What is the issue?
An individual who is a confirmed case of measles has spent significant time in Chadstone Shopping Centre, on 26th December, between 11am and 2pm. Anyone who presents with compatible signs and symptoms of measles should be tested and notified to the Department. There should be an especially high index of suspicion if they have been in Chadstone Shopping Centre at the times stated above.
Who is at risk?
Children or adults born during or since 1966 who do not have documented evidence of receiving 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. Individuals, especially children, are typically unwell.
The most important clinical predictors are the following features:
- generalized, maculopapular rash, usually lasting three or more days, AND
- fever (at least 38°C, if measured) present at the time of rash onset, AND
- cough or coryza or conjunctivitis.
Measles is transmitted by airborne droplets and direct contact with discharges from respiratory mucous membranes of infected persons and less commonly, by articles freshly soiled with nose and throat secretions.
Measles is highly infectious and can persist in the environment for up to two hours.
The incubation period is variable and averages 10 days (range: 7 ; 18 days) from exposure to the onset of fever, with an average of 14 days from exposure to the onset of rash. The infectious period of patients with measles is roughly five days before, to four days after, the appearance of the rash.
Use the most appropriate tests for diagnosis depending on timing of symptoms and presentation:
- Take blood for serological confirmation in all suspected cases. If a patient has measles, IgM is reliably positive if the rash has been present for three or more days. IgG in the absence of IgM indicates the patient is protected and means measles is unlikely.
- Nose and throat swabs for PCR diagnosis are best for early diagnosis (including prior to rash); you must contact the Department prior to taking swabs to gain approval for these to be tested at the Victorian Infectious Diseases Reference Laboratory. PCR testing for measles does not attract a Medicare rebate.
The picture below is typical of rash on the face. This is rash on day three in a young boy.
Picture courtesy of U.S. Centers for Disease Control and Prevention
- Be alert for new measles cases – ensure all staff, especially triage nurses, have a high index of suspicion for patients presenting with a febrile rash.
- Notify suspected cases immediately to the Communicable Disease Prevention and Control Section via telephone on 1300 651 160.
- Take blood for serological confirmation or call the department for PCR diagnosis.
- 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 two hours after the consultation.
- Seek advice from the Department of Health Communicable Disease Prevention and Control Section regarding:
- the management of susceptible hospital or clinic contacts
- prevention of measles in susceptible contacts.
- On advice, follow up all persons who attended the emergency department or clinic at the same time as a case and for two hours after the visit. These people are considered to be exposed to the measles virus.
- Check your staff vaccination records.
- Earlier outbreaks have affected health care workers, including some who have not been involved in the direct care of measles cases and have only been in the same ward, clinic, or department as a case. All staff born during or since 1966 should have documentation of two doses of measles-containing vaccine, or laboratory-confirmed evidence of past measles infection.
For further information please contact the Communicable Disease Prevention and Control section at the Department of Health on 1300 651 160 (business hours) or 1300 790 733 (after hours).