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Measles case confirmed in Auckland – Expert Reaction

New Zealand’s first measles diagnosis since 2019 was announced last night – an Aucklander infected overseas.

Though now isolating at home, the person had earlier attended events in the week to 11 February, including a Waikato festival, a Tauranga hotel, and Auckland CBD shops where measles may have been passed on to others.

The SMC asked experts what the news means for Aotearoa, and how our vaccination statistics stack up.

Professor Nikki Turner, Director Immunisation Advisory Centre, University of Auckland, comments:

“Measles is a highly infectious virus that can cause severe illness and death. It is one of the most highly transmissible viruses known, transmitted aerially through coughs and sneezes. On average the number of infected contacts for one infected person is 15. Compare that with the current  COVID-19 Omicron variant which is thought to be  up to around 11.

“Measles usually presents with a moist cough, red eyes and a rash. It frequently leads on to ear infection (acute otitis media) and diarrhoea.  However it is the severe effects that are most concerning. These incude pneumonia, low platelet count, and weakened immune system to further infections after having recovering from measles.  About one in 7 cases are hospitalised in New Zealand. Acute encephalitis (inflammation of the brain) occurs in around 1 in 1000-2000. The overall death rates can get to as high as 1 in 1000 though has been lower in New Zealand with excellent tertiary hospital care. There is a terrible degenerative brain disease (SSPE) that occurs years later in around 1 in 100,000 cases and is always fatal. Measles during pregnancy increases risk for miscarriage and premature birth.

“As this is such a spreadable disease, it’s important that infected people must isolate, staying at home from school or work. People who are infectious will need to isolate from the time that they may have become infected until four days after the rash first appears.

“Measles is very much a vaccine-preventable disease. With high immunisation coverage in a community the virus is eliminated. We could eradicate it internationally if we had sustained high coverage across all communities. All it requires is two doses of the  MMR (measles, mumps and rubella) vaccine. In New Zealand the first dose  is recommended at  12 months of age and the second at 15 months. Two doses will protect around 99% of people long term. All older children and adults up to the age of 55 years are recommended to check they have had two doses of the vaccine. It is free and safe to access further vaccines if they are unsure of their immunisation history. Adults may also be vaccinated if they have missed these childhood vaccinations. Adults 55 years and older do not need further vaccinations as they are very likely to have had contact with the virus as children.”

“The World Health Organisation says the vaccination programme from 2000 and 2018 ‘prevented an estimated 23.2 million deaths.’

Vaccination works well against measles. However, sadly since 2018 the coverage rates have been dropping in New Zealand and more so since the onset of the COVID-19 pandemic. The 24 month coverage has come down from 93% in 2017 to 83% in Jan 2023. To protect against mealses, coverage needs to be at least 90% to prevent harm to the community. Dropping rates are also seen in many countries internationally. The global risk of outbreaks is high because of these drops in coverage. The Centers for Disease Control and Prevention says that over 61 million doses of measles-containing vaccine were postponed or missed due to COVID-19 related delays in supplementary immunization activities. This increases the risk of bigger outbreaks around the world, including the United States.

“Māori and Pasifika rates are lower still which shows an urgent need to support and expand the good work being done by Māori and Pasifika health providers working closely with their communities to reach those that can’t easily access vaccinations.

“The best protection against measles is to be vaccinated with two doses of the measles, mumps, rubella (MMR) vaccine.  It is safe to have an extra MMR vaccination if you can’t remember whether you have had two doses already.

“MMR vaccine is free. If you or anyone in your whānau born after 1969 has not had an MMR vaccine, or aren’t sure, ask your GP, parent or caregiver.”

Conflict of interest statement: Professor Turner is a member of the PITAG immunisation subcommiteee to Pharmac; Chair of NVC – the measles national verification committee for the Ministry of Health; a member of the CVTAG – COVID-19 Technical Advisory Group to the Ministry of Health; and a member of PHEAG – Strategic COVID-19 Public Health Advisory Group to the government. The Immunisation Advisory Centre (IMAC) has a contract with the Ministry of Health to deliver clinical advice, promotion, education and training to the healthcare sector for the national schedule vaccines and COVID-19 vaccines.

Dr Anna Howe, Research Fellow, Paediatrics: Child and Youth Health at the University of Auckland, comments:

“Here in New Zealand our childhood immunisations are dropping, creating larger and larger equity gaps meaning those children most at risk are getting more and more at risk of getting sick or even dying from vaccine-preventable illnesses. This is why it’s vitally important that parents and caregivers get their tamariki vaccinated without delay when they’re eligible, which provides them with life-saving protection.”

Dr Howe provides the Immunisation Advisory Centre with immunisation coverage information for children in New Zealand.