minisiry 01 new zealand health of manatu hauora manatu ... · nurses teams. by including nurses,...

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MINISIRY 01

HEALTH New Zealand

Ministry of Health Manatu Hauora

MANATU HAUORA

SITREP 09 Serogroup W Meningococcal Disease Northland Outbreak

Issued: 1200 hrs, 21 December 2018

New information is in red

Situation

IN CONFIDENCE

1. There has been an increase in notifications of Serogroup W Meningococcal Disease (MenW) in New Zealand in 2018. This year so far, there have been 30 cases and six deaths. In 2017 and 2018, group W meningococcal disease had a case fatality rate of 25% in New Zealand.

2. There is an ongoing outbreak in Northland of Serogroup W Meningococcal Disease (MenW) with seven cases and three deaths as of 21 December 2018. The overall rate in this region is now 8.1 per 100,000 and the rate for Maori is 22.7 per 100,000.

3. A targeted vaccination programme has been approved to run in Northland from 5 December 2018 until 21 December 2018. This programme will be delivered by Northland DHB, Hokianga Health Services Trust, and lwi Providers.

4. This targeted vaccination programme will be free for all chi ldren aged 9 months up to five years, and youth from 13 to up to 20 years of age residing in Northland. The goal of this programme is to reduce the impact on the Northland region population of the current MenW community outbreak.

Nine months 13 year olds Total for Population up to five up to 20 Primary Care

years of age years Campaign*

Maori 5,305 6,261 11 ,566

Pacific 262 293 555

Non Maori Non Pacific 4,154 6,432 10,586

Total 9,721 12,986 22,707

Table 1. Total eligible population enrolled in Northland PHO as at November 2018

5. PHARMAC and the Ministry of Health have been working together, and have procured a total of 25,000 doses of meningococcal vaccine. Initially, only 20,000 doses of Menactra vaccine were procured (which covers strains A, C, Y and W). The remaining 5,000 doses are the Nimenrix vaccine, and have been sourced by PHARMAC from Australia, which also covers meningococcal strains A, C, Y, and W.

6. The first 10,000 doses of Menactra arrived in Northland on 4 December. The remaining 10,000 doses arrived in Northland on 18 December. The first batch has been distributed to Propharma for storage.

7. The Nimenrix vaccine is not approved for use in children under 12 months of age, therefore children aged from 9-1 1 months will need to be prioritised to receive the Menactra vaccine.

8. The additional 5,000 doses of Nimenrix arrived in New Zealand at 1400hrs on 6 December. These arrived in Whangarei on 12 December. ProPharma in Whangarei are managing stock carefully to ensure the cold chain remains intact.

IN CONFIDENCE Page 1 of 25

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Key actions

9. This situation report covers the period from 1500hrs on 19 December 2018 until 0900 hrs 21 December 2018.

10. The targeted vaccination programme commenced at 11 00hrs Wednesday 5 December, at three main clinic locations: Kaitaia Hospital, Kerikeri High School and Whangarei Girls' High School.

11. Additional small clinics were added from 6 December onwards. Appendix 1 contains information on the locations and times of all the clinics for the vaccination campaign.

12. A stocktake of remaining vaccines is being completed , and results from this will be used to determine future provision of vaccines across the region . A full reconciliation process with be completed at the end of the campaign . Northland DHB have ind icated that they are amenable to any unused vaccine being pulled into national stock.

Public Information Management/ Media

13. Publ ic information and media releases are being jointly managed by Northland DHB and the Ministry of Health.

14. Updates have been made to the Ministry of Health website, and Northland DHB has released communications regarding the extra 5,000 doses that have been sourced.

15. The Ministry of Health published the Meningococcal W : Technical Advisory Group minutes on 6 December.

16. Northland DHB has issued a press release advising parents that there is plenty of vaccine available, and there is no need to rush to the clinics.

17. The Ministry of Health webpage titled "Meningococcal disease: Information for general practitioners and emergency departments" was updated on 5 December.

18. Last week, the top news item on the Ministry of Health website was "change to treatment recommendations for meningococcal disease", with 9.66% of all hits in the previous week (311 hits total). The "targeted vaccination programme for meningococcal disease" new item had 5.9% of all hits (190). The top search terms on the Ministry of Health webpage were "meningitis" or "meningococcal".

19. A group of teenagers will be developing an lnstagram campaign in collaboration with Northland DHB to assist with targeting the 13-19 year old children.

20. Northland have produced 3 videos on meningococcal disease and the vaccination programme. These have been translated into NZ Sign Language and Te Reo Maori. They are on the Northland DHB website and Facebook page.

21 . TV One visited a special clinic in Hikorangi on Wednesday 19 December. This clinic was organised by the mother of a child who died from meningococcal disease, and is sponsored by the local community. Northland has approached the local MP, Willow-Jean Prime, to see if she would like to attend. TV One interviewed the mother of the child who passed away.

22. This week (17 December - 21 December) there will be increased media coverage of three special clinics . There will be interviews with the parents of children who have contracted meningococcal disease, and a key message from these interviews will be to encourage those who have not yet been vaccinated to attend a clinic and receive their vaccination.

23. Northland DHB have developed a summary of their public communications during the vaccination period, which is attached to this SITREP.

Key Messages

24. The main centres and outreach clinics are running smoothly. Numbers being vaccinated each day seem to be decreasing.

25. The consent and evaluation forms have been put online and quite a few patients are presenting with these completed so they can be fast tracked. All of the clinics are well staffed. Staff are being rotated through in order to ensure adequate breaks are given.

26. It is estimated that by December 21, over 50% of the target population wil l have been vaccinated.

27. It has been noted that there was a clear equity gap in the fi rst few days of the vaccination programme, in that the Maori and Pacific ethnic groups had lower rates of vaccination compared


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to the Pakeha/Other population. This gap seems to be increasing. More information on the vaccination rates in each ethnic group can be seen in Figure 3, and information on the equity gap can be seen in Figure 4. A concerted effort is being made to target the Maori population.

28. A review of all areas and the numbers vaccinated is being performed, and a decision will be made whether to offer either more clinics in some areas or provide a mobile service that can go into some other areas.

29. The outreach clinics are variable in the numbers of people presenting for vaccination. Data regarding numbers of vaccinations given at these clinic will be provided once numbers have been finalised.

30. Vaccination clinics are being established in Kohanga Reo.

31 . A clinic has been confirmed at Raurimi Kohanga Reo in Raumaunga. Vaccines under cold storage were delivered to the site on 17 December.

32. The Women's Refuge has been approached so that children living at the residencies can be vaccinated.

33. Northland are liaising with local lwi to ensure that a mobile vaccination unit is deployed to remote areas effectively.

34. Standing orders have been developed for pharmacists so that they can vaccinate the full extent of the older age group.

35. Northland DHB are gathering a list of employers in the region who may employ people in the 13 to under 20 age group, so that a targeted campaign can be directed at them .

36. There has been continuous liaison with local Maori Health providers to ensure local lwi are given as much opportunity as possible to be vaccinated.

37. Northland are processing a stock take to determine how much vaccine is in warehouse storage compared to clinic fridges. Stock management is crucial to avoid vaccine wastage through a breach of cold-chain integrity. Stock may also need to be transferred from clinics with low uptake to the busier centres.

38. It is anticipated that there will be approximately 3000 doses of vaccine that will not be used in this campaign. Planning has commenced to determine the best use for this remaining stock. Plans will not be finalised until January 2019 when coverage rates can be confirmed and a final stock take of unused vaccine can be completed.

39. Consideration is being given to the following options:

• extending the programme to children aged 5-12 years, • targeting children in remote areas who are not registered with a PHO, • targeting children over 13 who missed out on vaccination in this programme by running a

school-based programme, • keeping the stock to administer a booster to the under 5's later in 2019, • keeping hold of stock to respond to any other community outbreak.

40. To ensure that the vaccination campaign can continue during the Christmas break, seven pharmacies will be administering vaccine to children aged 13 to 19 years with support from nurses teams. By including nurses, the younger cohort will also be able to be vaccinated in pharmacies over the holiday period . The pharmacy based vaccination programme began on 19 December.

41. The local Medical Officer of Health is visiting each pharmacy and viewing cold chain storage, vaccinating area and recovery area.

42. Pharmacies that are providing the vaccine over the holiday period have been identified, and opening days and hours have been collated into a document and put into advice for the public.

43. Vaccines in the outreach clinics are being moved back to Whangarei for storage. Clinical equipment is also being moved back to Whangarei hospital.

44. The main concern over the Christmas period is related to staff fatigue in Northland. There are additional pressures during this period, such as proposed strikes by midwives and registrars.

45. Northland DHB are creating plans for reactivation of the campaign in the New Year to target the remaining children. Their plans include reactivating clinics in the main centres, having more clinics in the remote areas, and in it iating a high-school vaccination programme.


s 9(2)(a)

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46. The tentative end date for the vaccination campaign is 22 February.

47. Contact numbers for the Christmas period have been distributed this week . This includes contacts at the Ministry of Health and at ProPharma, as well as Northland DHB contacts.

Events of note

48. A case of meningococcal W disease has been reported in Palmerston North. The case is a • This was confirmed as serogroup W on 14 December. The case has a

large number of close contacts, who are being traced and given antibiotic chemoprophylaxis. There is no association with the outbreak in Northland.

49. There is variation in response from GP practices to their patients about the availabil ity of the vaccine. Another communication was provided to the PHOs to disseminate to practices (7 December) reinforcing the need to provide a waitlist of patients so that they can be contacted when the new stock arrives.

50. On Monday 1 O December, Dr Shane Reti worked at a clinic and vaccinated children.

51. A new case of meningococcal disease was notified in Northland on 10 December. The case is a He has responded well to treatment, and was discharged from

Whangarei Hospital on 11 December. All close contacts have received antibiotics. Serotyping of the organism has been performed, and it has been determined to be serogroup Y.

52. On 10 December, one of the chilly bins used to store the vaccine dropped below 2 degrees, which has put the 14 vaccines stored inside at risk of becoming inactivated. The vaccines have been isolated. They have been considered safe for use following advice from the Quality Supervisor at Sanofi.

53. On Thursday 13 December a clinic was established at a special needs school (Bloomfield) with 40 enrolled students. These children are in the 13 to under 20 age group.

Next situation report

54. The next situation report will be via email at 1600 hrs on 8 January 2018.

Drafted by: Planning and Intelligence, Tara Swadi

Approved by: Response Manager, Sarah Reader


s 9(2)(a)s 9(2)(a)

RELEASED UNDER THE OFFICIAL INFORMATION ACT 1982

HEALTH TRACKING & REPORTING (as at 0900hrs 21 December)

1. Vaccination Clinics Data

NOTE: Numbers from 5 December have been amended since SITREP01 due to miscounting in Northland

Date Number of vaccines administered 9mths- Number of vaccines administered 13-

I I Adverse Event Reported

(Date/time of cl inic Total operations)

under5 under20 (Y/N and detail)

Maori I Pacific I Other Maori I Pacific I Other 5-Dec

1 000hrs to 1830hrs 275 I 5 I 361 162 I 5 I 308 I 1116

Cumulative %

I I I I I I I indicated 5.2 1.9 8.7 2.6 1.7 4.8 4.9

population*

6-Dec I

184 I

8 I

306 I

172 I

8 I

31 9 I

997 1 000hrs to 1830hrs I No adverse events reported

Cumulative % indicated I 8.6

I 5.0 I 16.1 I 5.3 I 4.4 I 9 .8 I 9.3

population* 7-Dec 180 12 I 216 I 183 I 5 I 296 I 892

1 000hrs to 1830hrs Cumulative %

I I I I indicated 12.1 9.5 21.3 8.3 6.1 14.4 13.2

population* 8-Dec I 71 I 9 I 135 I 125 I 4 176 520

1 000hrs to 1830hrs

Cumulative%

I I I I I I I indicated 13.4 13.0 24.5 10.3 7.5 17.1 15.5

population*


s 9(2)(a)s 9(2)(a)


9-Dec I 40 I 0 I 76 I 43 I 6 I 115 I 280 1 00Ohrs to 1830hrs

Cumulative %

l 1 indicated 14.1 13.0 I 26.3 I 10.9 I 9.6 I 18.9 I 16.8 population*

10-Dec I 293 I 9 I 278 I 243 I 12 I 343 I 1178 1000hrs to 1830hrs

Cumulative %

I I I I I indicated 19.7 16.4 33.0 14.8 13.7 I 24.2 I 21.9 population*

11-Dec I 235 I 6 I 220 I 216 I 4 I 281 I 962 1000hrs to 1830hrs

Cumulative %

l I indicated 24.1 18.7 I 38.3 I 18.3 I 15.0 I 28.6 I 26.2 population*

IN CONFIDENCE Page 6 of25

s 9(2)(a)

s 9(2)(a)

RELEASED UNDER THE OFFICIAL INFORMATION ACT 198212-Dec 214 6 276 164 6 282 948

1 000hrs to 1830hrs I No adverse events reported Cumulative % 21.0 45.0 20.9 17.1 33.0 30.4

. I

lndicated population 28.1

13-Dec 152 11 224 I 175 I 10 I 252 I 824 1 00Ohrs to 1830hrs

No adverse events reported Cumulative %

31.0 25.2 50.4 23.7 20.5 36.9 34.0

indicated population 14-Dec 124 6 138 154 6 223 651

1 000hrs to 1830hrs I No adverse events reported Cumulative%

33.3 27.5 53.7 26.1 22.5 40.3 36.9

lndicated population 15-Dec I 68 I 6 I 64 I 74 I 3 I 90 I 305

1 000hrs to 1830hrs

Cumulative% I I 29.8 I 55.2 I 27.3 I 23.5 I 41.7 I 38.2 indicated population

34.6

16-Dec 15 1 26 36 1 47 126 1000hrs to 1830hrs I No adverse events

Cumulative% 30.2 55.8 27.9 23.9 42.5 38.8 indicated population

34.9

17-Dec 106 2 67 100 0 120 395 1 000hrs to 1830hrs No adverse events

Cumulative % 30.9 57.5 29.5 23.9 44.3 40.5 indicated population 36.9

18-Dec I 100 I 3 I 166 I 104 I 5 I 212 I 590 I No adverse events 1 000hrs to 1830hrs



Cumulative% I 38.8 I 32.1 I 61.5 I 31.2 I 25.6 I 47.6 I 43.1

indicated population 19-Dec 8 77 78 2 110 365

1 000hrs to 1830hrs 90

I No adverse events Cumulative % 35.1 63.3 32.4 26.3 49.3 44.7

I

indicated population 40.5

20-Dec 55 0 57 45 2 90 249

1 000hrs to 1830hrs I No adverse events Cumulative % 35.1 64.7 33.1 27.0 50.7 45.8

I

indicated population 41 .5

21-Dec 1 000hrs to 1830hrs

- 2202 I 92 I 2687 I 2074 I 79 I 3264 I 10398 *Percent of target population vaccinated is based on Northland PHO enrolment data from November 2018


RELEASED UNDER THE OFFICIAL INFORMATION ACT 1982"O Q)

ro

60

50

-~ 40 (.) (.) ro > C 0

~ ~30 0 0.

Q) 0) '-2

~ 20 (.) '-Q)

Q_

10

0 5-Dec 6-Dec 7-Dec 8-Dec 9-Dec 10-Dec 11-Dec 12-Dec 13-Dec 14-Dec 15-Dec 16-Dec 17-Dec 18-Dec 19-Dec 20-Dec 21-Dec 22-Dec

Date of vaccination programme

Figure 2. Actual rates and forecast of total percent population vaccinated.



70

60

50

40

30

20

10

0

5-Dec 6-Dec 7-Dec 8-Dec 9-Dec 10-Dec 11-Dec 12-Dec 13-Dec 14-Dec 15-Dec 16-Dec 17-Dec 18-Dec 19-Dec 20-Dec 21-Dec

-+-Maori 9mnth-5yrs -+-Other 9mnth-5yrs Maori 13-20yrs -+-Other 13-20yrs

Figure 3. Vaccination rates per age group in Maori and Other ethnic groups (Northland MenW outbreak)



25 .00

20.00

15.00

10.00

5.00

0.00

5-Dec 6-Dec 7-Dec 8-Dec 9-Dec 10-Dec 11-Dec 12-Dec 13-Dec 14-Dec 15-Dec 16-Dec 17-Dec 18-Dec 19-Dec 20-Dec 21-Dec

....... 9mth-Syrs ....... 13-20yrs

Figure 4. Difference in percent target population that has been vaccinated (Maori ethnic group compared to Other ethnic group)



2. Northland DHB call centre data

DHB dedicated Meningococcal W 0800 Line Note: The 0800 line is operational between the hours of 0800 to 2000 daily.

Date Total Meningococcal Disease Additional Information enquires received

Call topics:

• Where and when can we get vaccinations? • How can the vaccine be accessed for those outside of the target aged groups .

• General questions about the vaccine and how safe it is to have . 5-Dec 39 • Unhappy with GPs response when they ring to ask questions about the programme .

• Is it contagious - can children still go to school? • 15 months lmms - can they get the MenW if they've just had this?

• Out of area people coming for a holiday in Northland - can they get vaccinated at a clinic? Call topics:


6-Dec 41 • General questions about the vaccine and how safe it is to have. • Unhappy with GPs response when they ring to ask questions about the programme .


• Can an international student who has lived in Northland for two years be immunised? Call topics:


7-Dec 29 • General questions about the vaccine and how safe it is to have. • Unhappy with GPs response when they ring to ask questions about the programme .


Can an international student who has lived in Northland for two years be immunised?



Call topics:

• Two people vaccinated on Thursday and Friday rang about a rash at the injection site. After 8-Dec 10 questioning the nurse on call thinks it is heat rash


Had MenzB vaccination in England so do they need this vaccination

Call topics:

9-Dec 2 • Where and when can we get vaccinations? How can the vaccine be accessed for those outside of the target aged groups.

Call topics:

10-Dec 33 Clinic times •

Quite a few asking for the address of the Kawakawa Clinic site

Call topics:

11-Dec 11 Clinic times and venues for next week •

Call topics:

• Where and when can we get vaccinations? • Reimbursement if age range changes eventually

12-Dec 20 General questions about the vaccine and how safe it is to have . • • Can you pay at clinics for 5-12yr olds

• Had HPV vaccine last week. Can they have this vaccine . How long are the wait times at clinics

Call topics:

13-Dec 9 • Is a caregiver required for a 13 year old • Asking if patient who previously vomited after MenzB vaccination is ok to have it done

• Dates and times of clinics



• Visiting from outside Northland in January - are they eligible

Call topics:

• Is a caregiver required for a 13 year old • Asking if patient who previously vomited after MenzB vaccination is ok to have it done

• Dates and times of clinics • Visiting from outside Northland in January - are they eligible

14-Dec 20 • Child is unwell, should I wait until next week • Is it only for Northland residents

• Dates and times of clinics • What are the symptoms of MenzW

• What paperwork is required • What is the vaccine called, how many cases in Northland

Where can they get the vaccine if outside of age range

Call topics:

• Clinic times and venues for next week 15-Dec 7 • Can 16 year old sign own consent

• Why is it important • Can child have it two days before 13th birthday

Query of child's reaction to vaccine - red and bruised

Call topics:

16-Dec 5 • Clinic times and venues for next week • What do they need to bring

When does the programme finish

Call topics:

9 • Youth Space clinic hours 17-Dec • Dates and times of clinics • Granddaughter had Menze vaccine in Perth

• What paperwork is required



• Sore arm from vaccination yesterday • Where can they get the vaccine if outside of age range

Concerned about NDHB wording on FAQ sheet Call topics :

• Dates and times of clinics • Visiting from outside Northland in January - are they eligible

18-Dec 13 • Pharmacy clinics in January • What is the vaccine called , is it new

• Is a booster required • Clinic at Otamatea

Is it a live vaccine Call topics:

• Daughter is sleepy, has rash - told to go to ED • Dates and times of clinics

19-Dec 13 • Visiting from outside Northland in January - are they eligible

• Pharmacy clinics • What is the vaccine called, is it new

• Is it a live vaccine • Do we need an appointment

• What strains are covered

Call topics :

20-Dec 7 • Dates and times of clinics

• When does the programme finish 21-Dec

22-Dec

268



3. HEAL THLINE CALLS

· Date A. Total Meningococcal B. Total Meningococcal C. Total Meningococcal D. Total number of calls to

(24hr period from previous day) Disease enquires received Disease enquires received Disease enquires received HEAL THLINE (baseline from Northland residents from rest of New Zealand (A+ B) data)

only 6-Dec 13 23 870

(0700 5 Dec - 0700 6 Dec) 10

7-Dec 5 26 31 859 (0700 6 Dec - 0700 7 Dec)

8-Dec 8 16 24 853 (0700 7 Dec - 0700 8 Dec)

9-Dec 6 10 16 940 (0700 8 Dec - 0700 9 Dec)

10-Dec 5 6 11 898 (0700 9 Dec - 0700 10 Dec)

11-Dec 11 9 20 894 (0700 10 Dec - 0700 11 Dec)

12-Dec 6 9 15 900 (0700 11 Dec - 0700 12 Dec)

13-Dec 10 12 22 823 (0700 12 Dec - 0700 13 Dec)

14-Dec 3 16 19 804 (0700 13 Dec - 0700 14 Dec)

15-Dec 4 6 10 971 (0700 14 Dec - 0700 15 Dec)

16-Dec 2 3 5 894 (0700 15 Dec - 0700 16 Dec)

17-Dec 2 3 5 894 (0700 16 Dec - 0700 17 Dec)

18-Dec 0 8 8 901 (0700 17 Dec - 0700 18 Dec)



19-Dec I 2 I 7 I 9 I 875 (0700 18 Dec-0700 19 Dec)

20-Dec I 4 I 11 I 15 I 794 (0700 19 Dec - 0700 20 Dec)

21-Dec 1 3 4 759 (0700 20 Dec - 0700 21 Dec)

22-Dec (0700 21 Dec - 0700 22 Dec)

79 I 126 I 196

IN CONFIDENCE Page 17 of25


Appendix 1. Northland DHB Community Clinics Schedule

Northland DHB Community Clinics

Mon - Fri 11.00am - 6.00pm, Sat - 11.00 - 4.00pm, Sun (Whangarei only) - 11.00am - 2.00pm

Northland DHB Community Clinics Mon - Fri 11 .00am - 6.00pm Sat - 11.00 - 4.00pm, Sun(Whangarei only) - 11.00am - 2.00pm

!NDHB 3 large clin ics NDHB 3 large clinics

1

Whangarei Whangarei jWhangarei Girls Kerikeri High Kaitaia kerikeri IKerikeri High School IKaitaia iWhare in Hospital Entrance Hokianga Clinics

Rawene Clinic

9-3pm

Hokianga Clinics

Opononi Area School (9 - 12 only) I

NDHB 3 large cl inics Whangarei Kerikeri Kaitaia

~ okianga Clinics

aheke Clinic

l9-3pm e Kura Kaupapa

Maori o Te Tonga o IRawene Clinic Hokianga

9-3pm (1 - 2pm only)

Horeke Clinic Rawene Clinic

I 9-3pm

9-3pm

IN CONFIDENCE

NDHB 3 large clinics Whangarei Kerikeri Kaitaia

IHokianga Clinics

Rawene Clinic

l9-12pm only

ITaheke Clinic

j9-12pm only

INO CLINIC

Page 18 of 25

RELEASED UNDER THE OFFICIAL INFORMATION ACT 1982GP: Doctor

Pukenui Clinic

e Kao Clinic

e Hapua Clinic

Ki A Ora Ngatiwai

Oakura, First Aid Room 10.00-12.00

Pukenui Clinic Pukenui Clinic

Te Kao Clinic ITe Kao Clinic

e Hapua Clinic


RELEASED UNDER THE OFFICIAL INFORMATION ACT 19823 large clinics

Community hangarei Clinics hangarei Girls Mon - Fri High 11 .00am - Kerikeri 16.00pm Kerikeri High School :Sat - 11.00 - Kaitaia

.00pm, hare in Hospital Sun(Whangarei Entrance ionly) - 11 .00am -2.00pm Northland DHB !Clinic - Kawakawa Clinics Bay of Islands

Hospital Community Services Build in

Hokianga Clinics IRawene Clinic

3 large clinics 3 large clinics 3 large clinics 3 large clinics 3 large clinics Whangarei Whangarei Whangarei hangarei Whangarei Whangarei Girls Whangarei Girls Whangarei Girls High hangarei Girls Whangarei Girls High High Kerikeri High High Kerikeri Kerikeri Kerikeri High School Kerikeri Kerikeri Kerikeri High School Kerikeri High School Kaitaia Kerikeri High School Kerikeri High School Kaitaia Kaitaia Whare in Hospital Kaitaia Kaitaia Whare in Hospital Whare in Hospital Entrance hare in Hospital Whare in Hospital Entrance Entrance Entrance Entrance

Clinic - Kaikohe St Johns Ambulance station

Rawene Clinic

1

Clinic - Kaeo 1T e Runanga 0 Whaingaroa

Rawene Cl inic

Clinic - Dargaville Dargaville Hospital Outpatients Dept

Rawene Clinic

Clinic - Dargaville Dargaville Hospital Outpatients Dept

INo clinic

Clinic- Taipa Taipa Area School (Hours 1 0.00am -2Q_m If aheke Clinic 9-12pm only

l9-3pm l9-3pm 9-3pm 9-3pm

Broadwood Clinic ITaheke Clinic

12 - 3pm only l9-3pm

(Broadwood IPangaru Clinic School)

Panguru School Clinic

9-11 am only

9-3pm

Omapere Clinic

9-3pm

KohuKohu Clinic

9-3pm

aimamaku Clinic

9-3pm

Mangamuka Clinic

l9-3pm

IN CONFIDENCE

No clinic

Page 20 of 25

RELEASED UNDER THE OFFICIAL INFORMATION ACT 1982I

Ki A Ora Ngatiwai INo cl inic Clinics

e Ha Clinics No cl inic

No clinic

Kaihu Valley Primary School

10-12pm

e Ha Clinic Darg Hospital

9-12pm

HOON Broadway Health INo clinic Clinic-113 Broadway,Kaikohe

3.00pm - 6.00pm

Bream Bay ISiand Bay First Aid INo clinic Community Centre Room

i9.30am - 12.00

n-e Ha Clinic Darg Hosp

1

9-12pm

10.00 - 12.00

Te Ha Clinic Darg Hosp

9-12pm

No clinic

No clinic

No clinic

Broadway Health Broadway Health Broadway Health Broadway Health

No clinic

No clinic

Clinic - 113 Clinic - 113 Clinic - 113 Clinic - 113 INo clinic Broadway,Kaikohe Broadway,Kaikohe Broadway,Kaikohe Broadway,Kaikohe

3.00pm - 6.00pm I3.00pm - 6.00pm 3.00pm - 6.00pm p o.ooam - 2.00pm


RELEASED UNDER THE OFFICIAL INFORMATION ACT 1982e Kao Clinic IPukenui Clinic

ITe Kao Clinic IPukenui Clinic tTe Kao Clinic

e Hapua Clinic e Hapua Clinic

. r ease contact Please contact Whakawhiti Ora Pai Whakawhiti Ora Pai or clinic times and

Please contact for clinic times and confirmation of Please contact Please contact . Whakawhiti Ora Pai !confirmation of venue venue N\/hakawhiti Ora Pai Whakawhiti Ora Pa i for clinic times and or clinic times and for clinic times and confirmation of

~onfirmation of confirmation of venue enue venue


RELEASED UNDER THE OFFICIAL INFORMATION ACT 19823 large clinics ~ arge clinics 3 large clinics ~ arge clinics ~ arge clinics

Community ~ hangarei hangarei Whangarei hangarei hangarei Clinics erikeri erikeri Kerikeri erikeri erikeri Mon - Fri aitaia aitaia Kaitaia aitaia aitaia 11 .00am -6.00pm Sat - 11 .00 -

.00pm, Sun(Whangarei !only) - 11 .00am

2.00pm Northland DHB Extra clinic TBC Clinic - Otamatea Extra clinic TBC Clinic - Kaikohe Extra cl inic TBC INo cl inic INo clinic Clinics St Johns Ambulance St Johns Ambulance

Station station

Hokianga IRawene Clinic IRawene Clinic Rawene Clinic Rawene Clinic Rawene Clinic No clinic No clinic Clinics

9-3pm 9-3pm 9-3pm 9-3pm 19-12 pm

Broadwood Clinic Kohukohu Clinic Pawarenga Clinic Horeke Clinic

9-3pm 9-3pm l9-3pm 9-3pm

Mangamuka Clinic aheke Clinic

9-3pm 9-3pm

Ki A Ora ripiwai Sports No clinic Bream Bay Oakura First Aid No clinic No clinic No clinic Ngatiwai Clinics Complex Community Trust Room

Centre Hours TBC I I 110.00-12.00

9.30 -12.00



ITHOON Broadway Health Clinic-113 Broadway,Kaikohe

3.00om - 6. 00Q_m hakawhiti Ora IPukenui Clinic

Pai

10-2pm

Pouto

Rangitane Hall

10-1pm

e Ha Clinic

Darg Hospital

l9-12pm

Broadway Health Clinic-113

Darg Hosp

.9-1 2pm

Tinopai

10-12pm

Broadway Health Clinic-113

No clinic No clinic

Broadway,Kaikohe IBroadway,Kaikohe

e Hapua Clinic

3.00pm - 6.00Qm GP Pukenui Clinic IGP Te Hapua Clinic IPukenui Clinic

Pukenui Clinic

IN CONFIDENCE

No clinic No clinic

No clinic No clinic

Page 24 of 25

RELEASED UNDER THE OFFICIAL INFORMATION ACT 1982Please contact jTe Hapua Clinic IWhakawhiti Ora Pai

Please contact ~or clinic times and hakawhiti Ora Pai confirmation of

or clinic times and venue confirmation of venue

Still to confirm - Clinic for Motatau, Waikare, Moerewa in 3rd week.

Please contact Whakawhiti Ora

Please contact IWhakawhiti Ora Pai

Pai for clinic times ~or clinic times and !Please contact and confirmation !confirmation of venue Whakawhiti Ora Pai of venue or clinic times and

!

confirmation of venue


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