9. Question No. 9—HealthDr SHANE RETI (National—Whangarei) to the Minister of HealthQuestion No. 9—Health9. Dr SHANE RETI (National—Whangarei) to the Minister of Health: Does he stand by all his statements and actions and the actions of the Northland DHB relating to the outbreak of the meningococcal disease in Northland?Hon JENNY SALESA (Associate Minister of Health) on behalf of the Minister of Health: On behalf of the Minister of Health in particular I stand by the announcement yesterday of a targeted vaccination programme for the W strain of meningococcal disease in Northland. We know the vaccination campaigns work and I want to thank the Ministry of Health and Pharmac for securing 20000 doses of vaccine at a time when there is a shortage of supply of the vaccine due to international demand.Matt King: Why did the Northland District Health Board deem it appropriate to send out an internal memo in May to advise staff to get their children vaccinated but not let the Northland public know?Hon JENNY SALESA: In April of this year there were two unrelated adult cases of meningococcal disease W (MenW). Dr Hammer's memo in May encouraged clinicians to be alert to potential cases of meningococcal disease. That was appropriate at the time given the information available. The definition of an outbreak is one where there are three unrelated cases over a period of three months or when there are 10 cases out of 10000 people. The Ministry of Health and the Institute of Environmental Science and Research have been closely monitoring the rates of MenW across New Zealand since last year. In November of this year the technical advisory group convened by the Ministry of Health decided that the number of cases in Northland met the criteria for a community outbreak and it recommended that a vaccination programme be implemented. That programme will begin next week.Dr Shane Reti: How soon after the internal memo did the district health board (DHB) speak with the Ministry of Health about the meningitis outbreak given the Prime Minister's comment you would think that would be a trigger point at least for them to be talking to the Ministry of Health"?Hon JENNY SALESA: I refer to my previous answer of the definition of a community outbreak of meningococcal disease which is three or more confirmed cases of the same strain within the three-month period that are linked and are within a specific age group or community group and the rate of the disease is at least 10 cases per 100000 people. I do not know exactly when the DHB advised the Ministry of Health but I can say that the expert group the technical advisory group convened by the Ministry of the Health—8 November is when they actually then came to the conclusion that it is now an outbreak and that we should do as much as possible to make sure that we have a vaccination programme. Dr Shane Reti: Why was the decision made not to go public about meningitis concerns in Northland until after the vaccine was on order and on its way?Hon JENNY SALESA: As I said earlier on the definition of an outbreak of meningococcal disease is when there are at least three unrelated cases—Dr Shane Reti: I raise a point of order Mr Speaker.SPEAKER: Point of order Dr Shane Reti but I will warn the member that he might be being disorderly because the Minister is nowhere near completing her answer yet.Dr Shane Reti: Thank you Mr Speaker. I'll let her complete her answer.SPEAKER: Maybe the question could be repeated now it's been interrupted. Dr Shane Reti: Why was the decision made not to go public about the meningitis concerns in Northland until after the vaccine was on order and on its way?Hon JENNY SALESA: Because the technical advisory group that was convened by the Ministry of Health which then made the decision that this was an outbreak of meningococcal disease over in Northland was in November and as I said earlier on the definition of an outbreak is three—SPEAKER: OK I think we've got that.Dr Shane Reti: I raise a point of order Mr Speaker. I specifically crafted the questions in terms of meningitis concerns not a meningitis outbreak. We had a delivery about the outbreak. SPEAKER: I think that the Minister indicated that there was a responsibility for a response for an outbreak not a general response.Dr Shane Reti: Has he made any representations to Cabinet about increasing the $700000 available for outbreak meningococcal immunisation in light of the foreign affairs Minister announcing a $10 million immunisation project in Papua New Guinea?Hon JENNY SALESA: There is a shortage of this particular vaccine right now. The fact that the Ministry of Health and Pharmac have been able to obtain 20000 doses is actually a good thing which is why in my original answer I said that I would congratulate the Ministry of Health and Pharmac for getting these doses. We're getting 10000 of these doses from Australia. It takes about a week for them to come here. In order to ensure that we have this vaccine it takes about 18 months. This particular strain is a really devastating strain and there are other countries in the world that are experiencing MenW and we're doing as much as we can. This vaccination programme is going to be implemented next week and the Minister of Health has already announced this just a day or two ago and this is the vaccination programme that we're doing. He has done it without even coming through Cabinet."