Status:
Resolved
Health alert:
AL180006
Date Issued:
06 Apr 2018 (update to previous alert issued 29 March 2018)
Issued by:
Dr Brett Sutton, Deputy Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • There has been one additional confirmed case of measles in Melbourne which may be linked to a previously reported case from March 2018. This takes the total number of measles cases confirmed since early March 2018 to fourteen.
  • The list below outlines additional sites where the latest case may have been infectious with measles. Susceptible patients who attended these sites at the dates and times specified should continue to look out for measles until up to 18 days after their exposure.
  • Be alert for measles in patients presenting with a fever at rash onset, particularly if they attended any of the places listed and  notify the Communicable Disease Prevention and Control Section at the Department of Health and Human Services on 1300 651 160 of suspected cases immediately.
  • Avoid sending suspected cases to an emergency department unless the illness is severe enough to warrant admission. Isolate suspected cases to minimise the risk of transmission within your department/practice.
  • 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.

What is the issue?

There has been one additional confirmed case of measles in Melbourne which may be linked to an earlier reported case from March 2018. This brings the total number of measles cases since March 2018 to fourteen.

Seven of the confirmed cases are linked to a previously reported case who was infectious on flight D7214 from Kuala Lumpur to Melbourne, and in Tullamarine airport on Wednesday 7 March  from 9.30am until midday. Three of the additional confirmed cases of measles were likely to have been acquired overseas, in different locations, with one case directly linked to one of these confirmed cases.

The latest case has identified as a rough sleeper and has attended a number of locations in and around Melbourne whilst infectious including:

  • Thursday 29 March to Wednesday 3 April – Coburg Motor Inn
  • Thursday 29 March – Launch Housing, St Kilda from 9.00am to 12pm
  • Tuesday 3 April – Launch Housing, St Kilda from 9.00am to 12pm
  • Wednesday 4 April – Launch Housing, St Kilda from 9.00am to 12pm, The Engagement Hub, St Kilda from 11.30am to 1.30pm, Jam Factory South Yarra from 1.00pm to 8.30pm

Cases may still emerge from the below sites previously listed and linked to earlier cases:

  • Thursday 22 March – Woolworths Echuca from 1pm to 2.30pm
  • Friday 23 March – Langwarrin Discount Pharmacy 10.00am
  • Saturday 24 March – Waterside Bar, Flinders St Melbourne 10pm to12 midnight
  • Sunday 25 March – The Classic Pizza House Langwarrin 5.00pm

Further sites may be added as cases are confirmed. None of the sites above need to be avoided now as they do not pose an ongoing risk to visitors.

As measles is highly infectious through airborne transmission, other secondary cases may occur in susceptible people. Measles has an incubation period of between seven and 18 days (average 14 days from exposure to rash) so should be considered in the differential diagnosis of any susceptible person who presents with a compatible illness, with an onset date between 29 March and 22 April 2018. Particular attention should be given to patients who identify as rough sleepers or attend homeless accommodation services.

Anyone who presents with signs and symptoms compatible with measles should be immediately notified to the Department on 1300 651 160 and tested. Do not wait for test results before notifying. There should be an especially high index of suspicion if the patient has attended any of the areas stated above and are unvaccinated or partially vaccinated for measles.

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. Individuals are typically unwell, especially children.

The most important clinical predictors are the following features:

  • generalised, 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, coryza or conjunctivitis.

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.

This picture is typical of rash on the face. This is a rash on day three in a young boy.

Example of measles rash on the face of a young boy.
Picture courtesy of U.S. Centers for Disease Control and Prevention

Summary of recommendations

  • 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 (24 hours).
  • Manage suspected cases in the GP setting if appropriate and avoid sending to a hospital emergency department unless your patient is severe enough to warrant admission to hospital.
  • 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.
  • Seek advice from the Department of Health and Human Services Communicable Disease Prevention and Control Section regarding:
    • the management of susceptible hospital or clinic contacts
    • prevention of measles in susceptible contacts.
  • Take blood for serological confirmation.
  • Call the department to discuss the need for PCR diagnosis.
  • On advice, follow up all persons who attended the emergency department or clinic at the same time as a case and for 30 minutes 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.

More information

Clinical information

The Australian Immunisation Handbook; 10th edition, 2013

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).

Find out more about the Chief Health Officer.