Status:
Resolved
Health alert:
AL190004
Date Issued:
28 Mar 2019 (update to Alert issued 26 March 2019)
Issued by:
Dr Brett Sutton, Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • There have been additional unrelated cases of measles in persons who may have been infectious whilst attending multiple public areas across metropolitan Melbourne. To date, a total of nine cases of measles have been notified in Victoria for 2019.
  • Be alert for measles in patients presenting with a fever at rash onset, particularly if they attended the places below in the 7-18 days prior to onset of illness.
  • Isolate suspected cases to minimise the risk of transmission within your department/practice.
  • 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 adults born during or since 1966.

What is the issue?

There have been additional unrelated cases of measles in persons who may have been infectious whilst attending multiple public areas across metropolitan Melbourne. The table below is a summary of all exposure sites for current measles cases in Victoria.

Date Time Location Onset of symptoms up to
Saturday 16 March Day Australian Grand Prix - Jones Stand, Gate 2 entrance and food areas at Gate 1 Wednesday 3 April 2019
Sunday 17 March 12pm - 1pm Woolworths Braybrook Thursday 4 April 2019
Sunday 17 March Day Australian Grand Prix - Fangio Stand, Gate 2 entrance and food areas at Gate 1 Thursday 4 April 2019
Monday 18 March 1pm - 2pm Woolworths Braybrook Friday 5 April 2019
Tuesday 19 March  3:30pm - 7pm  JQ517 Sydney to Melbourne Airport - Terminals 2 and 4  Sunday 7 April 
Tuesday 19 March  6:35pm - 11:35pm  Flight VA99 from Melbourne to Christchurch Sunday 7 April 
Thursday 21 March 5am - 8am  QF1543 Brisbane to Canberra Tuesday 9 April 
Thursday 21 March 8am - 10am  QF809 Melbourne to Canberra  Tuesday 9 April  
Thursday 21 March 10am - 11am  Melbourne Airport - Terminal 1  Tuesday 9 April  
Thursday 21 March 10:30am - 11:30am  Skybus Airport Shuttle to Melbourne, Southern Cross Station  Tuesday 9 April  
Thursday 21 March 11am - 11:30am  Southern Cross Station - Bus Terminal  Tuesday 9 April  
Thursday 21 March Day  Nomads All National Hostel - Spencer Street, Melbourne  Tuesday 9 April  
Friday 22 March Day  Nomads All National Hostel Tuesday 9 April 
Friday 22 March  9:00pm - 9:30pm  7-Eleven, 2 Spencer Street, Melbourne  Tuesday 9 April 
Saturday 23 March  Day Nomads All National Hostel  Wednesday 10 April 
Saturday 23 March  6pm - 7pm Chemist Warehouse, Paramount Centre, Bourke Street, Melbourne  Wednesday 10 April  
Sunday 24 March  Day  Nomads All National Hostel  Thursday 11 April 

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 attended any of the areas stated 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 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.

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 starting on the face. Individuals, especially children, are typically unwell. The infectious period of patients with measles is roughly 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. The picture below 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.

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).
  • Take blood for serological confirmation.
  • 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).