National Health Advisory Measles Response Update - 18 September 2019 19 Sep 2019

The current measles outbreak has created pressure across the health system, particularly in Auckland, and we thank you for your continuing work to protect the health of New Zealanders.

ADVISORY SUMMARY:

The current measles outbreak has created pressure across the health system, particularly in Auckland, and we thank you for your continuing work to protect the health of New Zealanders. We are pleased to confirm that, subject to final regulatory approval, a further 100,000 vaccines have been allocated to New Zealand and PHARMAC is confirming delivery details.

Over the past two weeks, the Ministry of Health, PHARMAC and DHBs have managed distribution to ensure that MMR vaccine is available to meet priorities. It is critical that this process continues so we can be confident that our most vulnerable communities are able to be protected. To assist with this process, each DHB has been asked to nominate a single point of contact for stock management, and to communicate that to their PHOs and general practices.

DHBs will keep working closely with regional distributors, PHOs and practices to manage the distribution of stock over the coming weeks, to ensure that vaccine stock is going to where it is needed most. The Ministry reiterates the focus on priority groups (detailed below), to help continue the careful management of vaccine stock. We ask that general practice and PHOs reserve vaccine for these priority groups. Any orders placed with regional distribution centre prior to 18 September 2019 have been cancelled and will not be filled. A new temporary ordering system is now in place and will continue for at least six weeks (see below).

The priority for MMR vaccinations should be:

Auckland

•    ensure all children receive their MMR vaccinations on time at 12 months and 4 years to maintain the national Childhood Immunisation Schedule
•    targeted community outreach managed by the three Auckland DHBs, namely groups who are most affected by the outbreak including 15-29 year olds and Pacific peoples within those groups.

Rest of New Zealand

•    ensure all children receive their vaccinations on time at 15 months and 4 years to maintain the national Childhood Immunisation Schedule
•    susceptible close contacts within 72 hours of first exposure to measles when possible.

You can help to ensure that MMR vaccine is used to protect the most vulnerable populations by only vaccinating people from the groups listed above. We will review these priority groups when PHARMAC is able to confirm delivery details for the additional stock.

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 distribution returns to normal.  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.

You will need to calculate the number of children at your practice who are due their 15 month (12 month in Auckland) or four-year MMR vaccine every fortnight. Please liaise directly with your DHB’s nominated stock manager to ensure you have enough stock to deliver your schedule vaccines each fortnight. We have asked that DHBs communicate this to you. If you have not received this, the National Health Coordination Centre Operations team will be able to provide their contact details. You can contact the centre at NHCC_Operations@health.govt.nz

Your DHB’s nominated stock manager will be the sole point of contact for ordering the MMR vaccine. Please continue to order other schedule vaccines in the normal way through your regional distribution centre.

Additional information regarding priority groups:

Travelling to areas with serious measles outbreaks (international and Auckland) for infants under 15 months If you have children under 5 who are not up to date with their scheduled MMR vaccinations, we recommend they are vaccinated at least two weeks before travel to areas where there are serious measles outbreaks. Infants aged 6–15 months who are travelling to areas where there are serious measles outbreaks are able to get the MMR vaccine before leaving. For parents who request an MMR dose 0 (infants aged 6–11 months) due to concerns about their infant being at high risk of exposure, a GP may provide a prescription for this vaccine dose to be administered if felt to be appropriate. Your child will still need two more doses of the MMR vaccine between the ages of 1 and 4 years old.

Active recall of children under 5 years of age In accordance with the national Childhood Immunisation Schedule, all children under 5 who have not yet received their second dose of MMR should be actively recalled. We consider this group to be in with the priority groups above.

Vaccination of people excluded from work or school in the case of an outbreak People outside of the priority groups who may be excluded from work or school will be managed as part of any outbreak response required by the relevant local public health unit.

Vaccination of healthcare professionals The Ministry and DHBs continue to focus on ensuring healthcare professionals are fully immunised, however, they are not included in the current priority groups for MMR vaccine. Non-immune individuals at high risk of exposure to measles will need to be assessed, and vaccinated if required, on a case by case basis and we recommend this is discussed with your DHB.