Measles and immunisation

Our practice in this area

In all of our engagement with tamariki, whānau or family and caregivers, we need to be first guided by our values and how we will ensure the oranga (safety and wellbeing) of tamariki, whānau or family and caregivers. This guidance helps us to modify our usual social work practice approach in the context of a measles outbreak to prevent the transmission of the measles virus. Please be mindful our current health and safety guidance must also be followed when applying this guidance. We should also take into account our existing practice guidance and practice policy where it does not conflict with the specific guidance provided here.

What is measles

Measles is a highly infectious viral illness that can be very serious. It can lead to pneumonia, brain infection and sometimes death. It can spread quickly and easily through breathing, sneezing and coughing. It is especially dangerous for pregnant women who are not immune, pēpi and people with weakened immune systems.

Because measles is highly infectious, it's important for us to consider when engaging with tamariki and whānau or family who are living in overcrowded households and particularly relevant if tamariki and whānau or family are living in emergency centres or temporary accommodation due to the recent Cyclone impacts as transmission can occur very rapidly.

Measles symptoms include a high fever, runny nose, cough and sore 'pink' eyes. A few days later, a rash starts on the face and neck, and then spreads to the rest of the body. A person can have measles and spread it to others before they feel sick or show any symptoms. Symptoms can start 7 to 18 days after you're exposed to the virus. The symptoms usually start within 10 days.

It is important to stay vigilant about this illness as cases are currently being reported in Aotearoa New Zealand. The country's measles vaccination rates have fallen in the recent years, and we need to boost them again as we reopen to the world after COVID-19. People are being asked to vaccinate with the MMR vaccine and be on the lookout for symptoms of measles. The MMR vaccination helps protect all of us.

MMR vaccination

Measles vaccinations should be offered to those who are not fully immunised. People born before 1 January 1969 are considered immune. People born after 1 January 1969 require 2 measles vaccinations to be fully immunised. On average, one dose is 95% effective, and two doses is more than 99% effective. People who have had their measles vaccine can't catch measles.

MMR vaccinations are scheduled at 12 months and 15 months of age.

The vaccinations are free for anyone aged 18 years or under, regardless of their visa or citizenship status. For people over 18 years old, the vaccination is free for New Zealand residents and people eligible for free healthcare in New Zealand. People who have had 2 MMR vaccinations, have had measles before or are over 50 years old are considered immune to measles, and should not worry. Everyone else over 12 months old should be immunised with at least 1 MMR vaccination.

Infants 6 months and over can be given MMR early if necessary. Advice on early vaccination would be provided by a medical practitioner.

It can take around 2 weeks for a person to be fully immune after being vaccinated. The MMR vaccine is the best protection against measles, and the most important thing people can do to protect themselves is to ensure that they and their tamariki are immunised.

Measles, mumps and rubella (MMR) vaccine | Health New Zealand Te Whatu Ora

Vaccination is particularly important for those planning to travel overseas – to protect them and prevent outbreaks in Aotearoa New Zealand.

Safe Travel | Ministry of Foreign Affairs and Trade

Identifying tamariki and rangatahi who are not immune to measles

Good health is essential to oranga and positive life outcomes. We need to support and assist tamariki and whānau or family we're working with to access health services, both to maintain their oranga and meet any health and disability needs – this includes access to immunisations and ensuring they are up to date.

For tamariki and rangatahi in the custody of the chief executive, we need to proactively engage to understand if they are already vaccinated and, if they are not, to support them to receive the MMR vaccine. Key steps include:

1. Check CYRAS to see whether a tamaiti or rangatahi that we have guardianship or custody for is considered immune (they have had 1 or 2 MMR vaccinations). This should be identifiable in their gateway report.
2. If it cannot be determined from CYRAS whether or not a tamaiti or rangatahi has been vaccinated or has had measles in the past, we should contact their parents or guardians to try to find out this information.
3. If they don't know, we should request consent to obtain this information from the healthcare provider of te tamaiti or rangatahi.

Consent for tamariki and rangatahi to receive the vaccine

While everyone has the right to information to make an informed choice or give informed consent, the law relating to tamariki and rangatahi consent to medical treatment, including vaccination, is complex. We have guidance to support us with consent for medical examinations and treatment.

In addition to this guidance, there are some specific considerations in relation to vaccinations:

• Take a whole of whānau or family approach when discussing MMR vaccination, as parents and caregivers may also not be immune.
• We make sure we are familiar with the legal status and who the legal guardians are of any tamariki or rangatahi we are working with in relation to the MMR vaccine.
• For tamariki in the care or custody of the chief executive, consent must be obtained from their guardians before booking a vaccination.
• It is the role of the healthcare professional to determine whether a tamaiti or rangatahi is competent to give informed consent.
• Caregivers are unable to take tamariki in their care to be vaccinated without the consent of the legal guardians.
• If the caregiver for te tamaiti or rangatahi is also a legal guardian, engagement must still occur with the other guardians, parents and whānau or family, and any other guardians should also provide consent.
• If tamariki or rangatahi can't provide informed consent, we should talk to them about the importance of vaccination and hear their views, considering their age and development.
• Engage with the guardians for te tamaiti or rangatahi – clearly record their decision about consent, their views and those of te tamaiti or rangatahi as a casenote on CYRAS.

Rangatahi aged 16 years and older can give their own consent for vaccination

• Rangatahi aged 16 years and older do not require a guardian to give consent to receive the measles vaccination – they can give their own consent. They can also decline to give their consent.
• Even when rangatahi aged 16 years or older make their own decision about being vaccinated, we should (with their consent) speak with their guardians and keep them informed about their decision about measles vaccination.

Rangatahi aged 16 years and older will be assessed by the vaccinator as having the capacity to provide informed consent to being vaccinated. Consent must be given by a guardian for those rangatahi aged 16 years and older who are unable to give informed consent.

When Oranga Tamariki can consent to vaccination

Oranga Tamariki practice leaders have the delegation to solely consent to the measles vaccine being administered where we hold:

• sole guardianship
• specific guardianship for medical purposes, or
• wardship of tamariki or rangatahi and our role as an agent of the court specifies guardianship responsibilities, including relating to approving health or medical treatment.

Even when we have the authority to consent to te tamaiti or rangatahi being vaccinated, we must still speak with, and seek the agreement of other guardians before proceeding. We must also talk with the lawyer for child (where one is appointed). Only in circumstances where a medical practitioner advises that not receiving the vaccine may result in serious health complications for tamariki or rangatahi if they contract measles should we proceed with vaccination without the agreement of other guardians.

If Oranga Tamariki holds additional guardianship

Where we hold additional guardianship, we must talk with other guardians about the importance of vaccination and seek their consent to the vaccination of their tamaiti or rangatahi.

If the other guardians do not provide their consent, we cannot proceed with vaccination of their tamaiti or rangatahi using our consent alone.

We should inform the lawyer for child (where one is appointed) of the outcome from these discussions.

If Oranga Tamariki holds custody but not guardianship

Where we have a custody order but no guardianship order, we cannot provide consent. We must speak with the guardians about the importance of vaccination and seek their consent to the vaccination of their tamaiti or rangatahi.

If they do not provide their consent, we cannot proceed with vaccination for te tamaiti or rangatahi (unless te tamaiti or rangatahi is deemed by the vaccinator to be competent to consent).

If there is disagreement

Only in extreme circumstances (for example, where not receiving the vaccination may result in serious health complications for te tamaiti or rangatahi if they contract measles) would we consider further options to legally enable a measles vaccine to be administered. This would be by way of on-notice application to the court where all parties would have the opportunity to be heard.

When we have identified guardians for te tamaiti or rangatahi, we should seek advice from Legal Services and inform the lawyer for child (where one is appointed) when there is disagreement about consenting to the measles vaccine between:

• tamariki, rangatahi and their guardians
• other guardians.

Providing consent to the vaccinator

A guardian for tamariki or rangatahi aged up to 15 years must provide consent for te tamaiti or rangatahi to receive the vaccine.

If the adult accompanying te tamaiti or rangatahi is not their legal guardian, the social worker needs to obtain consent before the vaccination and the vaccinator will need to confirm consent from a legal guardian either:

• verbally by phone with a legal guardian, or
• by being provided with a signed copy of the measles vaccination consent form or other written consent (such as a letter or email) completed by a guardian.

Although the vaccinator only requires consent from a guardian, we engage with and require consent from all guardians for te tamaiti and rangatahi we are working with.

If guardians have given consent to vaccinate their tamaiti or rangatahi but someone else is accompanying them, we make sure that we keep the whānau or family informed about the vaccination and the wellbeing of their tamaiti or rangatahi

Speaking with tamariki, rangatahi, whānau or family and caregivers about vaccination

Where it is known that a tamaiti or rangatahi cannot be vaccinated for medical reasons or is already susceptible to infection, we must take extra care about ensuring we don't expose them to measles. If we suspect or are unsure if a tamaiti or rangatahi is non-immune to measles, consider ensuring that the Oranga Tamariki staff they have contact with are immunised. If tamariki or rangatahi are showing symptoms, caregivers should seek medical advice. This may include being quarantined at home.

Uphold the mana of te tamaiti or rangatahi by engaging with them about their health needs. This includes enabling and supporting te tamaiti or rangatahi to make choices about treatment or intervention in their health. Offer opportunities for te tamaiti or rangatahi to ask questions about vaccines and give them access to information to answer their questions.

Help whānau or family to access reliable information and listen to any concerns they have. Support a whānau or family-based approach to vaccination. If whānau or family need support to be vaccinated themselves, ask how we can assist them (for example, transport or explore the possibility of them being vaccinated at the same time as their tamariki). Provide specific information about where and when whānau or family can be vaccinated in their community. Explore familiar environments and people who whānau or family trust.

Visiting tamariki, rangatahi, whānau or family and caregivers

Oranga Tamariki provides essential services to tamariki and their whānau or family and we need to keep doing this in a way that keeps everyone safe and well when there are community health concerns, including when there are measles outbreaks.

That includes the manner and frequency that tamariki in care are engaged with during a measles outbreak if they are vulnerable to exposure or if they are quarantining or if there are conditions within a Public Health Order. In order to limit the spread of measles in the community, social workers may need to modify their approach to engaging with tamariki in care to ensure they are not increasing the risk of exposure to them and the wider community.

If there is widespread measles transmission in the community, there may be limitations on the social worker's ability to undertake kanohi ki te kanohi visits with tamariki, whānau or family and caregivers.

If there is widespread measles in the region where we are working, our manager should support us if we need to implement Infection Prevention and Control measures, such as using appropriate personal protective equipment or only allowing immune staff to have kanohi ki te kanohi contact with tamariki or rangatahi when they have not been vaccinated or their immune status is unknown.

When measles is confirmed

Our social workers need to continue engaging with tamariki who are in care and we need to consider their needs outlined in their All About Me plan in the context of the current situation. The All About Me plan should specify the frequency of visits to te tamaiti or rangatahi. This should be the starting point for determining the nature and frequency of contact during a spread of measles in communities.

A measles diagnosis could add additional stress to te tamaiti or rangatahi or their whānau or family or caregivers. If anyone needs to stay at home quarantined for a long period of time, it could bring about more challenging dynamics with people in a confined space not being able to engage with their usual daily activities.

This is a time when tamariki and those who care for them are likely to need more support from us than usual. Therefore, providing support to tamariki in care presents unique challenges and we need to be creative and innovative in exploring other ways of engaging that is not person to person. 

We are not prevented from person-to-person engagement (unless contrary to any Public Health Order issued by Medical Officers of Health under the Health Act 1956) but should use remote engagement wherever it is possible to do so effectively. Kanohi ki te kanohi engagement can only occur where there is a safety or welfare concern that is unable to be effectively addressed or mitigated through remote means and is required. Before undertaking kanohi ki te kanohi engagement, we must be satisfied that this cannot be done appropriately by remote means.

In the absence of kanohi ki te kanohi contact from the social worker and limited contact with whānau or family and others in their whanaungatanga networks, more frequent episodes of engagement using remote means may be appropriate to support both te tamaiti or rangatahi and those caring for them.

More information

For Oranga Tamariki specific information, contact the Health and Safety team.

Email: HealthandSafety@ot.govt.nz

For more information about measles:

• 0800 611 116 (freephone Healthline)
• Ministry of Health website
• Immunisation Advisory Centre