Health Professionals
Current measles outbreak - recommendations for primary care
The measles outbreak, which has particularly been affecting Auckland over the past couple of months, has now spread to the Bay of Plenty and Lakes regions. We recommend the following measures be taken in primary care in an attempt to control the situation:
First dose of MMR should be administered from 12 months
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Active invitation of infants aged 12 months or older for MMR dose one, to be followed by a recall for a second dose 28 days later. All other non-MMR vaccinations usually administered at 15 months can also be given at this time.
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Active recall of children under 4 years who have not had their second dose of MMR; to be given anytime after 28 days from dose one. The vaccine for DTaP-IPV should still be administered separately at age four.
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Active invitation for children and young people aged up to and including 15 years of age if they have not had two doses of MMR vaccine, ensuring two doses are administered (28 days apart if they have not received a previous dose).
Immunisation for patients over 15 years of age
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Where the opportunity arises, invitation for people aged from 16 to 42 years of age if they have not had two doses of MMR vaccine, ensuring two doses are administered (28 days apart if they have not received a previous dose). This will most likely be when patients in this age group visit or call for a separate reason.
Prioritisation of first vaccination
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It is recommended that you focus initially on reaching those who have not yet had one dose of MMR (i.e. infants aged 12 -15 months who have not yet received a dose of MMR, and children and adults up to age 42 years who have not received a dose of MMR) and subsequently focus on achieving second dose coverage.
Proactive immunisation of your staff
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All staff born from January 1969 who have not had two doses of MMR, or who are unsure of their immunisation status, should be given two doses of MMR vaccine 28 days apart as soon as possible.
Notes:
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MMR should not be given to pregnant women or immune compromised people.
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Routine serology - IgG testing is not recommended however may be used for vulnerable people such as pregnant women to determine risk and other preventive measures required. In all other cases it is preferable to vaccinate without obtaining a test result.
Key documents
Case notification
Please notify any suspected measles cases immediately to the Medical Officer of Health and discuss the process for laboratory confirmation of the diagnosis without delay.
Our current rates of immunisation coverage are well below the 95% required to prevent the spread of measles, and so urgent public health follow up of suspected or confirmed cases is important.
Measles overview
Key points:
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Measles occurs in all ages.
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The characteristic maculo-papular rash follows first prodromal symptoms by 2-3 days.
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Patients are infectious 3-4 days before the onset of the rash until 4 days after onset of the rash.
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Measles is highly contagious, spreading via the air or surface droplets.
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A single case is defined as an outbreak requiring urgent public health intervention – therefore urgent lab testing for confirmation of a suspected case is critical.
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Clinical events |
Infectivity |
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Contact
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10-12 days Incubation period Apart from the clinical picture, other factors which should raise clinical suspicion include:
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Possible Contact / Exposure with known or possible case eg: school, pre-school, playmates, friends, relatives with above symptoms.
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Increased Community Risk – if individuals were born between 1969 and 1975, they may not have a good measles immunity.
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Susceptible Individuals – those who do not have documented immunity to measles or who have not received two doses of MMR vaccine or, for those aged < 4 yrs, have not received one dose after 12 months of age.
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Immunocompromised Individuals – should be considered for immunoglobulin.
Websites with measles information
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Immunisation Advisory Centre, measles resources for Health Professionals
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Immunisation Advisory Centre, Health Professionals home page and latest news and updates
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National Measles Laboratory, specimen collection and transportation
Documents
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Measles - GP Flow Chart - Toi Te Ora - Public Health Service summary and advice on local guidelines for diagnosis and management.
- Infectious Disease Notification Form
On-call Medical Officer of Health - 07 579 8000 (Tauranga Hospital)
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