New Zealand is “close to the tipping point” of unimmunised children that set off measles epidemics in previous years, public health experts have warned. 

In a briefing released this morning, the Public Health Communication Centre (PHCC) said the number of measles-susceptible children is increasing by about 1000 every month and is now close to that before the 1980, 1985, 1991 and 1997 measles epidemics. 

“Compared to those years, we now have more susceptible young adults, and hence may be primed for a large epidemic,” the briefing read. 

In 2019, an overlapping series of measles outbreaks infected more than 2000 people and resulted in the hospitalisation of more than 700. 

New Zealand’s 2019 outbreak spread to Samoa, resulting in 83 measles-related deaths, largely in children younger than 5 years. 

Dr Oz Mansoor and co-authors outlined three actions that are “needed urgently”, alongside improving infant immunisation coverage, to prevent another measles epidemic. 

Mansoor said that first, and most importantly, a catch-up immunisation is required for those aged 15 months to 9 years who didn’t get the MMR (measles-mumps-rubella) vaccine. 

“We can use existing immunisation requirements for primary schools and pre-schools to reach [the] 95 per cent coverage required to stop spread.” 

A poster at a medical centre warns against the spread of measles. Photo / RNZ 

Mansoor added this would require staff to identify the unvaccinated and engage with parents who may be “vaccine hesitant”. 

“It can take time to build a relationship and to be able to explain the benefits and potential risks of the MMR vaccine with vaccine misinformation so prevalent.” 

PHCC said measles immunity in the primary school population limited the spreading of the disease during the 2019 epidemic, but with immunisation coverage low for those born since 2016, that protection is largely gone. 

The second action, improved communication to travellers about the risk of measles, is needed for residents even more than visitors because those returning home are more likely to import the virus. 

The briefing suggested immediate government action, in the form of enforcing compulsory measles immunity documentation to leave or enter the country, would raise legal and other challenges, but “its feasibility could be rapidly evaluated”. 

“It does not matter how many susceptible children there are, if the measles virus is not brought into the country,” PHCC said. 

In 2019, an overlapping series of measles outbreaks infected more than 2000 people, and resulted in the hospitalisation of more than 700. Photo / Warren Buckland 

Another measure suggested in the report to identify people who bring measles into New Zealand is “wastewater surveillance on aircraft”, although this would require additional work to identify the person. 

“Nevertheless, the concept is worth exploring as part of national wastewater surveillance of a range of infectious risks, given its value for Covid-19 surveillance,” the briefing read. 

The third point of action advised by the briefing is to have a stronger immunisation component in response to measles cases. 

“This could include targeted vaccination of susceptible individuals in communities where cases occur. Basically, looking at a wider ring of immunisations around an outbreak, using the Aotearoa Immunisation Register.” 

The measles component of the MMR vaccine will protect for life, with a single dose working for about 90 per cent of children. The second dose protects those where the first dose failed, leading to about 99 per cent being protected after two doses. 

“In addition to preventing a serious disease that can kill and have other serious consequences, being immunised means that there is no need for quarantine if the child becomes a close contact of a measles case,” Mansoor said. 

Measles symptoms: 

- The first symptoms of measles are similar to Covid-19, or the common cold. 

- The illness begins with fever, cough, runny nose, and sore, red eyes (conjunctivitis). 

- A rash appears two to four days after the first symptoms, beginning on the face and gradually spreading down the body to the arms and legs. The rash lasts for up to one week. 

If you or someone in your family has measles symptoms, stay at home and call Healthline immediately on 0800 611 116 so you can get free advice and public health support. 

Benjamin Plummer is an Auckland-based reporter who covers breaking news. He has worked for the Herald since 2022. 

This article was originally published on the NZ Herald here.