What is the issue?
Any overseas travel at the current time could lead to exposure to measles. Outbreaks of measles continue to affect Asia, the Pacific Islands, Europe and America. New Zealand and Samoa are currently experiencing widespread outbreaks of measles.
The table below is a summary of public exposure sites for all current measles cases in Victoria.
||Onset of symptoms up to
|Tuesday 7 January
||12pm – 1pm
||Woolworths Waurn Ponds, 173-199 Pioneer Rd, Waurn Ponds
||Saturday 25 January 2020
|Thursday 9 January
||7.15pm – 8.30pm
||Soul Pattinson Chemist, 148 Myers St, Geelong
||Monday 27 January 2020
In 2019 there were 57 cases of confirmed measles notified in Victoria. A returned traveller from Italy has been identified as the first case of measles identified in Victoria in 2020. Almost all recognised 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.
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.
For resources related to this outbreak go to: DHHS - Measles outbreak in Victoria
The Australian Immunisation Handbook:
The Blue Book Guidelines for the control of infectious diseases
Better Health Channel
Also see three videos on measles at YouTube
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).