West Moreton measles outbreak - Amazon Web...
Transcript of West Moreton measles outbreak - Amazon Web...
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Dr Vicki Slinko (Public Health Physician WMPHU)
West Moreton measles outbreak
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Acknowledge the traditional
owners of the land we meet
on today and pay my
respects to the elders: past,
present and emerging
Art work: Sally Harrison https://www.artpal.com/saharrison#i8
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One of the most contagious diseases
• Transmission
o Airborne droplets and direct contact with discharges
o Highly infectious
• Incubation period
o 7 to 18 days
• Infectious period
o 24 hours prior to onset of prodromal symptoms or 4 days before
rash onset
o Until 4 days after rash onset
Measles: overview
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• Fever (>38oC at time of rash onset)
• Morbilliform rash
o Face → rest of body
• The three C’s
o Cough
o Coryza
o Conjunctivitis
• Koplik spots
Recent vaccination → vaccine-strain measles
Partially vaccinated → modified measles
Measles: clinical presentation
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Outbreaks declared in 2019
• New Zealand
– 2154 cases; 752 hospitalisations (35%)
• Samoa
– 4693 cases; large proportion hospitalised, 70 deaths
• American Samoa
– 9 confirmed cases
• Fiji– 18 confirmed cases
• Philippines, USA, Europe
• An the list goes on…
Measles outbreaks overseas
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Measles: Australia
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• Metro South area has been dealing with an outbreak since early
October 2019 centred around the Pasifika community
• WM first case diagnosed 21 November 2019
Measles outbreak in West Moreton area
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Measles outbreak in West Moreton area
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MEASLES
SPREADS!
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• Measles disease is not common and not understood by community
• Clinicians have often not seen measles: late diagnosis
• Often out of time for when any specific interventions can occur
• Case where no source identified
• Infectious cases in many public areas (including medical services)
• “Considered” immune is not a 100% guarantee that will not become
a case
• Exclusion enforcement
• Getting vaccination: barriers
Issues with measles in WM
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• Staff immune to measles
• Education of all staff
• Identification of measles cases
• Infection control
• Timely notification
• Appropriate testing
• Contact tracing: Public Health Unit support
• Opportunistic vaccination
• Patient messaging: Resources (PHN support)
Measles issues for GP
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• Required for accreditation
• Time for your practice manager to make sure everyone is up to date
– Medical
– Nursing
– Reception
– Allied health
– Cleaning staff etc
• “Considered” immune
– Documented MMR x 2
– Evidence of previous infection/vaccination (IgG)
– Born before 1966
• Everyone
Staff immune and educated about measles
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Suspect measles if the person has:
• Fever, and
• Conjunctivitis or cough or coryza or Koplik spots; and
• Generalised maculopapular (non-itchy) rash - usually begins on the
face before spreading to the rest of the body; appears 2 to 7 days
after initial symptoms so may not assist diagnosis in early disease.
N.B. The clinical presentation may be modified with milder symptoms if
a person has partial immunity
Remember vaccine strain “measles”
Contact with a measles case: check
https://www.health.qld.gov.au/news-events/health-alerts/measles or
Google “measles alert Queensland Health”
Measles: identification
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• Educate your patients to phone ahead
before attending if measles symptoms
• Signage about symptoms/wearing masks
• Symptomatic patients
– Those who phoned ahead, examine them
• at home or
• in a separate area outside of your usual practice space e.g.
patient’s car
– Those presenting unannounced:
• triage patients quickly with fever and rash to a room that can be left
vacant for 30 minutes after consultation
• ensure patient wearing surgical mask for the entire time
in practice/health facility, particularly if they need to walk
through the practice or shared areas
Infection control
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West Moreton Public Health Unit
• Working hours
– Mon-Fri: 08:30 – 17:00
– 3818 4700
• After hours
– PAH Switch: 3176 211
– Ask to speak with public health
Timely notification
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PCR
• Nasopharyngeal or throat swab (NOT nasal or skin)
• Urine (does not need to be sterile catch)
Serology
• IgG for immunity
• IgM for recent illness/vaccination (remember cross reactions)
Appropriate testing
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• Huge amount of work
• PH will provide
– contact tracing pack
– phone support
• Will require extra staffing
– preferably nursing staff
– competent in Excel
• According to CDNA guidelines: file:///C:/Users/SlinkoV/AppData/Local/Microsoft/Windows/INetCache/IE/QCN0XY9Q
/Measles-2019.pdf
Contact tracing
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• Who is a contact?
‒ Household, sharing communal facilities
‒ Early childhood education and care services
‒ School, university etc
‒ People who shared a waiting- /consult room with the case, or
who were in the same waiting- /consult room within 30 minutes
after the case had left
‒ Work settings
‒ Community (buses, trains, cinemas, events, airport …)
• Who carries out contact tracing?
– Hospital: for patients, visitors
– Public Health; GPs; Pathology companies
Measles: contact tracing
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• Time of entry to facility (patient interview)
• Route of entry into facility (patient interview)
• Time of registration at clinic (admin)
• Time given surgical mask and entered separate room
(ideally with separate air conditioning
• May include other businesses sharing waiting space eg.
pathology, pharmacy, allied health, specialists etc.
• NEED STAFF LISTS / PATIENT LISTS for affected
areas
Measles: identifying contacts
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• IMMUNE if: MMRx2 OR IgG OR Born <1966 (documented!)
– 2 doses MMR vaccine = 97% effective
– 1 dose MMR vaccine = 93% effective
• FOR ALL OTHERS– MMR vaccine within 72h of 1st exposure to case
• NB: Contra-indications!
• Susceptible contacts >72h → Information + exclusion if high
risk (HCW, CCW)
– NHIG within 144h (6 days)
• Too young for vaccine AND susceptible
• Pregnant or immunocompromised
– EXCLUSION (CCC, primary school, care care
services) if > 6 days
• Outbreak – community mass vaccination (?)
Measles: contact management
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• MMR usually given at 12 months; MMRV at 18 months
• New Australian recommendations
– From 6 months if travelling to outbreak area
– Will still require usual 12 and 18 month vaccines
• Queensland Immunisation Program (QIP) stock can be
used for “other identified at-risk individuals/populations”
• If require further stock will need to order as usual through
QIP; QIP closed for orders 18 Dec 2019 - 2 January 2020
• All vaccines need to be recorded on AIR
Opportunistic vaccination
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Resources
• Many developed by Metro South PHU
• Rebranded by QH (with permission)
Messaging for patients
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Messaging for GP
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