselves to prevent spreading the disease and seek medical assistance by calling ahead for advice or calling Healthline on 0800 611 116.
Public Health EOC remains open, but at a reduced capacity. The contact is 03 470-9910.

Fact Sheet

The Immunisation Advisory Centre has provided up to date information – including a printable fact sheet - about measles immunity and the MMR vaccine on their website: https://www.immune.org.nz/hot-topic/measles-overseas-and-new-zealand

Thank you for your support. Please continue to check HealthPathways for information and updates.

Measles Update #8 - 13 September

The number of cases of measles in this district remains at 19 in Queenstown. At present, there are no more public vaccination clinics scheduled for Queenstown or elsewhere.

The measles EOC in Dunedin is expected to continue but is downscaled.

Please read this notice carefully as there is a change/additional steps involved in the ordering and allocation of MMR vaccines in the Southern district in the coming weeks.

Vaccines:

MMR vaccines are available but supply is limited. A small allocation of vaccine has been sent to practices that have reported zero supplies and those with the highest need.
Priorisation: MoH directive is that the priority is to maintain the Childhood Immunisation Schedule:
- MMR1 should continue to be given at 15 months and actively recalled. (Infants travelling to Auckland can be given MMR1 from 12 months. This should happen at least two weeks before travel.)
- MMR2 should continue to be offered at 4 years old with active recall.
- Recall those under 5 who are overdue, as per business as usual.

Allocation and distribution of vaccines:

Southern DHB is now managing the distribution of vaccines. Please see the proposed processes below which are meant to help with prioritisation:

During the current measles event there will be a changes to how practices order and receive Priorix + Diluent vaccine. This is to help prioritise limited supplies.

Process:

General practices should order vaccines through Propharma as you currently do.
1. You will receive a “Temporarily unavailable” message, but the order is received and recorded;
Propharma will forward all orders to Public Health’s Emergency Operations Centre (EOC) for approval and release. The allocation of vaccine will be based on the priorities stated above.
Practices that have submitted orders will be advised by EMAIL from WellSouth if they will receive their order (and at what quantity if this has been modified) by 3:30pm daily (Monday to Friday)
Those orders released will be processed by Propharma following their normal procedure for delivery.

If you have any questions of Public Health during the weekend, the on-call health protection officer can be contacted via Dunedin Hospital switchboard, (03) 474 0999.

Please continue to check HealthPathways for updates.

Thank you, again, for all your work. Please contact Dunedin.reception@wellsouth.org.nz if you have any questions or matters you would like to discuss.

Additional Resources:

The Immunisation Advisory Centre has provided up to date information about measles immunity and the MMR vaccine on their website: https://www.immune.org.nz/hot-topic/measles-overseas-and-new-zealand
For more information on measles please visit the Ministry of Health website.
Continue to consult HealthPathways for updates and measles treatment and management advice.

Requests for measles serology

Southern DHB SCL agreed terms for Immunity testing:

Uncertain immune status and contact of known case – we test as part of our contract – we need GP/MW etc to write on request form that person is a contact of known case
Uncertain immune status and pregnant – we test and do not ask for payment
Uncertain immune status and not pregnant or contact – public health advice is to give MMR – if they want to have IgG they have to pay for it

Refer to HealthPathways:

If you see a suspected measles case (high fever + rash and at least one of the following - cough, coryza, conjunctivitis, Koplik spots) please follow the measles Health Pathways:

Immediately notify Public Health South by telephone 0800 NOTIFY (0800 668 439) or go through the Dunedin Hospital switchboard (03 474 0999).
Please use the correct swab with the correct technique as all swabs need to go to Canterbury Reference Lab for processing and any incorrect swab delays results considerably.
Please take the chance to check MMR vaccine status of your patients and proactively give MMR to those who have not or cannot document having had 2 x MMRs. Free for all <50 years. Currently follow usual childhood vaccination schedule MMR at 15 months and 4 years unless traveling to affected locations when MMR can be given earlier as per information on Health Pathways.

Swabbing:

Taking a swab is not necessarily self-explanatory. This video gives short instructions.

https://www.youtube.com/watch?v=DVJNWefmHjE

Additional Ministry of Health information:

https://www.health.govt.nz/our-work/diseases-and-conditions/measles-information-health-professionals

Notice to patients:

This notice can be printed out and used on your doors if necessary.
For additional information for your patients, please refer to the Southern Health website:
https://www.southernhealth.nz/living-well/measles-what-you-need-know

Additional Information for patients:

Key messages

MMR Vaccination
- In anticipation of increased interest and need for MMR vaccinations across our community please consider reviewing patient records for documented proof of two MMR vaccinations, if you have capacity to do so. If there is any doubt if the person has had two MMR vaccinations, or it is not easy to access this information, please offer vaccination to the client. Catch up MMR vaccinations are free to the client.

Please refer to the Immunisation Advisory Centre link here https://www.immune.org.nz/hot-topic/measles-overseas-and-new-zealand for the most up to date vaccination advice from the

Testing

Please discuss any suspected measles cases and get approval for testing with the on call Medical Officer of Health Phone 0800-668-439 (0800 NOTIFY, available 24/7 for all providers). Please refer to Health Pathways for further information about measles case management.

Measles PCR testing from nasopharyngeal swab is the test of choice.

Ensure correct technique for measles nasopharyngeal swab is used to ensure sufficient collection of cells available for PCR test to be reliable. Please refer to SCL Instructions for Respiratory Viral Testing link: https://www.southerndhb.govt.nz/files/17261_2016061082055-1465503655.pdf

GP Practice Considerations

Please ensure all front line health care staff born on/after 1 January 1969 have two documented MMR vaccine doses.
Consider placing signage is on the entrance door advising clients not to enter if displaying signs or symptoms of measles and to call instead. This will ensure prompt isolation and minimise potential spread to waiting room clients.

Clinical features of measles:

runny nose, cough, fever for 3 - 4 days before the onset of a generalised maculopapular rash, starting on the head and neck

fever (at least 38ºC if measured) present at the time of rash onset
cough or coryza or conjunctivitis or Koplik’s spots present at the time of rash onset
the case is infectious from the start of the prodrome (5 days before rash and 5 days after rash emergence).

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