Measles Update for the Health Sector - 12 September 2019 12 Sep 2019

The Ministry of Health has provided guidance to the primary care sector and vaccinators about distribution of vaccinations.

Ministry gives clarity about immunisation

The Ministry of Health has provided guidance to the primary care sector and vaccinators about distribution of vaccinations. The Ministry continues to work with DHBs to manage distribution and asks general practices and PHOs to reserve vaccines for priority groups. The first priority for MMR vaccinations should be:

• ensuring all children across NZ receive their vaccines on time at 15 months (12 months of age in Auckland) and 4 years to maintain the National Childhood Immunisation Schedule
• vaccinating groups who are most affected by the outbreak in the Auckland area, namely children under 4 years of age, those aged 15-29 years and Pacific peoples within these groups
• proactively contacting children aged up to 14 years who have not had a single dose of vaccine to get vaccinated
  
  More detailed advice for vaccinators can be found below.                  

Help ensure MMR vaccine is used to protect the most vulnerable populations – only vaccinate people from priority groups (listed above)

• If you have patients booked in for MMR or who are eligible, but who don’t meet the above priorities, we recommend you offer to rebook, at least a month out, or put them on a call list.
• It’s really 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, practices should be offering two documented doses of MMR vaccine to those who need it.
• 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 appropriate.
• We understand GPs are best placed to understand the risk as it is presented to them.        

Detailed advice for vaccinators
Within Auckland region:

• Actively recall babies for MMR1, to be delivered from 12 months of age – this can be recorded as 15-month event on the NIR
• Other 15-month vaccines can be given at the same time if this is what the parent/caregiver wishes
• MMR2 should continue to be offered at 4 years old with active recall
• Continue to recall those aged under 5 who are overdue, as per business as usual
• MMR0 can be given to infants aged 6 to 11 months, however as this is "off-label", it needs to be given on the specific recommendation of a GP or nurse prescriber. When given to this age group, it can be entered on the NIR, using the PMS high-risk MMR vaccine option. These younger infants will need two further doses of MMR. Antibodies transferred from the mother to the baby can provide some protection and make the MMR vaccine less effective until about 1 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 once they turn 1, for long term protection. This additional vaccination at 6 to 11 months of age is funded. The best protection for very young children is to ensure those around them are vaccinated, such as whānau and carers
• 15 – 29 year olds, and particularly from Pacific fanau aged 15-29 year olds, should be offered 1 dose of MMR vaccine. This age group is not on the NIR so you will have to use your practice management system to identify these patients.

Outside Auckland:

• The priority is to maintain the Childhood Immunisation Schedule.
• MMR1 should continue to be given at 15 months and actively recalled. However, MMR1 can be given from 12 months. These infants should not be actively recalled at this time but can be vaccinated if the family wishes.
• Infants travelling to Auckland can be given MMR1 from 12 months. This should happen at least two weeks before travel.
• MMR2 should continue to be offered at 4 years old with active recall.
• Continue to recall those under 5 who are overdue, as per business as usual.
• Any regions outside Auckland with sustained community transmission will be advised if MMR1 needs to be given routinely at 12 months instead of 15 months. Currently, only Auckland is immunising at 12 months.