In the last outbreak from August 2011 to December 2013 about 11,000 cases were notified; there were three deaths of babies and young children and hundreds needed hospital treatment.
Apart from encouraging the immunisation of pregnant women and babies the Ministry of Health is also promoting the vaccination of health staff – particularly amongst those who regularly work with babies, children and pregnant women – because immunity (whether acquired by natural infection or vaccination) wanes over time.
Dr Nikki Turner, the Director of the Immunisation Advisory Centre (IMAC), said at present the Ministry of Health’s Immunisation Handbook recommends that midwives, doctors and nurses who regularly work with infants to get a pertussis (whooping cough) booster every 10 years, and this is what IMAC recommends.
Immunity wanes – boosters needed
But she said it also recognised that vaccine immunity wanes earlier than 10 years so some people advise shorter booster intervals for those in contact with very high-risk babies or women; for example, those in neonatal units.
“There is no hard and fast rule, but in high-risk contact situations maybe every five years would be our suggestion, but there is no national or international guidance on what would be the appropriate intervals,” said Turner.
She also pointed out that even when immunity is present an individual can still carry and spread pertussis. “So standard hygiene precautions remain important (such as hand hygiene and covering your cough) and staying away from vulnerable people when unwell.”
The Ministry of Health’s director of Public Health Dr Caroline McElnay said the best way to protect babies from whooping cough is for pregnant women to get their free immunisation between 28 and 38 weeks of pregnancy and to take their baby for free immunisations when they’re six weeks, three months and five months old.
She said any siblings should also be up to date with their immunisations – older children receive free boosters at four and 11 years of age. If people are unsure whether they or their children have been immunised, they can talk to their health practitioner, doctor or nurse.
“On time immunisation is vitally important,” says Dr McElnay. “If immunisation is delayed, babies are vulnerable for longer.”
Turner said pregnant woman are advised to get immunised for each pregnancy because the main purpose of vaccinating in pregnancy was to pass on protective antibodies to the newborn infant. “Antibody levels need to be boosted with every pregnancy to ensure the infant gets adequate protection,” she said.
Turner said that a local reaction (e.g. a sore arm) can be experienced after the vaccine; this is more likely to occur after receiving more doses of toxoid vaccine. Hence, the usual advice is to have the pertussis vaccine 10-yearly unless the health professional or other person was likely to be in contact with high-risk infants, who are at greatest risk of severe pertussis, or was a pregnant woman.
For more information on whooping cough, including videos and interviews with parents whose babies have caught whooping cough, click here.
]]>Pharmac announced last week that it will fully fund the shingles vaccine Zostavax for 65-year-olds from April 1 next year and also fund a catch-up programme for people aged 66-80 years until March 2020.
It is envisaged that people will receive their Zostavax vaccine the same time they receive their annual influenza vaccine but it will only be available at general practices and not pharmacies at this point.
Pharmac said some concerns were raised during the consultation process about the extra workload the shingles vaccine could bring in an already busy time for general practice, but it believed the net overall impact would be positive as it would reduce the incidence of shingles and the more serious complications that can arise for older adults.
Pharmac director of operations, Sarah Fitt, said the vaccine would make a big difference to the one in three New Zealanders who would have at least one attack of shingles in their lifetime.
“Shingles can occur in people at any age but older people are the most affected and complications can be more serious and require admission to hospital,” Fitt said.
“While most cases of shingles can be managed at home, these attacks can sometimes lead to other serious health complications. Some people may continue to experience pain for months to years after an initial shingles attack.”
Shingles is caused by the same virus as chickenpox, varicella-zoster. Anyone who has had chickenpox is at risk of developing shingles later in life, although the most significant risk factor for developing shingles is age.
During the consultation some respondents had called for the vaccine to be available for people younger and older than the selected 65-80 years age range. Pharmac said its Pharmacology and Therapeutics Advisory Committee considered the costs and benefits of different age bands and opted for age 65, plus catch-up vaccinations to the age of 80 years, as the clinical evidence showed that vaccine efficacy dropped to 18 per cent in people aged over 80 years at time of vaccination. In addition, the vaccine’s efficacy waned over time and if people were vaccinated when younger than 65 they might not remain protected when they were older when the incidence of the herpes zoster virus was higher and the risk of complications also higher.
Fitt said the shingles vaccine would help to reduce the number of serious cases, and provide many flow-on benefits to families and whānau, as well as the wider health system.
Zostavax will be available from general practices from 1 April 2018.
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The online immunisation catch-up calculator for immigrant or refugee children took out the $8000 Clinician’s Challenge* New Idea award presented last week. The project was co-lead by nurse Jillian Boniface, the Southern District Health Board’s Programme Leader for Vaccine Preventable Disease and DHB public health analyst Dr Leanne Liggett.
Boniface, formerly a practice nurse, said she and Liggett worked together as a team to turn a nursing issue and a good idea into a proposal for a nursing tool that won over the judges at their presentation at the Health Informatics New Zealand (HiNZ) conference in Rotorua last week.
Leanne Liggett said the Invercargill-based pair’s aspiration was for the tool to become a national tool for everyone to benefit from.
The $8000 prize would be used to fund a feasibility study for the calculator and the pair would then knock on doors seeking the extra funding needed to develop and pilot the calculator in the Southern region before rolling it out nationwide.
The idea came about in response to the increasing workload faced by nursing staff to calculate the ‘catch-up’ immunisations required by new migrants and refugee children to bring them in line with the national immunisation schedule.
Boniface said with each country having different schedules and different vaccine combinations it was a time-consuming, manual task for a practice nurse to work out how many antigens a migrant child had received to date and then to calculate how many vaccinations they needed in the future – and when they should receive them and in which combination – to gain the same immunisation coverage as Kiwi-born children.
The complex task could also cause hiccups in clinical records in practice management systems that weren’t flexible enough to cope with the ‘catch-up’ process. So the Southern DHB decided several years ago that practices should send migrant children’s immunisation records to the DHB’s immunisation co-ordinators who would manually calculate the catch-ups required and then the child’s record and catch-up programme would be manually entered into the National Immunisation Register (NIR) where the general practice could access the accurate details and enter it into their own systems.
Growing migrant numbers in the deep south – from an increasing diverse range of countries drawn to the region for different reasons – had seen the co-ordinator’s workload grow. “We’ve got the dairy industry families coming into Otago and Southland, we’ve got families coming to the tertiary education institutions in Dunedin, we’ve got offshore families attracted to SIT’s free fees and we’ve got the Queenstown/Central lakes (tourism industry) migrant population,” pointed out Boniface.
Further highlighting the need – and kick-starting the project – was Dunedin last year becoming a refugee resettlement city with the first group of 205 refugees – mostly from Syria – arriving in April 2016. Liggett, a public health analyst involved in the region’s Refugee Strategy Evaluation discovered how much Dunedin general practices valued the ‘catch-up’ service when she asked nurses, GPs and administrators what was hindering and helping their work with the refugees. “One of the first helping ‘angels’ identified by practices was Gillian’s team helping with the immunisation calculations,” said Liggett.
Boniface said she was grateful to hear from Liggett that practices were singing the praises of her team. “I said that’s really great but I told her it was just about drowning my staff and what’s more the refugee component is only one component of the ‘catch-ups’ needed.”
She estimated her staff were doing about 600 ‘catch-up’ complex calculations a year – and that didn’t include the ‘quick, easy ones that probably didn’t hit the radar’. So they started to discuss finding a solution which prompted public health physician Dr Naomi Gough to ask them why they didn’t use a catch-up calculator like the South Australia one. “And we said ‘what South Australia calculator?’” The team went online and discovered an “amazing” online calculator available in South Australia where you entered the child’s birthdate, ticked off which antigens they had received and it calculated what the child needed.
Boniface said they approached the Ministry-funded Immunisation Advisory Centre (IMAC) about it developing something similar for New Zealand. She said IMAC agreed it was a great idea but didn’t have the capacity to take on another project.
The pair then heard applications were open for this year’s Clinician’s Challenge and decided to give it a go and put together a submission seeking funding for a feasibility study into developing, piloting and ultimately incorporating the tool into the NIR. “So it became part and parcel of the national immunisation programme.”
Boniface and Liggett’s proposal was selected as one of two finalists for the New Idea category (the $2000 runner-up prize went to a proposal for secure web and mobile app called GreenHub) got to fly to Rotorua to the HiNZ conference and give their winning presentation.
Two of the four finalist proposals in the clinician’s challenge were co-lead by nurses and Boniface said the proposal she and Liggett – neither of whom “were IT people” – had developed with the support of the other nurses in the immunisation team, was to create a tool to help resolve a nursing issue.
“This would be a tool that would empower practice nurses to be able to take the child’s overseas (immunisation) history, plug-it into this online tool, create the catch-up programme and deliver the first event of that catch-up knowing that the information they had inputted would be sent off to the NIR and sit in the patient’s record.”
Boniface said she would encourage other nurses to enter the Clinician’s Challenge. “You’ve just got to come up with a good idea and nurses always have good ideas – it’s how you move it to the next step.” In her case she worked in partnership with Liggett’s analyst skills to help frame a good idea into a meaningful package and a winning presentation.
She added that while Liggett and her had put together the proposal – the idea itself had stemmed from the work that her team had done and the “incredible work that practice nurses do”.
*The Clinicians Challenge is an annual joint initiative by the Ministry of Health and Health Informatics New Zealand (HiNZ). There are two main awards – New Idea and Active/Project Development with the winner of each award getting $8000 and the runner-ups $2000.
The other $8000 Clinician’s Challenge prize – for an already active project – was won by the DermNetNZ.org team for its work on adding a skin disease image recognition tool to the internationally successful online skin resource website founded by dermatologist Associate Professor Amanda Oakley with the support of her daughter Emily Oakley. The $2000 runner-up prize went to the Ask Ruru app – designed to help support young people in crisis that was created by Wellington mental health nurse Dion Howard, working with development team Jaymesh Master, Michael Smith and Rosie Parry.
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The World Health Organization (WHO) has just verified that New Zealand has successfully eliminated endemic measles and rubella for the first time.
This means no measles or rubella cases have originated here for the past three years, the Ministry of Health’s director of public health Dr Caroline McElnay said.
The MMR vaccine protects against measles, mumps and rubella, all which can be serious in young adults. Measles is extremely contagious and more than 95 per cent of people need to be fully vaccinated to prevent sustained outbreaks, McElnay said.
“About 90 percent of young children have received both doses of MMR by age five in New Zealand, but only about 80 percent of teenagers and young adults have had both doses, which leaves them at risk.
“In New Zealand, people aged 12 to 32 years have lower vaccination rates than young children so are less likely to be protected against these diseases. That’s why teens and young adults have been most affected in the recent mumps outbreaks.”
Professor of public health at the University of Otago Michael Baker said it was the culmination of decades of work to achieve high coverage of vaccinations.
“It’s just a great success story for New Zealand… In the end it means a high level of safety and protection for our children.”
Baker explained that the term “elimination” did not mean that no one would ever get a case of the measles, but that there had been no occurrences of a transmission of measles lasting more than 12 months in the last three years and no case of congenital rubella in 20 years.
“It essentially fizzles out. That means you don’t get a sustained epidemic.”
]]>This winter was the second in three years in which the DHB required unvaccinated frontline staff to wear masks when caring for patients during the declared flu season (low influenza rates last year meant a flu season was never declared).
This winter the DHB also asked for visitors who hadn’t had the season’s flu vaccine to wear masks when with patients from July 3 until September 19, when the Medical Officer of Health Dr Felicity Dumble declared the flu season officially over.
The NZNO at the start of the flu season expressed ‘significant concerns’ about the DHB’s ‘vaccinate or mask’ policy, particularly because of the suspension of two unvaccinated nurses who declined to wear masks in the first winter the policy was in force.
Director of nursing Sue Hayward told Nursing Review that no issues involving staff unable to wear masks when working clinically had been brought to her attention this winter.
In late June, 71 per cent of nurses had had the seasonal flu vaccine but Hayward said by the end of the flu season 81.6 per cent of nurses had taken up the option of vaccination, which was slightly higher than the 80 per cent who had received the vaccine by the end of winter last year.
]]>Only 20 cases of mumps were reported across the whole of the country last year and Auckland alone has at least 300 cases to date. The disease can be mild for young children but adults who get mumps can experience severe disease.
“Unfortunately we are bearing the brunt of a mumps outbreak in Auckland,” said Dr Josephine Herman, Auckland Regional Public Health’s medical officer of health. The outbreak had now spread to the Waikato and mumps cases were also being reported in smaller numbers across the country.
She said it was looking to the primary health sector and nurses in particular – who are the backbone of primary care – to help promote the MMR (measles, mumps and rubella) vaccine amongst the younger, adolescent population.
Public Health are particularly concerned about a “lost generation” now in their 20s who either did not receive the MMR vaccine in the first place or may have missed out on their second MMR dose when the timing of the second dose was shifted in 2001 from being done at age 11 to age four. They are also at risk of measles and rubella.
Henman said the difficulty was that this age group was generally healthy and independent so didn’t often visit health services. Also the national immunisation register was only 12 years old so it was difficult to identify those who had or hadn’t been vaccinated.
Practice nurses had an important role as families were being urged to check with their family’s general practice to see whether family members had been fully immunised – and also to check their child’s blue Well Child (Plunket) book.
The Immunisation Advisory Centre (IMAC) says the last major mumps epidemic in New Zealand was in 1994 which lead to 188 hospitalistions. Mumps is a viral illness spread by coughing, sneezing and direct contact with infected saliva.
The incubation period (time from infection to onset of symptoms) is on average 16-18 days, and can range from 2-4 weeks. A person with mumps may be infectious from seven days before the salivary glands swell until nine days after.
Henman said for the majority of people who catch mumps it is a mild illness with some painful swelling in the jaw. Some don’t get any swelling with 30 per cent of mumps cases being asymptomatic (though still contagious). But in some cases – with adolescents and adults at higher risk of severe disease from mumps – there can be serious consequences including meningitis, hearing loss and in the case of young and older men it is orchitis (painful swelling and inflammation of the testicles) which in rare circumstances lead to infertility. Henman said women can also have pain through swelling of the ovaries.
According to national immunisation data, the coverage rates in young children up to the age of 12 years are around 80 percent. Today’s mid twenty year olds have even lower rates, with a national coverage survey reporting that only 60 percent of Pakeha children were fully immunised in 1991, with lower rates for Maori (42 percent) and Pacific children (45 percent).
ARPHS has been notified of 300 cases from January 1 to 4 September 2017, with this total greater than all the cases of mumps in the last 16 years. But Henman says there are probably a significant number of cases that have been brought to the services’ attention.
“Mumps is now at large in the community and the only way we can stop this spreading further is to achieve high levels of MMR vaccination in the population,” said Herman.
]]>The Auckland Regional Public Health Service had been notified of 300 cases of mumps from January 1 to September 4 this year.
“Mumps is now at large in the community and the only way we can stop this spreading further is to achieve high levels of MMR vaccination in the population,” Medical Officer of Health Dr Josephine Herman said.
She said the large number of mumps cases meant a large number of people were also at risk of contracting measles and rubella.
“The implications for young adults are deeply concerning, given the risk of non-immune pregnant women catching rubella. This can result in miscarriage or still birth and babies developing severe birth defects,” Herman said.
Mumps also posed a risk of miscarriage for women who were in their first three months of pregnancy, and in rare cases could cause male sterility.
She said there was a “lost generation” where many young people between 10 and 29 had not been vaccinated.
That was partly due to the now discredited MMR controversy from 1998 onwards and a pool of adults who may have missed out on receiving the second dose of the MMR vaccine when they were children when the timing of this dose was moved from 11 years to 4 years in 2001.
Herman said measles was an additional threat to communities with low vaccination coverage.
“It is likely we’ll see further measles outbreaks in schools similar to those in 2011, 2014 and 2016. The measles virus is highly contagious and can lead to serious medical complications as well,” Herman said.
Parents who were unsure about their family’s MMR vaccinations were being urged to check with their practice nurse or look up their children’s blue Well Child book.
According to national immunisation data, the coverage rates in young children up to the age of 12 years were about 80 per cent.
Today’s mid 20-year-olds had even lower rates, with a national coverage survey reporting that only 60 per cent of Pakeha children were fully immunised in 1991, with lower rates for Maori (42 per cent) and Pacific children (45 per cent).
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The two projects are among the four finalists from 41 entries received this year for the $20,000 annual digital health challenge, with the winners decided at the 2017 HiNZ conference in Rotorua in early November.
An app designed to help support young people in crisis has been created by Wellington mental health nurse Dion Howard, working with development team Jaymesh Master, Michael Smith and Rosie Parry, and is one of two finalists in the Active Project category.
The Ask Ruru app creates a log of all crisis-based texts and calls between community health workers and young adults and teenagers (who generally rely on mobile calls and texts to communicate). The aim of the app’s log is for mental health professionals to be able to deliver safe and more effective crisis coaching for young people by being able to access and analyse their communications with health workers. The information could be used to help promote earlier intervention, decide on therapeutic models and manage ongoing crisis support.
Southern District Health Board nurse Jillian Boniface and public health analyst Leanne Liggett are finalists in the New Idea category, with a proposal to develop an online immunisation ‘catch-up’ calculator for immigrant or refugee children.
Boniface is the DHB’s programme leader for vaccine preventable diseases. The pair says that planning immunisation catch-ups is a “complex, time-consuming and manual process for busy practice nurses”. The aim of the calculator is to simplify data collection, improve workflow efficiencies, support timely clinical delivery and ensure the National Immunisation Register is updated.
The other finalist in the New Idea category is from Dunedin family physician Dr Adrian Laurence, who is proposing to develop a web and mobile application called GreenHub to help simplify the Green Prescription (GPX) system for consumers, providers and clinicians.
The aim of this secure application is to streamline consumer enrolment, management and communication to save time and improve health outcomes for consumers who are given green prescriptions to support them in making healthy lifestyle changes, such as increasing exercise levels and improving dietary habits. The proposal is for GreenHub to combine multiple communication methods, including smartphones, secure video chat, messaging and notifications, enabling patients to communicate in the ways they choose. GPX clinicians, such as nurses and doctors, could also use GreenHub to monitor their patient’s progress and set triggers to know when patients need extra support.
The other finalist in the Active Project category is dermatologist Associate Professor Amanda Oakley, the founder of the online skin resource website DermNetNZ.org, and her daughter Emily Oakley, who is the website’s development manager.
The mother and daughter team aim to add a skin disease image recognition tool to the website, which would use artificial intelligence software to identify images of skin diseases through pattern recognition, leading to quicker, easier and more accurate diagnosing. Their intent is for the tool to be either free or low cost to healthcare providers worldwide as long as they have a mobile or desktop device that can connect to the internet. The pair say that an estimated one in six visits to a doctor are for skin complaints and many communities worldwide have very limited access to dermatologists.
The Clinicians’ Challenge is a joint initiative by the Ministry of Health and Health Informatics New Zealand (HiNZ) and the finalists receive free registration to the three-day HiNZ conference. The four finalists present their cases at the HiNZ conference and the winners will be announced at the awards lunch on 3 November. The winner of each category receives a grant of $8,000 and the runner-up $2,000.
New idea: a disruptive innovation for a digital system or application to deliver health services in new ways to enhance patient outcomes, improve workflows, deliver efficiencies and/or support more integrated care.
Active project/development: an innovation for a system or application being developed, or already developed, that improves the way people work, supports better patient care, delivers efficiencies and results in more integrated health services.
]]>These new research findings from the University of Auckland Centre for Longitudinal Research – He Ara ki Mua were published on 18 August in the journal Pediatrics. This publication reports the findings from a project that analysed the data from the longitudinal child study Growing Up in New Zealand.
Study senior author Professor Cameron Grant says that children need to receive scheduled vaccinations on time for national immunisation programmes to have their maximal health benefits. The series of immunisations for babies in the first months of life is particularly important as delays increase the risk of hospital admissions attributable to vaccine-preventable diseases.
As part of the study, more than 6,000 pregnant women were asked what information they had received about infant immunisation during a face-to-face interview in the final weeks of their pregnancies. With parental consent, the study then used the National Immunisation Register to check the timeliness of the women’s babies’ immunisations.
Fewer than half (44 per cent) of the 6,182 mothers interviewed recalled having received any information about the immunisations of their future children. Thirty per cent said they had received only encouraging information, while nine per cent received both encouraging and discouraging advice and five percent received only discouraging information.
Of those women who did not recall receiving any information during pregnancy, 70 per cent of their babies were immunised within a month of the vaccine due date. This compares with 57 per cent of babies of women who received discouraging information and 61 per cent of the babies of women who received both encouraging and discouraging information.
The babies of women who received only encouraging information about immunisation during their pregnancies were no more likely to be immunised on time than the babies of women who received no information.
The main sources of immunisation information identified by the women were healthcare providers (identified by 35 per cent), family and friends (14 per cent), and media (14 per cent).
Most said they received only encouraging information from healthcare providers, while the main sources of discouraging information were family and friends and media.
Professor Grant says he was concerned to see that one in six women who recalled receiving discouraging information identified healthcare providers as a source of that information.
“It is clear that pregnant women receiving information which discourages infant immunisation has a negative effect on subsequent healthcare delivery to that infant, even when they have also received information which encourages immunisation,” says Grant.
But receiving encouraging information about infant immunisation during the pregnancy was no more effective in ensuring timely immunisation than receiving no information.
“The ambiguity created by pregnant women receiving conflicting advice about infant immunisation is an area which requires some focused attention,” says Grant.
“We cannot prevent pregnant women from being exposed to information discouraging immunisation, but we can improve the ways in which we deliver encouraging information and ensure that they meet the information needs of everyone.”
Study details: Veerasingam P, Grant CC, Chelimo C, Philipson K, Gilchrist CA, Berry S, Atatoa Carr P, Camargo Jr CA, Morton S (2017). Vaccine education during pregnancy and timeliness of infant immunization. Pediatrics
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The Lancet this week published New Zealand-led research that has found that the mass MeNZB vaccination programme of young New Zealanders between 2004-2008 has lead to a drop in cases of gonorrhoea, also known as ‘The Clap’ in vaccinated young Kiwis compared to those who weren’t vaccinated.
The study, lead by University of Auckland researcher Dr Helen Petousis-Harris, found that having the MeNZB vaccine reduced the incidence of gonorrhoea by about 31 per cent.
This is the first time a vaccine has shown any protection against gonorrhoea and the researchers say it may provide an avenue for developing a vaccine against the sexually transmitted infection (STI).
The study, funded by GSK vaccines, says that although meningoccal disease and gonorrhoea are very different diseases there is an 80 to 90 per cent genetic match between the bacteria that cause the diseases therefore providing a “biologically plausible mechanism for cross-protection”.
Gonorrhoea was once simply treated by an oral antibiotic but the development of antibiotic resistant strains means it now requires treatment by an intramuscular antibiotic plus an oral antibiotic.
The latest available STI statistics for New Zealand are from 2014 and, based on laboratory surveillance data, estimate that the national gonorrhoea rate is 70 cases per 100,000 people. Nearly three-quarters of cases reported by laboratories are in people aged between 15 and 29 years old.
The Meningococcal B (MeNZB) vaccine was used as epidemic control vaccine after New Zealand noted from the late 1990s an increasing number of cases of meningococcal disease linked to one particular strain of meningococcal B bacterium. The mass public health campaign was launched in 2004 with anyone under the age of 20 offered the free MeNZB vaccine up until 2006. Routine immunisation for babies and preschoolers continued until June 2008.
The Ministry of Health reports that in all more than 1.1 million young New Zealanders received the MeNZB vaccine during this immunisation programme. The number of people developing meningococcal disease due to the epidemic strain of meningococcal B reduced from over 300 cases in 2001 to less than 30 cases in 2010 but the disease has not entirely disappeared.
STUDY
Published in The Lancet, July 10 2017