Measles is still a concern:

• Babies can be vaccinated from 6 months in Auckland or if travelling to the Pacific Islands and/or Philippines.
• Adults under 50 years old travelling to the Pacific Islands and/or Philippines are recommended to have had 2 documented doses or MMR (Measles/Mumps/Rubella) vaccine.
• Adults under 30 years old with no recorded MMR should have at least 1 dose of the MMR vaccine.
  Please check the Ministry of Health website for the latest updates:
  https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/measles/2019-measles-outbreak-information
  

Gardasil (HPV vaccine) – while your teens or Uni students are home over the holidays, ask them to come in to complete their Gardasil (HPV vaccine) course if not already completed (3 doses of the vaccine).

Zostavax (Shingles) vaccine – current funding for the 66-80 year olds runs out on 31 March 2020 – if you are in the 66-80 year age bracket and have NOT had a funded shingles vaccine, please phone for a Nurse Appointment well before the end date.

One dose of Zostavax^® is indicated for the prevention of shingles. It can be given to patients who have previously had shingles. 

Since 1 April 2018, one dose of Zostavax is funded for adults aged 65 years. A ‘catch-up’ programme is available for people aged from 66–80 years inclusively until 31 March 2020. Funded vaccine doses are only available through general practice. 

As of 21 October, Ministry of Health have recommended for Auckland region vaccination of 6 months to 11 months.  This is a summary of current MOH recommendations. We are in the process of recalling the 6 months to 1-year olds – this age group is most likely to be hospitalised in the current outbreak and are a priority for protection (60% of cases of measles in babies younger than 12 months have been hospitalised).

1. Active recall of 6-11 month olds (MMR0) prioritising Pacific and Māori and opportunistic vaccination of this age group (these babies will still need two further immunisations and nurses will discuss the timing of this when baby is here for vaccination.

2. Continue scheduled 12 month and 4-year-old vaccine

3. One dose of MMR to people aged under 30 years with no recorded MMR1, with particular focus on:

• Pacific and Māori people
• Students including both school and tertiary students
• Postpartum women and family members of new-born babies (0-6 months).
• Teachers and early childhood educators.

4. Based on clinical judgement: we may give one dose of MMR to people aged 30-49 years:

• Who work in higher risk environments such as institutions (e.g. prisons)
• Who are in one of priority groups in point 3 (e.g. teachers or new mothers aged 30-49 years)

It is with sadness that we say a fond farewell to Mikaela who has been one of our Nursing team for almost 4 years, she will be greatly missed.

Mikaela is moving back to Hawkes Bay with her husband where both their families are living.  We wish them an exciting future and best wishes for their new start.

We do have a new Nurse starting in a couple of weeks, but until then Annette will be working solo.

A big thank you for your patience with all the disruptions caused by the Measles outbreak, we have been extremely busy ensuring all our children from 12 months to 4 years are up to date with their scheduled vaccines.

Looking ahead, as new information comes to hand about when extra MMR supplies are available for the under 50 year olds, we will advise via our website when we can take bookings again to ensure all people under the age of 50 years old have 2 documented doses of the MMR vaccine.

MMR vaccine management advice to General Practice from MoH, ADHB, and PHO

MMR Vaccine Stock: Ongoing Advice for Auckland Region

Current MMR stock in Auckland remains limited and stocks continue to be required to be reserved for priority groups only as listed below:

1. Scheduled immunisations at 12 months and 4 years
2. In special circumstances, based on clinical judgement, one dose MMR can be given to:
   • People under 30 years of age with no recorded MMR1 with a particular focus on Pacific and Maori.
   • Babies 6 to 12 months.
3. MMR may not be given to anyone 30 years or older

♦ Adults aged 50 years or older (born in New Zealand or overseas before 1969)

• Not recommended to receive MMR vaccination. They are considered to be immune to measles.
• No measles vaccine was available in New Zealand until 1969 and measles is so infectious that people born before this were highly likely to be exposed.
• For those born overseas, it is fairly similar as most countries introduced a measles vaccine in the late 1960s, 1970s or later.

Meadowbank General Practice is following the recommendations for Auckland and will be reserving our very limited MMR stock for:

• First priority: 1-4 year olds scheduled immunisations, 2^nd dose MMR will be given at 4 years of age as per schedule, unless more stock become readily available
• Second priority: unimmunised Pacific and Maori people aged under 30 years

Information received today from Auckland, Counties and Waitemata DHB’s advises there are current vaccine distribution issues.

They have directed Primary care practices that the aim is to protect those children most at risk from measles, and have advised us to focus on childhood immunisations and on Pacific people aged between 15 and 29 years.

We will continue to update and appreciate your understanding. This measles outbreak began back in February and we have tried to accommodate as many requests for MMR vaccines as possible up until now, as such this has left us with very limited stocks and therefore we will be cancelling appointments of those not considered high risk.

We are unable to order any vaccines today and there are no stocks available at MGP until further notice (hopefully next week).

We have enough for the vulnerable people who are already booked here for vaccinations this week.

We will update the website as soon as this situation changes, so please watch here and we will advise when further vaccines available.

The advice in entry from 1st September below is still current.

We will have to prioritise immunisations so :-

• If you need MMR immunisation for an unimmunised child enrolled at this practice, who is over 6 months and attends school or daycare, please contact reception who will pass the message to our nurses to contact you.

• If you were born from 1969 onward and have no idea if you are immune see our previous web post which details how you can go to Labtests and have your immunity tested for approximately $50-$55 – you do not need a form from us – but you can ask them to copy your doctor in so it is in your records.

1 Sep, 2019

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. 

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 AND THE WAIT TO HAVE IMMUNISATIONS AT OUR PRACTICE IS ONE TO TWO WEEKS.

There are more than 770 cases in Auckland as of 1 September 2019. 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.

We are able to immunize only our enrolled patients. We are aware that the Newspapers are saying you can go to any GP for free jabs, but we do not have the capacity to immunize non-enrolled patients. Those who are not our enrolled patients need to go to their own registered doctors or go to one of the following drop in clinics:

• Monday to Friday 9am to 4pm:Clendon Public Nursing Office, Clendon Shopping Center
• Saturday and Sunday 9am to 4pm: Manukau SuperClinic, 901 Great South Road

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. Also if they are travelling overseas soon to countries with an active measles outbreak
• 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. 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, in Australia in 1969, Ireland in 1985. 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.

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

• Japan
• Taiwan
• Philippines
• Thailand
• Syria
• Anywhere in the USA
• 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

I cant get an appointment with your clinic for a measles vaccine (MMR) this week

We are trying our best but are absolutely swamped, and have to continue with our regular work whilst we are coping with this outbreak. 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 and we will email it to you. 

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. see bottom of page for details. 

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, in Australia in 1969, Ireland in 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 immunosupressant treatment 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

• Fact sheet – Information for people with suspected measles
• Fact sheet – Information for close contacts exposed to measles
• Immunisation Advisory Centre phone 0800466863
• Pack – Whānau Pack for GPs and EDs
• Calculate your quarantine period
• Translated key messaging
• Poster – Stop! Do you think you have measles?
• Latest measles advisories
• Information Sheet for MMR Vaccine
• Data Sheet for MMR Vaccine

Doctors Resources

• Guide – Managing measles in primary care
• Clinical pathway
• Form – Notifications

This information is not copyrighted – please feel free to share, link or use this information to help our communities.

Vaccination Advice for the Auckland region (Auckland, Counties Manukau and Waitemata)

 
Infants aged 6–11 months

• Can have their first MMR vaccination (MMR0):
  • If they are travelling overseas to a country with a measles outbreak, as advised by the Ministry of Health/Immunisation Schedule, or
  • If parents have concerns about their infant’s potential exposure to measles, on the advice of their GP.
• The 15 month and 4 year MMR vaccinations remain due to be administered at the relevant ages as per the Immunisation Schedule.

 
Children aged 12–15 months

• Pre-call children from 12 months of age to receive all four 15 month vaccinations (MMR, varicella, Hib and PCV10).
• Children who received MMR0 when aged under 12 months, must have a minimum interval of 4 weeks between MMR0 and the MMR vaccination due from 12 months of age.

 

Children aged 16 months to under 5 years

• Recall children from 16 months to under 5 years of age who do not have one documented dose of MMR vaccine.
• Administer the second MMR vaccination at 4 years of age as per the Immunisation Schedule.

 

Children from 5 years of age, adolescents and adults aged under 50 years who do not have two documented doses of MMR vaccine

• Opportunistically offer catch-up MMR vaccination to anyone aged 5 years to under 50 years who does not have at least one documented dose of MMR vaccine administered when 12 months of age or older.
• A second documented dose of MMR vaccine administered a minimum of 4 weeks after the first MMR dose will be required for the person’s MMR vaccinations to be up-to-date as per the Immunisation Schedule.

 

Primary care resource

• Please download the  Measles whānau pack for GPs and EDs from the Auckland Regional Public Health Service measles webpage and print copies of the fact sheet to use if your practice sees a person suspected of having measles or a person with confirmed measles.

 

For more information… https://www.immune.org.nz/hot-topic/measles-overseas-and-new-zealand