Status:
Resolved
Health alert:
AL19009
Date Issued:
16 Sep 2019 - Update to Alert issued 11 Sep 2019
Issued by:
Dr Brett Sutton, Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • A new confirmed measles case has been identified in a visitor from New Zealand. This case is unrelated to the previous three cases confirmed in the last three weeks. This person was infectious while attending multiple public areas across Melbourne.
  • New Zealand is currently experiencing a widespread outbreak of measles with over 1200 cases notified this year, including ongoing cases in Auckland and more recently, Queenstown.
  • A second confirmed measles case has been identified in a Victorian resident who had contact with a confirmed case. This person was infectious while attending multiple public areas across Melbourne.
  • A large outbreak of measles continues to affect Asia, Europe and America. Virtually any overseas travel could lead to exposure to measles at the current time.
  • People who are planning any overseas travel should ensure they have received vaccinations appropriate to travel, including an MMR vaccine if they do not have a documented history of two previous MMR vaccinations. 
  • 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 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.
  • Offer free measles-mumps-rubella (MMR) vaccine to all eligible people born during or since 1966. Patients unsure of their vaccination status, or who are aged over 18 months and have only had one measles-containing vaccine, should be vaccinated.
  • Infants as young as six 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.

What is the issue?

The most recent case of measles is in a visitor from New Zealand. This new case is unrelated to the previous three cases notified within the last three weeks. The table below is a summary of all public exposure sites for all current measles cases in Victoria.

Date Time Location Onset of symptoms up to
Friday, 30 August  10.30am  Air New Zealand flight NZ123, departing Auckland 08.45am and arriving Melbourne 10.30am  Tuesday, 17 September 2019 
Friday, 30 August  10.30am – 12pm  Melbourne Tullamarine airport, terminal T2  Tuesday, 17 September 2019 
Friday, 30 August   8.30am – 9am  Sons of Mary, 14 Spink Street, Brighton  Tuesday, 17 September 2019 
Friday, 30 August   12.30pm – 2pm  Port Park Café, 484 Graham Street, Port Melbourne  Tuesday, 17 September 2019 
Saturday, 31 August  10.30am – 12pm  Malvern Central, Wattletree Road, Armadale  Wednesday, 18 September 2019 
Saturday, 31 August  12pm – 1.30pm  Mr. & Mrs. P, 312 Bay Street, Brighton  Wednesday, 18 September 2019 
Saturday, 31 August  2.30pm – 4pm  Skateworld Mordialloc, 209 Boundary Road, Mordialloc  Wednesday, 18 September 2019 
Sunday, 1 September  2pm – 4.30pm  Donovans, 40 Jacka Boulevard, St. Kilda  Thursday, 19 September 2019 
Thursday, 5 September  11am – 12pm  Bernhart Allan Pharmacy, 600 Hawthorn Road, Brighton East  Monday, 23 September 2019 
Friday, 6 September  All day  The Nunnery Accommodation, 116 Nicholson Street, Fitzroy  Tuesday, 24 September 2019 
Saturday, 7 September  All day  The Nunnery Accommodation, 116 Nicholson Street, Fitzroy  Wednesday, 25 September 2019 
Sunday, 8 September  All day  The Nunnery Accommodation, 116 Nicholson Street, Fitzroy  Thursday, 26 September 2019 
Sunday, 8 September  5.30pm – 9pm  Universal Restaurant, 141 Lygon Street, Carlton  Thursday, 26 September 2019 
Monday, 9 September  All day  The Nunnery Accommodation, 116 Nicholson Street, Fitzroy  Friday, 27 September 2019 
Monday, 9 September  10pm – 12.15am  Melbourne Tullamarine airport, Terminal 2  Friday, 27 September 2019 
Monday, 9 September  11.45pm  Jetstar flight JQ217, departing Melbourne 11.45pm and arriving Auckland 5.20am on 10 September  Saturday, 28 September 2019 
Thursday, 12 September  7.30pm – 9.30pm  Lynbrook Hotel, 550 South Gippsland Hwy, Lynbrook  Monday, 30 September 2019 

In 2019 there have now been 36 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 travelled overseas or visited any of the areas listed above and are unvaccinated or partially vaccinated for measles. 

Who is at risk?

Free measles-mumps-rubella (MMR) vaccine is now available for people susceptible to measles. A person is considered susceptible to measles 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. Serology is not required before vaccinating.

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

  • Identify patients who are susceptible to measles, especially those planning travel overseas, and offer free measles-mumps-rubella (MMR) vaccine.
  • 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.

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).