Measles Outbreak 2019 - all you need to know.

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 will bring you in via the ambulance entrance on the side of the building, into a isolation room.

PLEASE DO NOT WALK IN FOR MEASLES IMMUNISATION (MMR) WITHOUT AN APPOINTMENT. YOU WILL BE ASKED TO MAKE AN APPOINTMENT AT A LATER DATE AS WE NEED TO PRIORITISE OUR VULNERABLE CHILDREN. WE ARE EXPERIENCING HIGH DEMAND

There are more than 800 cases in Auckland as of 3 September 2019 and growing number being confrimed in Waikato & BOP. There are about an extra 20 cases a day. 

Here is the latest information from Toi Te Ora in BOP, and 

What is Measles and why should we vaccinate?

Measles is highly contagious. One person with measles can pass on the disease to 13 other people who have not been immunised.

A person with measles is infectious from 5 days before and until 5 days after the rash appears (about 10 days in total). During this time the infected person needs to stay away from other people; children need to be kept home from school and adults from work, do not invite other children or visitors to your house.
Measles can cause serious complications including diarrhoea, ear infections, pneumonia and encephalitis (swelling of the brain). About 1 in 10 people with measles will need hospital treatment.

Measles during pregnancy increases the risk of miscarriage, early labour and low birth-weight babies. 

Early symptoms include:  runny nose, fever, cough & conjunctivitis (runny eyes),  a rash can then develop 2-4 days later.

This is an excellent link to the clinical symptoms of measles.    

When should my Child be vaccinated?

The Ministry of Health 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 aged 6-12months, if they are travelling overseas soon to countries with an active measles outbreak. Here is another link to information about countries with active measles outbreaks.
• Youth 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.  See FAQ for more info on when measles vaccines were introduced in different countries.

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?

• 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 sniffy as much as possible.
• Immunise her/him promptly at 12 months, and call us to discuss options if baby is 6-12 months and at day-care and might be exposed. Consider keeping baby home from daycare if possible.
• 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.

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 60-75% 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. However, if your baby is at day-care and likely to be exposed to measles, please call us to discuss, we will certainly recommend immunising your baby from 6-12 months if they are at risk.

I can't get an appointment with your clinic for a measles vaccine (MMR) this week

• We are trying our best but are experiencing high demand at present due to the outbreak, and have limited supplies of the vaccine.   As per our advice from MOH (above) we need to prioritise vaccination supplies to our most vunerable children on the schedule and then those on catch up programs, and  high risk occupations.
•  We are very sorry that we cannot immunise everyone immediately but it is not possible. 
• While you are waiting for your jabs, please stay away from coughing/sniffly people, stay away from big gatherings e.g. sports events/shopping centers etc. You may consider working from home or keeping your baby at home. We are happy to give your un-immunized child a sick note to stay at home from school until 14 days after they have had their jabs. Please phone to request this note.

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 so will have 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 Pathlab 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 experiencing a heavy demand and you may not be able to get an appointment at a time that suits you for a jab for a week or more. Please do not walk in for a jab without an appointment, as our nurses need to prioritise 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 immunised: 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- Measles 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 can 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 immunosupressant treatment such as chemotherapy, oral steroids etc) PLEASE CALL US FOR ADVICE.

• If you ARE immunised: 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 immunisation.

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 ?

• Thankfully nobody has died yet during this outbreak but many have required admission to hospital. 
• 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 immunised 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. 
• 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. After this period, if you have not contracted measles, you can book in for an immunisation. Please do not come into the practice for an immunisation 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 1998 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 three month afters this vaccine is given.

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

• Except if on low doses the answer is no, as this virus is a weakened live virus and may harm you if you are on any of these medications.

Links to full resources 

Latest Measles Advisories
Fact sheet – Information for people with suspected measles
Fact sheet – Information for close contacts exposed to measles
Pack – Whānau Pack for GPs and EDs
Measles Quarantine Calculator
Translated key messaging
Immunisation Advisory Centre phone 0800466863
Information Sheet for MMR Vaccine

Acknowledgments to Dr Andrea Steinberg from Elleslie Medical Centre for kindly sharing her work on this topic on which this page is mostly based with only minor edits
Similarly this page is not copyrighted and please feel free to share this page, link or use information to help our communities