Status:
Active
Health alert:
AL20006
Date Issued:
04 Feb 2020
Issued by:
Dr Brett Sutton, Chief Health Officer, Victoria
Issued to:
Medical Practitioners and Hospital Emergency Departments

Key messages

  • Two new unrelated cases of measles have been identified in returned travellers from Nepal and the Philippines.
  • There have been three cases of measles identified in Victoria this year. These cases were infectious on their return flights to Australia.
  • Offer free measles-mumps-rubella (MMR) vaccine to all people born during or since 1966 who do not have documentation that they have received two measles containing vaccines, or are unsure of their vaccination history, regardless of Medicare status. There is no need to check serology beforehand.
  • Anyone planning overseas travel should ensure they have received vaccinations appropriate to travel.
  • For additional information and resources please go to the measles page.

What is the issue?

Any overseas travel could lead to exposure to measles at the current time. Outbreaks of measles continue to affect Asia, the Pacific Islands, Europe and America.

The table below is a summary of public exposure sites for all current measles cases in Victoria.

Date Time Location Onset of symptoms up to
Tuesday 28 January  Arrived 8.15pm  Malaysia Airlines flight MH129, Kuala Lumpur to Melbourne, departed 9.38am and arrived 8.15pm 
Saturday 15 February 2020 
Tuesday 28 January  8.15pm – 10pm Melbourne Tullamarine Airport, Terminal 3 Saturday 15 February 2020 
Friday 31 January  Arrived 12.06am  CEBU Pacific Air flight 5J49 / CB49, Manila to Melbourne, departed 12.30pm on 30 January and arrived at 12.06am on 31 January     Tuesday 18 February 2020 
Friday 31 January  12.06am – 1.30am  Melbourne Tullamarine Airport, Terminal 3  Tuesday 18 February 2020 

There have been three cases of measles identified in Victoria this year. Two returned travellers from Nepal and the Philippines respectively have been identified as the second and third cases of measles identified in Victoria in 2020. Almost all measles cases in Victoria in the last year have been 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 have been in 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 travelled overseas or visited any of the areas listed above and are unvaccinated or partially vaccinated for measles.

Who is at risk?

Any person born during or since 1966 and who does not have documented evidence of receiving two doses of a measles-containing vaccine or does not have documented evidence of immunity. 

Unvaccinated infants are at particularly high risk of contracting measles. Infants as young as six 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.

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

Free measles-mumps-rubella (MMR) vaccine is available for people susceptible to measles. People who are not Medicare eligible can also receive the free, state funded, MMR vaccine. Serology is not required before vaccinating. 

A person is potentially susceptible if they are born during or since 1966 and do not have documented evidence of receiving two doses of a measles-containing vaccine or do not have documented evidence of immunity. Anyone planning overseas travel should ensure they have received vaccinations appropriate to that travel.

General practices and emergency departments are recommended to:

  • 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 and 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.
  • 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. 
  • 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.

More information

For resources related to this outbreak go to: DHHS - Measles in Victoria

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).