Kyotra. I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by the New Zealand Herald. New Zealand may be on the cusp of another measles outbreak. Health en Z has said the risk of further measles cases, contacts and exposures across the country remains very high. The confirmation of new cases unconnected to international travel, though, has experts worried. Today on the front Page, University of Canterbury Senior lecturer in epidemiology, Anna Howe is with us to
discuss what you need to know. So, Anna, how likely is it that measles has started spreading through communities from what we've seen so far?
Oh, I think that's it's not even likely that's what's happening. We've seen that now with the cases crop up at Wellington High School. So I think we have got community transmission and we're sitting in an extremely precurious position.
What's the importance of knowing whether it's linked to overseas travel or not.
So the importance for us is typically with that index case because New Zealand doesn't actually have measles endemic, so we rely basically measles for us is an important disease, and so that's why it's incredibly important for us and incredibly important for people who are traveling to places where there are no and outbreaks to make sure that their vaccination status is up to date and that they're cognizant when they come home if they're feeling unwell.
Do you reckon we're good at that or not?
If I think it's hard. I think people have much greater awareness now post COVID because we've all been through the understanding isolation and trying to protect people that we love and being cognizant of illness. I think though there's a lot of fatigue that's happened post COVID as well, and so with the habits always slip right. But also I think some people have had negative experiences with that as well. I think most people genuinely mean, well, it's just sometimes we don't think about things.
Tell me a little bit about what happened in twenty nineteen and perhaps how our situation now might mirror that.
So twenty nineteen was one of our largest outbreaks in a really long time, and that was a direct result of under immunization and so having what we are or what I refer to as PAULS is susceptibility, right, So you have groups that are costed together and allow that measles to take hold and then it just it requires vaccination again to put a dampner on that. And what we saw was a lot of disease, and we saw about a third of our cases requiring hospitalization care, which
is quite a lot. We saw a lot of very serious cases, so they required intensive care, particularly in the very young. We actually had three infants that required EKMO,
which is the circulatary support, so very very unwell. We had three cases who had in caphalitis, and we had two pregnant people who lost who lost their babies, and so it was a really really severe event directly related to our underimmunization and we unfortunately are in the same, if not slightly worse place with our immunization coverage at the moment, and so we could see exactly the same thing happen again, if not worse.
Yeah, what level of vaccination coverage does New Zealand have now and what ideally should we be at.
So at the moment, our childhood schedule provides MMR at twelve fifteen months, and so we use our twenty four month coverage milestone, isn't indicator that we've got that people have got those two doses. So that twenty four month coverage at the moment is sitting at eighty two percent, that's a total, and we need to be at ninety
five percent in order to have that community coverage. The problem is is like I to talked about before, with the pools of susceptibility, so that coverage is not uniform across the community even at eighty two percent, and so we have areas like Northland and Lakes that have got really low coverage down at sort of sixty two and seventy three percent. And then we have other areas in
New Zealand. Fortunately some of those are in the Wellington region, so het Up Valley capitally in Coast and Canterbury for example have ninety percent coverage. And so we have, Yeah, we have this under immunization, which means that we do have these pools of susceptibility.
How do we like, what do we do to help that more awareness or I mean I suppose it's a question that's been pondered for years and years and years.
Yes, and It's not technically my area of expertise, but I work with a lot of colleagues who are in this space, and there's a lot of reasons why we have low coverage, particularly I mean ours, we're starting to go down even before the COVID pandemic, but the pandemic definitely interrupted immunization schedules, and as a result, we've also
seen grown vaccine hesitancy. We've seen a lot of that media from overseas as well being played out in New Zealand, and so I think there's I mean, I advocate compassion if people are hesitant, actually trying to understand why they might be hesitant, because there are lots of different reasons for that to be the case. But also there are lots of system problems, like healthcare system problems that also
contribute to our underimmunization. And so it's all very well and good to have a target, and we've had immunization targets before, and the healthcare system works really hard to try and achieve those targets, but that comes at a cost as well, and you get our worker fatigue and burnout along the way, and so we have to manage both the healthcare system side of things really well as
well as the individual level. So if you're having conversations with people, it's just really important, I think, to be compassionate and listen to what they have to say, reiterate what we know scientifically, and then give them space to actually think about that and make a decision.
The vaccine which protects us against measles, comes into combinations called the MMR so measles and months rebell it, so you actually get protected against three different diseases at the same time, which is great news. MEMR vaccine is supposed to stimulate your body to be able to fight off infection.
They if it sees the disease in real time, and so that potentially means that you can have some of those side effects that occur when you are vaccinated, getting a temperature that you may actually get a rash afterwards for the vaccine. That's actually quite common. Some people might find their glands actually go up after having the vaccine, and some people they can have a little bit of
achy body. For some people that symptoms may occur in the first few hours, for others it can occur up to a week or two weeks later, but actually they stay well with it, so despite having some mild side effects, they actually stay very well.
So the vaccine, it's the MMR vaccine, and you need two of them. How can you How easy is it for a New Zealander to check whether they actually had those two?
So if you're old like me, you might have to dig out your plunket book, which I actually did, as did I out of curiosity. Yep, but even I in twenty nineteen decided that I would just get a third dose because I fit into the age group where maybe there was waning immunity and so yeah, so pulling out your old health records. If you're old like me, or if you're born from two thousand and five onwards, the immunization register should have captured that, so you should be
able to talk to your healthcare provider. And I believe if you've got access to the electronic my health records, you should be able to see what your statuses as well. But generally speaking, if you're not pregnant or immuno compromised, then just get a third dose. So you can get a dose even if it's through a third one.
Yeah, okay, cool, Yeah, Because I had the awkward conversation of ringing my dad asking him him not knowing, and then him having to dive through a thousand boxes to try and find because I'm Australian, right, so even people from other countries need to be checking this. But you're saying that even if you don't have that information at hand, it's all good if you get a third dose.
That's correct and I think too, so you can get what we call SEROH testing done and that will check the antibody status or the level of protection that you have. But because for the most part, there's no harm in getting that third dose, it's just easier just to get that done.
In terms of what happened in twenty nineteen to now, and I know it's a tricky question because COVID has happened in between that time, but do you reckon we've learned anything?
Yes, we did. There are some very nice reports that have been produced about the twenty nineteen outbreak, and we've also had the Immunization Task Force put out recommendations as well about the New Zealand childhood schedule. It's just they require system changes and so that's the hard part.
Yeah, what out of all of those recommendations that you've seen what one do you reckon we should do tomorrow if we could sign it off, get it done.
I'm really in favor of what was trying to be achieved with the health reforms, and that was giving communities the ability to decide how best to help their communities. And we definitely learned that from COVID as well, that when we funded communities to decide how best to help their communities, we had a lot of success. And so I think that would be the most cost effective way to go to get good outcomes.
And let's not forget in twenty nineteen as well, measles imported from New Zealand resulted in five seven hundred ish cases in some more and that included eighteen hundred hospitalizations and eighty three deaths from measles, mostly children under five. So not only do we have to think about our own communities, but it's important to think about our Pacific neighbors as well.
Hey, absolutely, it is horrifying that we were responsible for such a horrific event, and we have a responsibility as caretakers in supporters of our Pacific nations to make sure that that's not actually happening. So particularly important for people who have holidays booked overseas to check out their vaccination status and or just get a dose.
So what symptoms should people be aware of?
How does it start?
When should you be you know, when should alarm bells start going off?
I mean alarm bell should start going off if you are feeling unwell and you have been a contact of a case, or if you've been overseas somewhere recently. Because the important part to notice that you can actually be contagious before you have symptoms. So that's fun. But it begins with a fever and a cough and a running nose and sore red eyes, and then you will probably start to see a rash which typically starts on the
face and then moves down the body. And so most people will feel really really crap for a while, and particularly our small peppy will be very very unhappy. And then you run into getting complications, so diarrhea, pneumonia, but also you can go into like cornial ulcerations potentially a leading to blindness. You've got titus media or air infections which can have implications if they're really bad. And then you start getting into the more severe end of in carefulitis,
so that fever cough, running nose, or red eyes. Yeah, big clues.
Yeah, and it must be so difficult, especially around the seasons changing as well, when people are getting you know those flu like cold like symptoms. I've got hay fever at the moment, which is super fun, but really recognizing a between A and B. Hey like, So, if you're feeling any of those things, you've been linked to a case, or you've traveled overseas, it's really important to maybe check the Ministry of Health website, check out those locations of interest, I suppose.
Oh, that's great advice. The other thing I would recommend too is you can call Healthline and have a chat with them because they'll guide you too. And that also means that you don't have to go into your GP or the hospital and be potentially contagious there too. So yeah,
so have a look see if it is. And I mean it's always better to err on the side of caution with this, so you know, isolate yourself if you think that you it might actually be that thing, and get somebody asked to bring over some goodies for you to hang out with by yourself.
Yeah, and with cat in terms of I know that the Ministry of health or health in New Zealand rather is saying that there are obviously burther cases, there's a risk of them, and exposures across the country remains high. Is New Zealand on the cusp of another measles outbreak? Or are we in it?
I think at this point it's safe to say that we're in an outbreak. It's just a case of waiting a few more weeks, probably to see how bad it's going to get. Because people talk about how infictious measles is. It's one of our most infectious diseases, and so in an unvaccinated population that one person can potentially make twelve to eighteen other people sick. And again this comes back to having those pools of unvaccinated people or grouped together
and then suddenly, yeah, we're off. It's like I describe it sort of as tender in a wildfire situation.
If we're looking at case numbers, what would be considered quite bad?
Well, personally, I would consider one case really bad because every case has the potential to have those severe complications, and also nobody makes it out of this without some kind of lasting consequence. So our research has shown that for those cases in twenty nineteen that even those who were based in the community and what we considered mild had sort of a knock on effect where they didn't
have the immunity that they had had beforehand. So compared to healthy controls, those cases had more non measles hospitalization events and pharmaceutical dispensing in the four years posts in fiction. So I guess I don't think anyone's coined it as long measles, but we're talking about the same sort of situation as long COVID that are even surviving. That infection itself doesn't come with our other consequences further down, so I would argue one case is bad. Thanks so much
for joining us, Anna, You're welcome. Thank you.
That's it for this episode of the Front Page. You can read more about today's stories and extensive news coverage at enzidherld dot co dot nz. The Front Page is produced by Jane Ye and Richard Martin, who is also our editor. I'm Chelsea Daniels. Subscribe to The Front Page on iHeartRadio or wherever you get your podcasts, and tune in tomorrow for another look behind the headlines.