Status:
Resolved
Health alert:
AL19007
Date Issued:
22 Jul 2019
Issued by:
Dr Brett Sutton, Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • A confirmed measles case has been identified in a Victorian resident whom is a returned overseas traveller. 
  • 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 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 ongoing international measles outbreaks 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 do not have a history of two previous MMR vaccinations. 

What is the issue?

There has been a new case of measles in a person who was infectious whilst returning from overseas travel in the Philippines.  The table below is a summary of all public exposure sites for the current measles case in Victoria

Date Time Location Onset of symptoms up to
Saturday 20 July 4pm – 6.30pm Cebu Pacific flight 5J49, Manila to Melbourne,  Melbourne Airport - Terminal 2 Wednesday 7 August 2019

In 2019 there have now been 27 cases of confirmed measles notified in Victoria. Almost all cases are 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 are 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 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 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. These pictures 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 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).