8/2/2019 How measles beats NZ's defences

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INSIGHTompost.co.nzSATURDAY, JULY 2, 2011 THE DOMINION POST B3

Home base: Sherry Tosh at home in Oratia, West Auckland, with two of her children, Morgan, 8, and Bianca, 9, and the dog Gina. The unimmunised children have been stuck at home for a week since an outbreak of measles at their school across the road. Photo: PETER MEECHAM

Howmeasles beats NZs defenceshe latest outbreak of measles hasfected dozens of people after annimmunised child brought the

sease back from overseas. Less-an-perfect immunisation rates putwis at risk, reports Kate Newton.

VACCINE LIST

New Zealands immunisationschedule states that by age four,all children should have had:

Four doses of the pneumococcal

vaccineTwo doses of the measles,mumps and rubella (MMR)

vaccineThree doses of the diphtheria/tetanus/whooping cough/polio/hepatitis B/haemophilusinfluenzae type B vaccineA haemophilus influenzae type Bbooster shotA diphtheria/tetanus/whoopingcough/polio booster shot.

VACCINE LIST

New Zealands immunisationschedule states that by age four,all children should have had:

Four doses of the pneumococcal

vaccineTwo doses of the measles,mumps and rubella (MMR)

vaccineThree doses of the diphtheria/tetanus/whooping cough/polio/hepatitis B/haemophilusinfluenzae type B vaccineA haemophilus influenzae type Bbooster shotA diphtheria/tetanus/whoopingcough/polio booster shot.

SYMPTOMSMeasles begins like a cold:

headache, fever, runny nose,cough and sore eyes.The characteristic measles rash is

red and begins several days after

the fever starts. It begins on thehead, then spreads to cover mostof the body, often causing itching.

COMPLICATIONSMiddle-ear infectionPneumoniaBronchitisSwelling of the brain, which at

worst can cause brain damage oreven deathA small risk of seizures

TREATMENTThere is no specific treatmentSee your doctor to confirm the

diagnosis.Rest and stay at home measles

is highly contagiousDrink plenty of fluids

RICHARD HOSKINS isstruggling to hold backhis exasperation. For thepast six weeks, the Auck-land medical officer ofhealths life has been

ed by little red dots as hempts to contain New Zealands

est measles outbreak.Despite the first people to show

mptoms being quarantined, theunt is up to 39 and cases areginning to appear all overater Auckland pinpointseading across a map like a casemeasles. Thats one of therrying things about how thisbreak is progressing.Its now looking like were not

ng to be able to contain it witharantine it looks like its gone

ond that. Id be pretty confi-t that it will go beyond Auck-

d as well.t started with one child onemmunised primary school pu-

w ho w en t o ve rs ea s a ndught the measles back.

Dr Hoskins frustration is be-se thats where he believes the

ection could have and shouldve stopped. The first case ins outbreak, unfortunately for usd now for the population, liveda community which has rela-ely low immunisation rates.The child was a pupil at Oratiatrict School in West Auckland,ere about 70 of the schools 533

pils are not immunised ghly 13 per cent of the roll.

More than 30 of them, theirmily members and other close

tacts have now been infected.That community with itsctices has really put other

ple at risk, Dr Hoskins says.Thats going to sound like an

ful thing to say but if the orig-l traveller had been immun-

d, if the school and the com-nity had a higher immunisa-

n rate, then in all likelihoodd now be experiencing the endhis outbreak rather than its

mping up.Dr Hoskins says hes no greatial commentator, but believes

mmunity philosophy has playedart in the low take-up rate of

munisation among Oratia chil-n. Its a really nice area; its ah socio-economic area itsstyle blocks and rural areas. Itludes in its roll a number ofple who live out at Piha and

rekare. A lot of people out thereve alternative lifestyles.

Theres a large number of

people out there that make aninformed decision not to havetheir children immunised.

Oratia mother Sherry Tosh whose three unimmunised chil-dren have all caught the measlesduring the outbreak agrees.

It will be the type of com-munity we live in. Its not likewere sock-and-sandal-wearingtree-huggers the area just at-tracts like-minded people.

There will not be many chil-dren there that would not havebeen immunised because theirparents couldnt be bothered ornever got around to it. Its a con-scious decision.

Oratia is not the only com-

munity with low vaccination rates and conscious opposition is notthe only explanation.

New Zealands immunisationrates have languished near thebottom of OECD figures for years.

In 2007, the Labour governmentintroduced a 95 per cent immunis-ation target for all two-year-olds,which the National governmentkept when it was elected in 2008.

Earlier this year, national cov-erage rates hit 90 per cent, withsome areas including Aucklandand Wellington reporting higherrates. However, immunisation andpublic health experts say the ratesare still not high enough.

Immunisation Advisory Centredirector Nikki Turner says a 95per cent target seems very high but its there because of the verydisease thats now circulating inAuckland.

Its for measles. You can erad-

icate measles if you get to thathigh. If you get enough people im-mune in a population the viruscan no longer spread.

For herd immunity to work,though, a high national average isnot enough.

It does fail if you have smallcommunities that are not immun-ised. Thats what weve seen atOratia School.

However, provided the nationalaverage does remain high, a

wholesale measles epidemic is un-likely, Dr Turner says.

Youll just have little out-breaks there wont be wide-spread outbreaks.

Dr Hoskins is not so sure.Lets assume that for the

under-30-year-old population ofAuckland, which will be about800,000 people, theyve got an aver-age 90 per cent immunity.

Weve then got 80,000 peoplewho are not immune to measles.Measles is incredibly infectious.Even if only 10 per cent get it,thats 8000 people in Aucklandwith the measles.

That scenario could see hun-dreds of people with ear infections

some of which will lead to deaf-ness and hundreds with lunginfections and even pneumonia.

Thirty per cent or so will needto be hospitalised because theyreso sick. And then a very small

number between four and eight will dieof measles.The same num-ber will have severe brain dam-age.

SOMETHING of that sorthappened in 1991, whenNew Zealand experiencedits worst measles epi-demic. About 10,000 caseswere formally reported,

but health officials estimated theactual number was likely to have

been more like 30,000.More than 600 children ended

up in hospital, and six of themdied.

That epidemic prompted the in-troduction of the current measles,mumps and rubella, or MMR,vaccine but as memories havefaded among a new generationof parents, immunisation rateshave remained below target.

There are myriad reasons whychildren are not vaccinated.

Research published by theHealth Ministry this year ident-ified five different groups amongparents.

Rejecters were opposed to im-munisation because of religious orother beliefs that vaccines areeither harmful or not beneficial.

Nurturers werent opposed toimmunisation, but believed theirchildren didnt need to be immun-ised because they were low risk.

Fearfuls were not philosoph-ically opposed to immunisation,but found the experience distress-ing for them or their child.

Vulnerables were also notopposed, but had difficulty ac-cessing immunisation services,because of poverty or other rea-sons.

The final group were the un-wells, who supported immunis-ation but had children whose poorhealth usually immuno-suppres-

sion meant they were unable tobe vaccinated.

Growing rates of immunisationmean many parents now havenever seen a case of measles orwhooping cough, and this hasproved a double-edged sword, DrTurner says.

Because measles used to affectevery child in the community, theassumption now is that it was amild disease. People have losttheir collective memory of thetimes that measles can be aserious disease.

In many cases, it is a mild dis-ease, she says.

You just dont know. One in1000 children actually dies and,separate from that, one in 1000children end up with brain dam-age.

Even for children who have aless-severe case, measles can stillaffect their health for a long time

afterwards. Measles virus sup-presses the immune system. Aftermeasles you can get recurrentinfections, so kids are poorly formonths after getting the infec-tion.

Members of a community such

as Oratia can reinforce eachothers beliefs, making it difficultfor health workers to counter op-position, she says.

Measles is a mild disease,the vaccines full of nasty prod-ucts that sort of myth spreadsaround in a community, especiallyif its your neighbour or someoneelse you trust.

Even long-discredited myths such as the now-widely debunkedlink between the MMR vaccineand autism still have a life insome pockets of the wider com-munity.

What Dr Turner finds difficultis when parents will not acceptthat their choice affects peopleother than their own children.

Theyre missing the point thatsome kids cant have the vaccines,or their immune systems are veryfragile.

Theyre at high risk of thesediseases they rely on communityprotection and theyve got some

terrible stories.Already, the Auckland out-

break has affected several peoplewhose lack of immunity was notby choice, Dr Hoskins says.

Theres now one case in some-one whose immune system hasbeen wiped out by their cancertreatment. Theres a case in some-one, a child under 15 months,whos too young to have had thevaccine. Their care has been im-pacted by the decisions of otherpeople.

How far do you go, though?The Government has ruled out

compulsory immunisation, but theHealth Ministry is investigatingwhether it is worth paying parentswho either fully immunise theirchildren or formally declare theirobjection.

That latter group makes up 2 to3 per cent of the population smallenough to leave alone provided

health workers can reach every-one else.

Earlier this year, Wellingtoninfectious diseases specialist Tim

Blackmore told TheDominion Posthe believed there ought to be astick as well as a carrot.

This is very contentious, buits starting to say that a conditionof employment, or enrolment in achildcare centre or school is thathese are the vaccinations youmust have.

Coercion will never work, DrTurner says but often peoplesanxieties are short-livedif a healthprofessional they trust is willingto discuss their specific concerns.

I know, as a parent myself, itshard my child [has] walked inwell and somebody stuck a needlein their arm. It just doesnt feelnatural and it doesnt feel right.

Some children do suffer side ef-fects, ranging from very mildsymptoms like redness or sorenessaround the point of vaccination tothe very occasional anaphylacticreaction to a vaccine ingredient.

Parents who know someone, orknow someone who knows some-

one, can be understandablyanxious, she says.

You hear a story all the sci-ence in the world is not the sameas the emotional fear.

Even when I vaccinated mykids, I waited for something to gowrong. Things do go wrong, be-cause if you give vaccines to mosof the population, somebody willhave side effects.

The vaccines on New Zealandsimmunisation schedule are ex-tremely safe, though, she says the chances of something goingseverely wrong are far less thanthe risks related to the diseasestheyre protecting us from.

Dr Hoskins agrees.Im struggling not to say we

know better . . . but its much,much safer to have the vaccinethan it is to have the disease.

Familys choice leaves children unprotected

SHERRY TOSH says she wouldnot wish illness on herchildren or any other child.But in the past fortnight, all

three of her children Jolie, 13,Bianca, 9, and Morgan, 8 have hadmeasles after being caught up in thecurrent Auckland outbreak.

Bianca and Morgan go to OratiaDistrict School, where the outbreakbegan when a pupil returned froman overseas trip.

None of the Tosh children havebeen immunised, a decision MrsTosh made when she was pregnantwith Jolie, after researching the risksand benefits. She says a lack of

transparency about the adverseaffects vaccines can have was amajor factor in her choice.

Theres not actually any kind ofopen monitoring of the detrimentaleffects of vaccines. Its a systemthat I dont actually trust itsholding hands with the doctors, thedrug companies and theGovernment.

Her decision has been tested inrecent weeks, after Bianca andMorgan were excluded from schoolon June 2 because they were notimmunised and therefore at risk ofbeing infected, then infecting others.Jolie has also been at home since

early June after coming into contactwith a cousin, also an Oratia pupil,who had been infected and probablypassed it on.

The children had not beenseverely ill, but the measles wasnot a nice thing for them, MrsTosh says. You dont will yourchildren to get unwell and I washoping they could have gonethrough life without coming intocontact with it.

She says she is aware of theimpact her choice could have onother people and has been careful toprevent the children passingmeasles on. Im not ignorant Im

not going to be putting my unwellchildren in front of other people.

[Jolies] best friend was havinga birthday sleepover her fatherhad had leukaemia and I said [toJolie] its a no-go theresabsolutely no way you can go.

Mrs Tosh has stayed home fromher job to look after the children.and is worried about whether shellbe paid for the time off.

Ive yet to be in negotiationsand discussions . . . regarding mypay I didnt have sick leave left.

The experience has not changedher mind about immunisation, butshe has heard of some Oratia

parents who have decided tovaccinate their children as a resultof the outbreak.

It could be the inconvenienceof work, or they could have donesome more reading.

She is upset at the wayunimmunised pupils at Oratia wereexcluded, saying parents were nottold who else had children athome, which would have allowedthem to share childcare. I knowthat you get unwell children itwas just the period of time andhow differently we were treatedfrom those who chose tovaccinate.