Status:
Resolved
Health alert:
AL19008
Date Issued:
05 Aug 2019 (update to Alert issued 1 August 2019)
Issued by:
Dr Brett Sutton, Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • Four confirmed measles cases have been identified in Victorian residents who have returned from overseas travel. Three cases were infectious while attending public places.
  • Be alert for measles in patients presenting with a fever at rash onset, particularly if they visited the areas indicated in the 7-18 days prior to onset of illness.
  • Isolate suspected cases to minimise the risk of transmission within your practice or emergency department.
  • Notify the Communicable Disease Prevention and Control Section at the Department of Health and Human Services on 1300 651 160 of suspected cases immediately.
  • Take blood for measles serology in all suspected cases.
  • Discuss whether to take nose and throat swabs for PCR with the department if your suspicion for measles is high. Approval is required prior to PCR testing at the reference laboratory. PCR testing for measles does not attract a Medicare rebate.
  • Free measles-mumps-rubella (MMR) vaccine is now available from GPs and some pharmacies for all eligible people born during or since 1966. Patients unsure of their vaccination status or are aged over 18 months and have only had one vaccine, should be vaccinated.
  • Infants as young as 6 months of age can receive free MMR vaccine prior to travel overseas to countries where measles is endemic, or where measles outbreaks are occurring.
  • Serology is not required before vaccinating.
  • There are a large number of ongoing international measles outbreaks in Asia, Europe and America. People who are planning overseas travel should ensure they have received vaccinations appropriate to travel, including an MMR vaccine if they do not have a history of two previous MMR vaccinations.

What is the issue?

There are now three cases of measles in people who were infectious whilst returning from overseas travel in the Philippines and Thailand respectively. The table below is a summary of all public exposure sites for the current measles cases in Victoria.

Date Time Location Onset of symptoms up to
Saturday 20 July 4pm - 6.30pm Cebu Pacific flight 5J49, Manila to Melbourne, Melbourne Airport - Terminal 2 Wednesday, 7 August 2019
Tuesday 23 July 9am - 6pm Eastland Shopping centre Saturday 10 August 2019
Wednesday 24 July 9am - 6pm Eastland Shopping centre Sunday 11 August 2019
Thursday 25 July 9am - 9pm Eastland Shopping centre Monday 12 August 2019
Friday 26 July 9am - 2pm Eastland Shopping centre Tuesday 13 August 2019
Saturday 27 July 9am - 7pm Adventist Women's Conference, Phillip Island Adventure Resort Wednesday 14 August 2019
Saturday 27 July 5pm - 7pm Pino's Trattoria, 29-31 Thompson Ave, Cowes VIC 3922 Wednesday 14 August 2019
Sunday 28 July 9am - 1pm Adventist Women's Conference, Phillip Island Adventure Resort Thursday 15 August 2019
Saturday 3 August  4pm - 5pm  Cebu Pacific flight 5J49, Manila to Melbourne, Melbourne Airport - Terminal 2  Wednesday 21 August 2019 

In 2019 there have now been 30 cases of confirmed measles notified in Victoria. Almost all cases are in people who are not fully immunised against measles, who have either travelled overseas or been in contact with travellers from overseas in Victoria. Many cases are people born since 1966 who believed they were fully immunised but who had not had two doses of MMR vaccine. 

Anyone who presents with signs and symptoms compatible with measles should be tested and notified to the department. There should be an especially high index of suspicion if they have visited any of the areas listed above and are unvaccinated or partially vaccinated for measles.

This is a timely reminder for individuals to check their vaccination records. Free measles-mumps-rubella (MMR) vaccine is now available for people born during or since 1966 who do not have documented evidence of receiving two doses of a measles-containing vaccine or do not have documented evidence of immunity or are aged over 18 months and have only had one vaccine. Serology is not required before vaccinating.

Unvaccinated infants are at high risk of contracting measles. Infants as young as 6 months of age can receive MMR vaccine prior to travel overseas to countries where measles is endemic, or where measles outbreaks are occurring. The first dose of MMR vaccine is usually given at 12 months of age as part of the National Immunisation Program Schedule (NIP). If an infant receives an early dose of MMR vaccine (e.g. at 8 months) prior to travelling overseas, they are still required to receive their routine 12 month and 18 months doses in line with the NIP schedule. MMR vaccine is now free for infants aged 6 to 12 months travelling to measles affected areas.

Who is at risk?

Children or adults born during or since 1966 who do not have documented evidence of receiving two doses of a measles-containing vaccine or do not have documented evidence of immunity are considered to be susceptible to measles. People who are immunocompromised are also at risk.

Symptoms and transmission

Clinical features of measles include prodromal fever, a severe cough, conjunctivitis and coryza, followed by a maculopapular rash usually starting on the face. Individuals, especially children, are typically unwell. People with measles are potentially infectious from around five days before, to four days after, the appearance of the rash.

Measles is highly infectious and can persist in the environment for up to two hours.

Example of measles rash on the face and neck of a man.Example of measles rash on the face of a young boy.

These pictures are typical of a measles rash.

Summary of recommendations

  • Be alert for measles infection - ensure all staff, especially triage nurses, have a high index of suspicion for measles in patients presenting with a febrile rash.
  • Notify suspected cases immediately to the Communicable Disease Prevention and Control Section via telephone on 1300 651 160 (24 hours).
  • Take blood for measles serology in all suspected cases.
  • Call the department to discuss the need for nose and throat swabs for PCR diagnosis. PCR testing for measles does not attract a Medicare rebate.
  • To minimise the risk of measles transmission within your department/practice:
    • avoid keeping patients with a febrile rash illness in shared waiting areas
    • give the suspected case a single-use face mask and isolate them, until a measles diagnosis can be excluded
    • leave vacant all consultation rooms used in the assessment of patients with suspected measles for at least 30 minutes after the consultation.
  • Identify patients who are susceptible to measles, especially those planning travel overseas, and offer free measles-mumps-rubella (MMR) vaccine.

More information

Clinical information

The Australian Immunisation Handbook:

The Blue Book Guidelines for the control of infectious diseases

Consumer information

Better Health Channel

Also see three videos on measles at YouTube

Contacts

For further information please contact the Communicable Disease Prevention and Control section at the Department of Health and Human Services on 1300 651 160 (24 hours).