2019-12-05 Health Sector Management Update Measles

5 December 2019

Health Sector Measles Management Update Tēnā koutou New Zealand is experiencing its largest measles outbreak in 20 years. There have been over 2,000 cases of measles nationwide so far this year with 73 in the Bay of Plenty and Lakes. Last year we had no cases of measles.

The measles outbreak in Samoa tragically illustrates how serious this disease is, and we are feeling for our Pacific neighbours.

Toi Te Ora Public Health (Toi Te Ora) has been coordinating the public health response to cases of measles within the Bay of Plenty and Lakes District Health Board (DHB) areas. In order to continue to proactively manage and contain the spread an Incident Management Team has been in operation for the past 14 weeks.

The following is a review of current information and items for actioning for Medical Practices, Primary Health Organisations and other health care facilities.

Current case numbers As at 5th December 2019, there have been 73 confirmed cases of measles since 1 January 2019, of which 24 have had a hospital admission. The last case of measles in the Bay of Plenty and Lakes districts was confirmed on the 29th of November. Confirmed measles cases by district:    

Western Bay – 41 Eastern Bay – 2 Rotorua – 19 Taupō – 11

Up to date information on confirmed case numbers can be found on our website: www.toiteora.govt.nz/measles (webpage updated weekdays at 11am).

Local outbreak management objectives The national focus is on controlling spread in the Auckland outbreak. We do not currently have uncontrolled spread locally, so are focussing on case and contact management.

Awareness campaign Radio 1XX (Eastern Bay) is airing a free public awareness campaign until 20 th December. The radio commercial scripts and audio are attached to this email for your use. Please add this audio to your ‘on hold’ telephone voicemail, or record your own version using the scripts provided. The content of the scripts may also be used for social media messaging.

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5 December 2019

Travel to the Pacific Given the tragic measles outbreak in Samoa, and other concerning outbreaks in Tonga, Philippines and Fiji, the Ministry of Health is asking primary care providers to ensure vaccinations are up-to-date for any individual (aged 50 and under) who indicates they will be travelling to one of these areas, or any country that has an active outbreak of measles.

We also recommend infants aged six to 11 months travelling to an outbreak area have one dose of MMR. Please remember that any child vaccinated before 12 months of age will still need two further doses of MMR. All people need to be vaccinated at least two weeks before travel.

People who aren’t immune and have early symptoms of measles (fever, cough, runny nose, sore eyes and/or a rash) should not travel.

Regional vaccination plan - Help ensure MMR vaccine is used to protect the most vulnerable populations The National Health Coordination Centre Response Manager has endorsed the joint Lakes District Health Board and Bay of Plenty District Health Board MMR vaccination strategic intent to proactively manage and contain the 2019 measles outbreak.

The parties to the plan are Bay of Plenty District Health Board (BOPDHB), Lakes District Health Board (Lakes DHB), Rotorua Area Primary Health Services, Western Bay of Plenty Primary Health Organisation, Ngā Mataapuna Oranga, and Eastern Bay Primary Health Alliance. Lakes DHB and BOPDHB are working together to manage the response to measles as a collective region.

The aims of our regional plan are to improve MMR uptake in the routine immunisation schedule (children under 5) to 95%, and to close by half the estimated immunity gap in the 5-29 age group. The number one priority remains the MMR vaccination programme of two MMR vaccinations for under 5 years olds. GP Practices are being advised to continue to prioritise on-time routine vaccination episodes and recall children who are overdue.

Secondly, GP Practices, Lakes DHB, and BOPDHB, have now been advised to vaccinate 5-14 year old children who have not received one MMR. GP Practices will implement this through their usual business routines and via our hospitals by opportunistic vaccination within identified departments, e.g. EDs, outpatient departments etc.

Young adults over 15, will be offered vaccination opportunistically when they present in primary care. Most of our local cases so far have been linked to the Auckland outbreak in some way, so controlling spread there is important for reducing risk across the country.

Please note, the MMR vaccination is fully funded for all New Zealand residents under the age of 50 years who are not immune, and for all children (under the age of 18 years) regardless of residency status.

If you have queries relating to vaccine stock, please contact:  Bay of Plenty Kerri Lawrence kerri.lawrence@ebpha.org.nz  Lakes (RAPHS) Sue Taft sue.taft@raphs.org.nz  Lakes (Pinnacle) Helen Thomas helen.thomas@pinnacle.health.nz

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022 023 3244 027 525 8238 021 241 7301

5 December 2019

Infection control/clinic signage Please ensure all your staff have confirmed immunity to measles and review your procedures to reduce infection risk in your clinic.  Please display a poster at all entrances to your clinic. Signage can be found and printed from our website: www.toiteora.govt.nz/gp_resources_measles.  If measles is a possibility, immediately place the patient in isolation to avoid exposure of others in the waiting room  If a patient phones ahead concerned about measles, we suggest that the patient could be reviewed in their car in the car park, or brought into the clinic via a separate entrance and placed in isolation, or seen at the end of the day after other patients have left  A room remains infectious for one hour after a person with measles has left  If the patient requires transfer to hospital, please advise hospital staff of your concerns about measles prior to transfer.

Suspected measles management If you suspect a case of measles, please notify the Medical Officer of Health promptly on 07 579 8000.

Alternatively, you can phone 0800 221 555 to speak to other communicable disease staff (select option 3 during business hours, or option 5 after hours).

Do not wait for laboratory results before notifying.

Measles typically begins with prodromal symptoms such as fever, coryza, cough and conjunctivitis. A maculopapular rash typically appears on day three to day seven of the illness. Koplik spots may be present.

In this outbreak, several patients have initially presented with diarrhoea and vomiting and significant dehydration.

Apart from the clinical picture, other factors which should raise clinical suspicion include:  Possible contact/exposure with a known or possible case eg: school, preschool, playmates, friends, relatives with above symptoms  Increased community risk – if individuals were born between 1969 and 1975, they may not have a good measles immunity  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 < four years, have not received one dose after 12 months of age  Recent overseas travel  Recent travel to Auckland.

The notifying clinician should also:  Arrange urgent laboratory tests (see below)  Exclude the case from work, kura, school, kohanga reo or preschool for at least five days after the appearance of the rash  Discuss contact tracing with the Medical Officer of Health.

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5 December 2019 Toi Te Ora will discuss the presentation and collect further details direct from the suspected case, but it would be useful to have information to hand if possible on:  Immunisation status  Overseas travel  Any likely contact with known or suspected cases  Occupation or educational attendance  What testing has been arranged  What infection control measures were in place at presentation.

Toi Te Ora will:  Ensure appropriate lab tests have been ordered  Review case management and immunisation status  Assist with contact tracing and management: - Check immunisation status and risk factors - Refer at-risk contacts to GP for vaccination - Exclude susceptible contacts where appropriate  Follow up with any involved kohanga reo, preschool, schools, kura, etc.  Collect data for national statistics.

Laboratory testing The choice of suitable laboratory tests can be discussed with the on-call Medical Officer of Health or the Clinical Microbiologist. The following can be used as a guide:  Take a nasopharyngeal or throat swab for measles PCR pre-rash or day 0-3 of rash (rash onset is day 0).

Please put the swab in viral transport media  Days 4-6 of the rash please do a PCR swab (in viral transport media) and blood test for IgM and IgG serology (SST tube)  >seven (7) days from rash onset: Blood for measles IgM and IgG serology (SST tube).

If possible, specimens are to be collected by the GP to minimise risk of infection. If a patient is to have a specimen collected at Pathlab, please phone ahead so that the laboratory can ensure appropriate infection control.

Serology testing capacity is limited. To minimise laboratory impact at present, please limit serology testing to suspected cases and contacts only.

For further information on which swabs to use, please phone Pathlab on 07 578 7073 or visit www.pathlab.co.nz/providers and click on swab charts.

Other information There is a suite of measles resources available on our website at www.toiteora.govt.nz/gp_resources_measles. Included within this package are Fact Sheets which have been translated in to the Samoan language for those with suspected measles, and for close contacts exposed to measles.

Toi Te Ora will follow this correspondence with regular updates on the measles situation within the Bay of Plenty and Lakes DHB areas. Thank you for your ongoing support in this response work.

Janet Hanvey Incident Controller

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