1) What is measles?

Measles (also known as English measles) is a serious, highly infectious disease caused by a virus.

2) How serious is measles?

Complications from measles are common. They may be caused directly by the measles virus, or by bacteria which take advantage of the lowered immunity during and after the measles infection.

The risk of complications is higher in children under five years and adults over 20 years of age. Anyone who has a weakness of their immune system is at greater risk of very serious disease. These people are often unable to be immunised and rely on protection from those around them being immunised (herd immunity). Measles during pregnancy increases the risk of miscarriage, premature labour and low birth-weight babies.

Occasionally people can die from measles. Seven people died during the 1991 measles outbreak in New Zealand.

3) How is the measles spread?

It’s spread by direct contact with a sick person and through the air by sneezing or coughing. You only need to be in a room for a few minutes to spread the measles virus through breathing. The virus can remain airborne for up to one hour. On average one person with measles passes the infection to between 12 to 18 people in groups of people who are not immune.

People with measles start to become infectious before they even get their first symptoms. The infectious period is from five days before, and until five days after the rash appears.

4) Who is most at risk of the measles?

Anyone who is either not immune or has impaired immunity. People at risk of severe disease or complications include:
• Non-immune pregnant women (MMR vaccine cannot be given during pregnancy)
• People with a weak immune system (from illness or medicine)
• Infants under 12 months old
• Adults aged over 20 years

5) How do I know if am likely to be IMMUNE and safe from measles?

You are likely to be immune if:
• You have received two doses of the measles, mumps, and rubella (MMR) vaccine. This will be recorded in your Well Child/Tamariki Ora or Plunket book, or with your GP.
• You were born before 1 January 1969. Before the vaccine was introduced in 1969, almost everyone caught the disease as a child. Occasionally those in isolated communities may have escaped it but that situation was very rare.
• You have previously been diagnosed with measles. Once you have recovered from measles, your body is protected from future illness. Please note that having had measles does not mean you are also immune from mumps and rubella (German measles).

6) How can I find out if I’ve been vaccinated?

You can check your vaccination status via your Plunket book or GP records. If there is still any uncertainty after checking these we recommend you contact your GP clinic for a MMR vaccination (please refer to question 12). It’s safe, and free for people aged up to 50.

7) How can I protect myself and my family?

Two doses of the measles, mumps and rubella (MMR) vaccine is your best protection against measles. This vaccine is safe and highly effective. It provides immunity for 95 percent of people after one injection and for 99 percent of people after two.

It’s important that the community continues to vaccinate children on time at 15 months and four years of age.

People born before 1969 are considered immune. As measles is a highly contagious illness, anyone born before the introduction of the MMR vaccine in 1969 are considered to be immune as they were highly likely to have been exposed to the measles virus when they were young.

8) I’m not sure if I’ve had two MMR doses, what should I do?

You are considered immune if you have had two doses if the MMR vaccine. It’s not uncommon for those under 50 to have only received one dose, so we encourage people to check their vaccination status via their Plunket Books or GP records.

If there is any uncertainty around whether you’ve received the second dose, contact your GP clinic for a MMR vaccination (please refer to question 12). It’s safe, and free for people aged up to 50.

9) Where can I go to get the measles vaccine?

You need to contact the practice nurse at your regular GP clinic for a vaccination (rather than going to a walk-in clinic). It is likely you will go on a wait list for the vaccine.

There has been an unprecedented demand for vaccinations across the country. While GP practice nurses are doing a great job, they have been overwhelmed by requests for vaccination, and it’s simply not possible to vaccinate everyone at once. At this stage, vaccines must go to those most vulnerable and at risk first.

10) Can I go to the Emergency Department to get the measles vaccine?

Taranaki’s hospital Emergency Departments do not give the measles vaccine. If you turn up to ED asking for the measles vaccine, you will redirected to make an appointment with your GP clinic.

11) What if I’m not enrolled with a GP?

You need to be enrolled with a GP to get the measles vaccine. Visit www.pinnacle.co.nz/practices for a list of GPs near where you live.

12) Is there enough measles vaccine in Taranaki?

There's been a huge public response to the current measles situation, and this has meant an unprecedented demand for vaccinations all around New Zealand. Practice nurses and general practitioners have been doing a great job but unfortunately demand has outstripped vaccine supply. By the end of September  2019, more than 175,000 vaccines have been given compared with  94,000 during the same period in 2018.

Currently we need to focus on immunising those most at risk.  Please check the current Ministry of Health vaccination priorities here and contact your general practice if you have a child in one of the vaccination priority groups. It is most important that all children receive their vaccinations on time at 15 months and four years of age (as per the National immunisation Schedule).

There are likely to be delays for people wanting vaccination if they are outside the priority groups. GP clinics are now putting people requesting vaccinations onto a recall list for when the vaccine stock is sufficient.

13) Can babies under 12 months be vaccinated?

The best protection for very young babies is to ensure that those around them are vaccinated, including family members, friends and other carers. Please check the current Ministry of Health vaccination priorities here and contact your general practice if you have a child in one of the vaccination priority groups.

Antibodies transferred from the mother to the baby can provide some protection and make the MMR vaccine less effective until about one year of age. As the vaccine's effectiveness is lower for babies under 12 months of age, if they are given the vaccine, they will still need two further doses of the MMR vaccine at 15 months and four years of age.

14) Can we give the MMR vaccine to infants earlier than 15 months?

The Ministry of Health is advising against vaccinating children younger than 15 months with MMR vaccine unless they plan to visit or live in an area where there is a measles outbreak such as Auckland or the Pacific islands.

The latest update on the Ministry of Health vaccination priorities can be found here.

15) How can I protect my baby until he/she can have the MMR vaccine?

The advice is to stay away from sick people and make sure everyone who has close contact with your baby has had two doses of the MMR vaccine. People aged over 50 are considered immune.

16) Should I keep my baby away from public places?

Currently there is not an outbreak of measles in Taranaki and the risk of accidently being in the same place as an infectious person is very low. The advice is to stay away from sick people and make sure everyone who has close contact with your baby has had two doses of the MMR vaccine.

17) Can my child have the 4 year MMR vaccine early?

Yes. The second dose of the MMR vaccine can be given as soon as four weeks after the first dose, however the priority at this stage is ensuring all children across NZ receive their vaccines on time at 15 months (12 months of age in Auckland) and four years to maintain the national childhood immunisation schedule.

If the second MMR dose is given early it won’t be required again at four years of age, but your child will still require the other vaccinations (one injection for diptheria, tetanus, pertussis and polio) at four years of age.

18) What symptoms should I look out for?

Measles is infectious before you develop the first symptoms, which begins as a flu-like illness. The tell-tale rash does not usually appear for two to four days after the other symptoms appear. By this time the person is very unwell, with red eyes, a hacking cough and a very high temperature. It may be possible to see small white spots inside the mouth.

The rash begins on the head and gradually spreads down the body to the arms and legs. It lasts for up to one week but the cough generally lasts for a few more days.

19) What should I do if I think I have the measles?

If you have a flu-like illness with a rash, call Healthline on 0800 611 116 for advise as soon as possible or make an appointment to see your family doctor. Please phone first before visiting your doctor because measles is easily passed on from one person to another.

Phoning ahead helps ensure steps are taken to avoid you spreading measles in the waiting room. You should also stay away from work, school or public places, to help prevent putting other people at risk. People with measles need to stay away from other people until five days after the rash appears.

20) Should I get a blood test to check immunity?

Generally speaking it is easier and much faster to simply get a MMR vaccination. In order to get a blood test you will need to get a laboratory request form from your GP clinic. You will also need to get the test done and then wait for the results. There is likely to be a cost for this service.

If there is any uncertainty around whether you’ve received the second dose of MMR or you think you are not immune, we recommend that you contact your GP clinic for a MMR vaccination (please refer to question 12). It’s also safe, and free for people aged up to 50.

21) What if I am immune?

If you are immune no action is needed and you can simply carry on as normal.

22) What are the risks if non-immune pregnant women are exposed to measles?

Non-immune women who become ill with measles while pregnant are at risk of miscarriage, premature labour and having a low birth weight baby. If you are pregnant and not immune, the best way can protect yourself and your baby is to ensure those around you are fully vaccinated.

If you are pregnant and have had two measles vaccines in the past you are almost certainly protected.

Non-immune pregnant women who think they have measles, or have come in contact with someone with measles, must call their doctor or lead maternity carer as soon as possible. You may also need to go into quarantine or isolation.

23) Can I have the MMR vaccine if I’m breastfeeding?

Yes. There is no risk to the mother or child from giving MMR to breastfeeding women. However, pregnancy should be avoided for 28 days following the MMR vaccine.

24) I’ve had the measles, do I still need the vaccine?

Yes. Two doses of MMR vaccine are recommended unless you’ve had confirmation via a blood test that you have immunity to all three diseases covered by the vaccine (measles, mumps and rubella).

25) Does the measles vaccine wear off over time?

The MMR vaccine gives a high level of long-term protection against measles.

26) Can I still get the measles if I have been vaccinated?

Vaccination against measles provides immunity for 95 percent of people after one injection and for 99 percent of people after two. This means there is a one percent chance that a fully vaccinated person could get the measles, however if they did it would be a much milder case.

27) How is measles treated?

Measles is one of the most contagious illnesses you can get and there is no cure; we can only treat the symptoms. Symptoms can be eased by:
• using pain relief, such as paracetamol or ibuprofen, to reduce pain and discomfort
• drinking adequate water or other fluids to avoid dehydration
• treating sore eyes by wiping the crustiness from the eyelids and lashes using cotton wool and water (use a separate piece of cotton wool for each eye) and avoiding bright light.

28) Why do you not recommend vitamin A as a form of measles treatment?

It is generally not required for less severe measles cases that can be nursed at home as most children in New Zealand do not have vitamin A deficiency. Vitamin A deficiency is known to be linked to more severe disease and is a big problem in third world countries.

If you are worried about the need for vitamin A supplementation it is best to discuss this with your doctor. It’s important to know that too much vitamin A can be toxic, especially for children.

Natural sources of vitamin A include meat (especially liver), eggs (especially the yolks), dairy products, fatty fish and colourful vegetables such as carrots, pumpkin, kumara and leafy greens. A sick child is unlikely to be interested in eating so it is best to incorporate these foods into a balanced diet before they get sick.

29) What are the complications of measles?

Most people will recover from measles after around seven to 10 days, but sometimes it can lead to serious complications, even death. Common complications include:
• ear infections
• diarrhoea, which can also lead to dehydration
• fits caused by fevers
• pneumonia - this is the main cause of deaths from measles
• Inflammation of the brain (encephalitis) – this occurs in about one in 1000 measles cases, with some of these people dying and one in three being left with permanent brain damage.

30) Has anyone ever died in New Zealand from the measles?

Yes. The most recent deaths occurred when seven people died during the 1991 measles epidemic.

31) Quarantine vs isolation?

Quarantine: when non-immune people who have been in close contact with a person confirmed as having the measles are asked to stay at home until it’s clear they have not caught the illness and can’t spread it to others. Quarantine lasts for 14 days after the last exposure to an infectious case.

Isolation: when a person is confirmed as having measles and must stay at home away from others until they are no longer infectious. People with measles are infectious for five days before the onset of the rash to five days after the rash appeared.

32) Why are the DHB no longer providing locations that the confirmed measles cases have spent time in?

The highest risk for catching measles is for unvaccinated people living in the same house as a case. The risks are lower in public settings. What is most important is that people ensure they are fully vaccinated. This is the safest and most effective way to protect yourself and those around you who can’t be vaccinated.

33) How safe is the MMR vaccine?

The MMR vaccine is very safe, and it is effective at preventing measles, mumps, and rubella. Vaccines, like any medicine, can have side effects. Most people who get MMR vaccine do not have any serious problems with it. Getting MMR vaccine is much safer than getting measles, mumps or rubella.

34) Is the MMR vaccine safe for people with egg allergies?

The MMR vaccine is manufactured in chick embryo cell culture so there may be trace amounts of egg protein in the vaccine. However various studies confirm that children with egg allergies can be vaccinated safely in general practice.

35) Why is there so much attention on the severity of measles? In my day you caught it and then recovered and we never heard about people with complications

Measles used to be very common before vaccinations started in 1969. It was so infectious that virtually every child had experienced it before the age of five years. A lot of people had complications and some died but in those days it was accepted as there was nothing you could do about it. Now there is an effective vaccine and people no longer have to suffer this disease.

36) Where can I find information about what is happening nationally with measles?

The Ministry of Health’s 2019 measles outbreak information web page has up-to-date information on case numbers, priority groups for vaccination and other useful information about measles at a national level.

More detailed information on notifiable diseases such as measles is produced by the Institute of Environmental Science and Research Ltd (ESR) for the Ministry of Health. Weekly surveillance reports on measles can currently be found here.

37) Where can I go for more information

- Call your GP or Healthline on 0800 611 116
- Phone the Taranaki Public Health Unit on (06) 753 7798 or free phone 0508 834 274
- Check the Ministry of Health website - www.health.govt.nz