Measles in Bay of Plenty and Lakes Regions

There have been 35 confirmed cases of measles since 1st January 2019 of which 14 have had a hospital admission.  For local information please check out Toi Te Ora's webpage: https://www.toiteora.govt.nz/measles

The following information has been written for people living in Auckland but will be very helpful for people living in Tauranga and for our patient’s here at Fifth Avenue Family Practice.

Where possible if you suspect that you or your child might have measles or have been in contact with a confirmed case please call the surgery first. We might ask you to come to the back door so that we can protect our vulnerable patients in the waiting room.

(with thanks to Ellerslie Medical Centre for allowing the free use of this resource) 

Measles Outbreak in Auckland

There are more than 800 cases in Auckland as of 2 September 2019. There are about an extra 20 cases a day. The majority of cases are occurring in South Auckland, particularly Mangere, Manurewa and Papakura. However the number of cases in the Auckland DHB area is growing. Current detailed information here.

Ministry have advised us to give MMR vaccines to the following:

  • Children on the current immunisation schedule – we have brought forward the 15 month immunisation to 12 months. This is given again at 4 years.
  • Children aged 6-12 months if in contact with a known case.
  • Children 6-12months they are travelling overseas soon to countries with an active measles outbreak.  Here is another link to information about countries with active measles outbreaks
  • Youths and adults under 50 years who have had no doses of  measles vaccine.
  • 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.
    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, Canadain 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 protects 95 people out of a 100 ie 95%. A second dose gives protection to another 3-4 people out of 100

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
  • Immunisation rates have dropped in many other countries, primarily because of the anti-vaccine movement, 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 sniffly as much as possible. Immunise her/him promptly at 12 months. Consider keeping baby home from daycare if possible. If your baby has been in contact with a known case of measles during their infectious period (5 days before and 5 days after came out) please call us for advice.

Can my baby have their MMR at 6 months?

Ministry is not recommending routine measles vaccines at 6-12 months unless your baby has been exposed to an active case of measles during the infectious period (5 days before the rash came out and 5 days afterwards)or will be traveling to a country with an active outbreak. This is because the MMR is only about 75% effective at 6 months of age, and we will need to give a total of three jabs if the first one is given at less than 12 months.

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

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 free for those who do not qualify.

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 50 years old, we will assume you were not immunised – please book in for an MMR

I am an adult under 50 years old and I really can’t remember if I had my jabs, and my mum/whanau can’t remember either

If you are a health care worker in contact with patients, a teacher working with children, or otherwise at risk, you might want to consider having a blood test to check if you are immune, see below. Otherwise please book in for an immunisation.

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

I am an adult/child less than 50 years old and I know definitely I didn’t have any  measles vaccines

You are eligible for a free measles vaccine at the GP. We are currently overwhelmed by the demand and are only able to immunize our registered patients. We are also experiencing a heavy demand and you may not be able to get an appointment for a jab for about 10 days to 2 weeks. Please do not walk in for a jab without an appointment, our nurses need to prioritize our vulnerable children first and you will be asked to make an appointment at a later date.

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 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 immunosupressanttreatment 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, but you are still generally vulnerable. Please call us to book an appointment for the immunization.

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. 1/10 people infected will need hospital admission for complications such as pneumonia and encephalitis. Babies and small children with lowered immunity 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, but you are still vulnerable to other cases in the community who might be infectious.. Please book in to have your measles jabs with us if you are not immunised against measles. (enrolled patients only)
  • If they have not followed quarantine instructions, and you have been exposed to them during the quarantine period, need to go into quarantine from 7 days after you first saw them and 7 days after ie a full two weeks.  After this period, if you have not contracted measles, you can book in for an immunization. Please do not come into the practice for an immunization during your quarantine period. 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 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 would like more information about vaccines

Immunisation Advisory Centre of New Zealand

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. 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.

Links to full resources from ARPHS

Doctors Resources