Speaker 1: Kyotra. I'm Chelsea Daniels and this is the Front Page,
Speaker 1: a daily podcast presented by the New Zealand Herald. New
Speaker 1: Zealand may be on the cusp of another measles outbreak.
Speaker 1: Health en Z has said the risk of further measles cases,
Speaker 1: contacts and exposures across the country remains very high. The
Speaker 1: confirmation of new cases unconnected to international travel, though, has
Speaker 1: experts worried. Today on the front Page, University of Canterbury
Speaker 1: Senior lecturer in epidemiology, Anna Howe is with us to
Speaker 1: discuss what you need to know. So, Anna, how likely
Speaker 1: is it that measles has started spreading through communities from
Speaker 1: what we've seen so far?
Speaker 2: Oh, I think that's it's not even likely that's what's happening.
Speaker 2: We've seen that now with the cases crop up at
Speaker 2: Wellington High School. So I think we have got community
Speaker 2: transmission and we're sitting in an extremely precurious position.
Speaker 1: What's the importance of knowing whether it's linked to overseas
Speaker 1: travel or not.
Speaker 2: So the importance for us is typically with that index
Speaker 2: case because New Zealand doesn't actually have measles endemic, so
Speaker 2: we rely basically measles for us is an important disease,
Speaker 2: and so that's why it's incredibly important for us and
Speaker 2: incredibly important for people who are traveling to places where
Speaker 2: there are no and outbreaks to make sure that their
Speaker 2: vaccination status is up to date and that they're cognizant
Speaker 2: when they come home if they're feeling unwell.
Speaker 1: Do you reckon we're good at that or not?
Speaker 2: If I think it's hard. I think people have much
Speaker 2: greater awareness now post COVID because we've all been through
Speaker 2: the understanding isolation and trying to protect people that we
Speaker 2: love and being cognizant of illness. I think though there's
Speaker 2: a lot of fatigue that's happened post COVID as well,
Speaker 2: and so with the habits always slip right. But also
Speaker 2: I think some people have had negative experiences with that
Speaker 2: as well. I think most people genuinely mean, well, it's
Speaker 2: just sometimes we don't think about things.
Speaker 1: Tell me a little bit about what happened in twenty
Speaker 1: nineteen and perhaps how our situation now might mirror that.
Speaker 2: So twenty nineteen was one of our largest outbreaks in
Speaker 2: a really long time, and that was a direct result
Speaker 2: of under immunization and so having what we are or
Speaker 2: what I refer to as PAULS is susceptibility, right, So
Speaker 2: you have groups that are costed together and allow that
Speaker 2: measles to take hold and then it just it requires
Speaker 2: vaccination again to put a dampner on that. And what
Speaker 2: we saw was a lot of disease, and we saw
Speaker 2: about a third of our cases requiring hospitalization care, which
Speaker 2: is quite a lot. We saw a lot of very
Speaker 2: serious cases, so they required intensive care, particularly in the
Speaker 2: very young. We actually had three infants that required EKMO,
Speaker 2: which is the circulatary support, so very very unwell. We
Speaker 2: had three cases who had in caphalitis, and we had
Speaker 2: two pregnant people who lost who lost their babies, and
Speaker 2: so it was a really really severe event directly related
Speaker 2: to our underimmunization and we unfortunately are in the same,
Speaker 2: if not slightly worse place with our immunization coverage at
Speaker 2: the moment, and so we could see exactly the same
Speaker 2: thing happen again, if not worse.
Speaker 1: Yeah, what level of vaccination coverage does New Zealand have
Speaker 1: now and what ideally should we be at.
Speaker 2: So at the moment, our childhood schedule provides MMR at
Speaker 2: twelve fifteen months, and so we use our twenty four
Speaker 2: month coverage milestone, isn't indicator that we've got that people
Speaker 2: have got those two doses. So that twenty four month
Speaker 2: coverage at the moment is sitting at eighty two percent,
Speaker 2: that's a total, and we need to be at ninety
Speaker 2: five percent in order to have that community coverage. The
Speaker 2: problem is is like I to talked about before, with
Speaker 2: the pools of susceptibility, so that coverage is not uniform
Speaker 2: across the community even at eighty two percent, and so
Speaker 2: we have areas like Northland and Lakes that have got
Speaker 2: really low coverage down at sort of sixty two and
Speaker 2: seventy three percent. And then we have other areas in
Speaker 2: New Zealand. Fortunately some of those are in the Wellington region,
Speaker 2: so het Up Valley capitally in Coast and Canterbury for
Speaker 2: example have ninety percent coverage. And so we have, Yeah,
Speaker 2: we have this under immunization, which means that we do
Speaker 2: have these pools of susceptibility.
Speaker 1: How do we like, what do we do to help
Speaker 1: that more awareness or I mean I suppose it's a
Speaker 1: question that's been pondered for years and years and years.
Speaker 2: Yes, and It's not technically my area of expertise, but
Speaker 2: I work with a lot of colleagues who are in
Speaker 2: this space, and there's a lot of reasons why we
Speaker 2: have low coverage, particularly I mean ours, we're starting to
Speaker 2: go down even before the COVID pandemic, but the pandemic
Speaker 2: definitely interrupted immunization schedules, and as a result, we've also
Speaker 2: seen grown vaccine hesitancy. We've seen a lot of that
Speaker 2: media from overseas as well being played out in New Zealand,
Speaker 2: and so I think there's I mean, I advocate compassion
Speaker 2: if people are hesitant, actually trying to understand why they
Speaker 2: might be hesitant, because there are lots of different reasons
Speaker 2: for that to be the case. But also there are
Speaker 2: lots of system problems, like healthcare system problems that also
Speaker 2: contribute to our underimmunization. And so it's all very well
Speaker 2: and good to have a target, and we've had immunization
Speaker 2: targets before, and the healthcare system works really hard to
Speaker 2: try and achieve those targets, but that comes at a
Speaker 2: cost as well, and you get our worker fatigue and
Speaker 2: burnout along the way, and so we have to manage
Speaker 2: both the healthcare system side of things really well as
Speaker 2: well as the individual level. So if you're having conversations
Speaker 2: with people, it's just really important, I think, to be
Speaker 2: compassionate and listen to what they have to say, reiterate
Speaker 2: what we know scientifically, and then give them space to
Speaker 2: actually think about that and make a decision.
Speaker 3: The vaccine which protects us against measles, comes into combinations
Speaker 3: called the MMR so measles and months rebell it, so
Speaker 3: you actually get protected against three different diseases at the
Speaker 3: same time, which is great news. MEMR vaccine is supposed
Speaker 3: to stimulate your body to be able to fight off infection.
Speaker 3: They if it sees the disease in real time, and
Speaker 3: so that potentially means that you can have some of
Speaker 3: those side effects that occur when you are vaccinated, getting
Speaker 3: a temperature that you may actually get a rash afterwards
Speaker 3: for the vaccine. That's actually quite common. Some people might
Speaker 3: find their glands actually go up after having the vaccine,
Speaker 3: and some people they can have a little bit of
Speaker 3: achy body. For some people that symptoms may occur in
Speaker 3: the first few hours, for others it can occur up
Speaker 3: to a week or two weeks later, but actually they
Speaker 3: stay well with it, so despite having some mild side effects,
Speaker 3: they actually stay very well.
Speaker 1: So the vaccine, it's the MMR vaccine, and you need
Speaker 1: two of them. How can you How easy is it
Speaker 1: for a New Zealander to check whether they actually had
Speaker 1: those two?
Speaker 2: So if you're old like me, you might have to
Speaker 2: dig out your plunket book, which I actually did, as
Speaker 2: did I out of curiosity. Yep, but even I in
Speaker 2: twenty nineteen decided that I would just get a third
Speaker 2: dose because I fit into the age group where maybe
Speaker 2: there was waning immunity and so yeah, so pulling out
Speaker 2: your old health records. If you're old like me, or
Speaker 2: if you're born from two thousand and five onwards, the
Speaker 2: immunization register should have captured that, so you should be
Speaker 2: able to talk to your healthcare provider. And I believe
Speaker 2: if you've got access to the electronic my health records,
Speaker 2: you should be able to see what your statuses as well.
Speaker 2: But generally speaking, if you're not pregnant or immuno compromised,
Speaker 2: then just get a third dose. So you can get
Speaker 2: a dose even if it's through a third one.
Speaker 1: Yeah, okay, cool, Yeah, Because I had the awkward conversation
Speaker 1: of ringing my dad asking him him not knowing, and
Speaker 1: then him having to dive through a thousand boxes to
Speaker 1: try and find because I'm Australian, right, so even people
Speaker 1: from other countries need to be checking this. But you're
Speaker 1: saying that even if you don't have that information at hand,
Speaker 1: it's all good if you get a third dose.
Speaker 2: That's correct and I think too, so you can get
Speaker 2: what we call SEROH testing done and that will check
Speaker 2: the antibody status or the level of protection that you have.
Speaker 2: But because for the most part, there's no harm in
Speaker 2: getting that third dose, it's just easier just to get
Speaker 2: that done.
Speaker 1: In terms of what happened in twenty nineteen to now,
Speaker 1: and I know it's a tricky question because COVID has
Speaker 1: happened in between that time, but do you reckon we've
Speaker 1: learned anything?
Speaker 2: Yes, we did. There are some very nice reports that
Speaker 2: have been produced about the twenty nineteen outbreak, and we've
Speaker 2: also had the Immunization Task Force put out recommendations as
Speaker 2: well about the New Zealand childhood schedule. It's just they
Speaker 2: require system changes and so that's the hard part.
Speaker 1: Yeah, what out of all of those recommendations that you've
Speaker 1: seen what one do you reckon we should do tomorrow
Speaker 1: if we could sign it off, get it done.
Speaker 2: I'm really in favor of what was trying to be
Speaker 2: achieved with the health reforms, and that was giving communities
Speaker 2: the ability to decide how best to help their communities.
Speaker 2: And we definitely learned that from COVID as well, that
Speaker 2: when we funded communities to decide how best to help
Speaker 2: their communities, we had a lot of success. And so
Speaker 2: I think that would be the most cost effective way
Speaker 2: to go to get good outcomes.
Speaker 1: And let's not forget in twenty nineteen as well, measles
Speaker 1: imported from New Zealand resulted in five seven hundred ish
Speaker 1: cases in some more and that included eighteen hundred hospitalizations
Speaker 1: and eighty three deaths from measles, mostly children under five.
Speaker 1: So not only do we have to think about our
Speaker 1: own communities, but it's important to think about our Pacific
Speaker 1: neighbors as well.
Speaker 2: Hey, absolutely, it is horrifying that we were responsible for
Speaker 2: such a horrific event, and we have a responsibility as
Speaker 2: caretakers in supporters of our Pacific nations to make sure
Speaker 2: that that's not actually happening. So particularly important for people
Speaker 2: who have holidays booked overseas to check out their vaccination
Speaker 2: status and or just get a dose.
Speaker 1: So what symptoms should people be aware of?
Speaker 2: How does it start?
Speaker 1: When should you be you know, when should alarm bells
Speaker 1: start going off?
Speaker 2: I mean alarm bell should start going off if you
Speaker 2: are feeling unwell and you have been a contact of
Speaker 2: a case, or if you've been overseas somewhere recently. Because
Speaker 2: the important part to notice that you can actually be
Speaker 2: contagious before you have symptoms. So that's fun. But it
Speaker 2: begins with a fever and a cough and a running
Speaker 2: nose and sore red eyes, and then you will probably
Speaker 2: start to see a rash which typically starts on the
Speaker 2: face and then moves down the body. And so most
Speaker 2: people will feel really really crap for a while, and
Speaker 2: particularly our small peppy will be very very unhappy. And
Speaker 2: then you run into getting complications, so diarrhea, pneumonia, but
Speaker 2: also you can go into like cornial ulcerations potentially a
Speaker 2: leading to blindness. You've got titus media or air infections
Speaker 2: which can have implications if they're really bad. And then
Speaker 2: you start getting into the more severe end of in carefulitis,
Speaker 2: so that fever cough, running nose, or red eyes. Yeah,
Speaker 2: big clues.
Speaker 1: Yeah, and it must be so difficult, especially around the
Speaker 1: seasons changing as well, when people are getting you know
Speaker 1: those flu like cold like symptoms. I've got hay fever
Speaker 1: at the moment, which is super fun, but really recognizing
Speaker 1: a between A and B. Hey like, So, if you're
Speaker 1: feeling any of those things, you've been linked to a case,
Speaker 1: or you've traveled overseas, it's really important to maybe check
Speaker 1: the Ministry of Health website, check out those locations of interest,
Speaker 1: I suppose.
Speaker 2: Oh, that's great advice. The other thing I would recommend
Speaker 2: too is you can call Healthline and have a chat
Speaker 2: with them because they'll guide you too. And that also
Speaker 2: means that you don't have to go into your GP
Speaker 2: or the hospital and be potentially contagious there too. So yeah,
Speaker 2: so have a look see if it is. And I
Speaker 2: mean it's always better to err on the side of
Speaker 2: caution with this, so you know, isolate yourself if you
Speaker 2: think that you it might actually be that thing, and
Speaker 2: get somebody asked to bring over some goodies for you
Speaker 2: to hang out with by yourself.
Speaker 1: Yeah, and with cat in terms of I know that
Speaker 1: the Ministry of health or health in New Zealand rather
Speaker 1: is saying that there are obviously burther cases, there's a
Speaker 1: risk of them, and exposures across the country remains high.
Speaker 1: Is New Zealand on the cusp of another measles outbreak?
Speaker 1: Or are we in it?
Speaker 2: I think at this point it's safe to say that
Speaker 2: we're in an outbreak. It's just a case of waiting
Speaker 2: a few more weeks, probably to see how bad it's
Speaker 2: going to get. Because people talk about how infictious measles is.
Speaker 2: It's one of our most infectious diseases, and so in
Speaker 2: an unvaccinated population that one person can potentially make twelve
Speaker 2: to eighteen other people sick. And again this comes back
Speaker 2: to having those pools of unvaccinated people or grouped together
Speaker 2: and then suddenly, yeah, we're off. It's like I describe
Speaker 2: it sort of as tender in a wildfire situation.
Speaker 1: If we're looking at case numbers, what would be considered
Speaker 1: quite bad?
Speaker 2: Well, personally, I would consider one case really bad because
Speaker 2: every case has the potential to have those severe complications,
Speaker 2: and also nobody makes it out of this without some
Speaker 2: kind of lasting consequence. So our research has shown that
Speaker 2: for those cases in twenty nineteen that even those who
Speaker 2: were based in the community and what we considered mild
Speaker 2: had sort of a knock on effect where they didn't
Speaker 2: have the immunity that they had had beforehand. So compared
Speaker 2: to healthy controls, those cases had more non measles hospitalization
Speaker 2: events and pharmaceutical dispensing in the four years posts in fiction.
Speaker 2: So I guess I don't think anyone's coined it as
Speaker 2: long measles, but we're talking about the same sort of
Speaker 2: situation as long COVID that are even surviving. That infection
Speaker 2: itself doesn't come with our other consequences further down, so
Speaker 2: I would argue one case is bad. Thanks so much
Speaker 2: for joining us, Anna, You're welcome. Thank you.
Speaker 1: That's it for this episode of the Front Page. You
Speaker 1: can read more about today's stories and extensive news coverage
Speaker 1: at enzidherld dot co dot nz. The Front Page is
Speaker 1: produced by Jane Ye and Richard Martin, who is also
Speaker 1: our editor. I'm Chelsea Daniels. Subscribe to The Front Page
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