Status:
Active
Health alert:
AL19006
Date Issued:
22 May 2019 (update to Alert issued 21 May 2019)
Issued by:
Dr Angie Bone, Acting Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • Seven confirmed measles cases have been identified in Victorian residents who had contact with two separate overseas travellers with measles. 
  • Be alert for measles in patients presenting with a fever at rash onset, particularly if they visited the places 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. If well patients are unsure of their vaccination status, or are aged over 18 months and have only had one vaccine, please vaccinate. Serology is not required before vaccinating. 
  • There are a large number of international measles outbreaks currently ongoing 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 are susceptible.

What is the issue?

In 2019 there have now been 22 cases of confirmed measles notified in Victoria. Almost all cases are in people who are not fully immunised against measles, and almost all cases are amongst people who have either travelled overseas or being 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.

Seven new cases of measles have now been identified in people who were susceptible to measles and who came into contact with two confirmed cases who were overseas travellers in Victoria in the last week of April and first week of May. All of these more recent cases have visited public areas whilst potentially infectious, creating a risk for transmission at a number of locations, across a number of areas.

Patients with a compatible illness who have travelled overseas or have visited a number of areas may be more likely to develop measles. Current areas where there may have been exposure to measles since the first week of May are: Ballarat, Bendigo, Geelong, Abbotsford, Fairfield, North Fitzroy, Melbourne CBD, St Kilda, Williamstown, Chadstone, Oakleigh, Mount Waverley, Frankston, Mornington, Epsom and Broadmeadows. Other places where there may have been exposures are Melbourne Airport, Monash University, Peninsula campus and Baxter.

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, please vaccinate. Serology is not required before vaccinating. 

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. These pictures below are typical of a measles rash.

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

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 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

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).