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Wednesday 06 September, 2017
Graph of mumps cases in Auckland

A ‘lost generation’ of young people is facing a triple threat of potentially serious diseases as a result of low immunisation rates in many Auckland communities. 

Auckland Regional Public Health Service (ARPHS) warns that the 300 mumps cases in the region since January points to a large number of 10 to 29 year olds who are also at risk of measles and rubella. 

Medical Officer of Health Dr Josephine Herman says young people and their whanau need to ensure they have had two doses of the measles, mumps and rubella (MMR) vaccine.

“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,” says Dr Herman. 

Mumps also poses a risk of miscarriage for women who are in their first three months of pregnancy, and in rare cases can cause male sterility. 

Measles is 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,” Dr Herman says. 

Parents who are unsure about their family’s MMR vaccinations are being urged to check with their practice nurse or look up their children’s blue Well Child book. This is free for any person who has not received two doses. 

This ‘lost generation’ of the unprotected is partly due to the now discredited MMR controversy from 1998 onwards. There is also a pool of adults who may have missed out on receiving the second dose of the MMR vaccine when they were children, as the timing of this dose was moved from 11 years to 4 years in 2001. 

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.

“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,” says Dr Herman. 
Thursday 10 August, 2017
Public health typically observes a seasonal increase of meningococcal disease from June to September each year and is currently managing new cases.

“Meningococcal disease is a serious and sometimes fatal disease.  It is caused by bacteria spread by very close or many hours of prolonged contact with an infected person.  Be alert for symptoms and if you suspect meningococcal disease visit your doctor immediately or call Healthline for advice,” says Medical Officer of Health Shanika Perera from Auckland Regional Public Health Service (ARPHS).

Symptoms to watch out for include some or all of the following: fever, headache, vomiting, feeling sleepy/confused/delirious, loss of consciousness, joint pains, aching muscles, stiff neck, dislike of bright lights, rash - purple or red spots or bruises.  Additional symptoms in babies and infants include being unsettled, floppy or irritable, refusing drinks/feeds and becoming harder to wake.

“Since June this year we have managed 12 cases which is to be expected at this time of year.  We are investigating these cases and monitoring the situation,” says Dr Perera.    

For more information on meningococcal disease visit the ARPHS web page here.

Call Healthline on 0800-611-116 or visit your doctor if you suspect meningococcal disease.
Monday 17 July, 2017

 

Dengue fever

There has been an increase (~120%) in the number of cases of dengue fever for the three months between April and June. A lesser increase (~50%) has occurred if the last quarter results are compared with the corresponding quarter in the last three years. Dengue is endemic in much of Asia, including India, and South East Asia, so consider the diagnosis in febrile patients returning from these regions.  The incidence of dengue fever in many of the South Pacific islands is rising (including Cook Islands, Federated States of Micronesia, French Polynesia, Fiji, New Caledonia, Niue, Samoa, Tonga and Vanuatu). Since 2014 there have been an increase in confirmed cases from these islands.

Mumps 
The mumps outbreak in Auckland continues, with the majority of cases occurring among  those aged 10 to 19 years and arising in West Auckland. Overseas incursions continue (15%), however the majority of transmission is occurring in the community. Low levels of immunity among cases (73% who have not received two mumps containing vaccines) are likely to be responsible.

Typhoid
The large increase in typhoid cases seen in Q2 was driven by a well-publicised outbreak in a Samoan community. It is believed to have been spread from a point source, ultimately leading to 23 notifications in the Auckland region, including one death. The outbreak is now considered over, but it is a timely reminder of the need for vigilance in considering the diagnosis since the disease is frequently imported from the Pacific and Asia.  

Pertussis
Pertussis case numbers have increased compared to the same period in 2016, however the increase is not unusual, considering the number notifications that have occurred over the same three month period during the last three years.
Wednesday 05 July, 2017
Auckland Regional Public Health Service (ARPHS) is investigating five new cases of mumps every day, as the number of notifications of the disease continues to rise.

The latest figures show 148 cases, up from 138 cases on Monday 3 July. This is compared with 13 cases for 2016 (see note to editor below).

ARPHS Clinical Director Dr Julia Peters is urging parents to check with their doctor to ensure their families’ measles mumps and rubella (MMR) vaccinations are up to date. The vaccination is free.

“The majority of cases are aged 10 to 29 years as this age group has had lower than average immunisation rates,“ says Dr Peters.  Around 80 percent of the current cases were not fully vaccinated.

Out of 126 locally acquired cases, 78 of these are Pacific Island people and 26 are Maori. The balance is Pakeha or other ethnicities.

“Most recover from this disease.  Eight people have been hospitalised, however, mostly males for pain and swelling in their testicles.  Some females have experienced ovarian inflammation and another person developed meningitis. 

Non immune pregnant women who catch the disease risk miscarriage in the first three months. In rare cases mumps can cause permanent hearing loss. 

Mumps can spread quickly among those who are not immune, particularly in schools.  Thirty schools around Auckland have seen 67 cases and non immunised students have also had to be kept at home for weeks.

“If parents do not organise vaccination quickly, their child may be excluded from school,” says Dr Peters.

Note to editor – please note the number of mumps cases in 2016 was 13, not 35 cases as previously released. There were 35 notifications in 2016.

If you suspect mumps call your doctor or Healthline for advice on 0800 611 116. 

For a mumps fact sheet click here, for a vaccination fact sheet click  here.  
 
For questions about vaccination call the Immunisation Advisory Centre on 0800 Immune or visit www.immune.org.nz.

Monday 03 July, 2017
Auckland Regional Public Health Service (ARPHS) is concerned not enough young Aucklanders are immunised in the face of an unrelenting mumps outbreak.

“This year we have had over 130 mumps cases in Auckland compared with 35 investigations last year. Unfortunately 80% of the current cases were not fully vaccinated.  It is disappointing because mumps is a preventable and serious disease,” says ARPHS Clinical Director Dr Julia Peters.

“Most recover from this disease. However in the last six months a number of people have suffered from severe complications caused by mumps.”  

This year some adolescent males have been hospitalized for pain and swelling in their testicles, which in rare cases can result in infertility. Some females have experienced ovarian inflammation and another person developed meningitis. 

Non immune pregnant women who catch the disease risk miscarriage in the first three months. In rare cases mumps can cause permanent hearing loss. 

“I urge parents to check with their doctor to ensure their families’ measles mumps and rubella (MMR) vaccinations are up to date.  The vaccination is free,” says Dr Peters.

Almost 70% of the cases are occurring in children and teens aged 10-19 years.  Mumps can spread quickly among those who are not immune, particularly in schools.  An individual with mumps at a secondary school could cause an outbreak, because immunity in that age group is well below the national average.

“If parents do not organise vaccination quickly, their child may be excluded from school. We are in the midst of an outbreak and already many students are scrambling to catch up on school work after missing school for several weeks,” says Dr Peters. 

ARPHS is working with primary care, early childhood, schools and tertiary institutions to provide support and resources to minimise the spread of mumps. 

See attached graph for history of mumps cases in Auckland, Jan-June 2014-2017.

If you suspect mumps call your doctor or Healthline for advice on 0800 611 116. 

For a mumps fact sheet click here, for a vaccination fact sheet click  here.  
 
For questions about vaccination call the Immunisation Advisory Centre on 0800 Immune or visit www.immune.org.nz.


Thursday 15 June, 2017
The Auckland Regional Public Health Service (ARPHS) welcomes the findings of the review into the recent typhoid outbreak in Auckland. The review’s recommendations have either already been implemented, or are in the process of being implemented.

The review was prepared by the Office of the Chairman of Auckland, Counties Manukau and Waitematā DHBs at the request of the Ministry of Health. It concludes ARPHS performed well with respect to the clinical management of the outbreak, which was brought under control relatively quickly. 

It also identifies shortcomings in ARPHS’s performance, especially with respect to communication and engagement issues, as well as broader issues relating to culture and management practice. 

Steps were already being taken before the outbreak to change and improve ARPHS’s culture and strengthen its management capability. The review also recommends these efforts be further strengthened, and accelerated with external support. 

The review also recommends closer working relationships between ARPHS and Auckland DHB to improve capability and collaboration, in particular with respect to communications and human resource practice. 

The full report is available here

If you have a media enquiry, please call the ARPHS Media line on 021 243 2421.

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