What is the issue?
A recent increase in measles transmission in Asian countries has
resulted in Australian travellers becoming infected with the disease and
infecting others after returning to Australia. All the recently
confirmed cases had not been vaccinated against measles, had received only
a single dose of a measles vaccine as a child or were unvaccinated as they
were under 12 months of age. All other States and Territories have also had
cases linked to travel within Asia.
Who is at risk?
Individuals planning to travel to Asia (especially the Philippines,
Bali, Thailand, India and Sri Lanka) or recently returned travellers and
those in contact with them.
Children or adults born in or since 1966 who do not have documented
evidence of two doses of a measles-containing vaccine or documented
evidence of laboratory-confirmed measles are considered to be susceptible
to measles. People who are immunocompromised may also at risk irrespective
of vaccine status.
Symptoms and transmission
Important clinical predictors are:
- prodromal fever (at least 38°C, if measured) present at the
time of rash onset, AND
- cough or coryza or conjunctivitis, AND
- generalised maculopapular rash, usually begins on the face and
lasts three or more days.
Measles is transmitted by airborne droplets by direct contact with
discharges from respiratory mucous membranes of infected persons and less
commonly by articles freshly soiled with nose and throat secretions.
Individuals, especially children, are typically unwell.
Measles is highly infectious and infective droplets may remain suspended in
the air for extended periods.
The incubation period is variable, but averages ten days from exposure
to the onset of fever (range: 7 – 18 days), with an average of 14
days from exposure to the onset of rash. The infectious period of patients
with measles is from roughly five days before, to four days after, the
appearance of the rash.
This picture is typical of the rash on the face at day three in a
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
- Be alert for new measles cases. Ensure all staff, especially triage
nurses, have a high index of suspicion for patients presenting with a
- Check your staff vaccination records. All staff born in or since
1966 should have documentation of two doses of measles-containing
vaccine, or laboratory-confirmed evidence of measles immunity.
- Notify suspected cases immediately to the Communicable Disease
Prevention and Control Section via phone on 1300 651 160.
- Call the Department for approved PCR testing and consider taking
blood for serological confirmation. (PCR testing for measles does not
attract a Medicare rebate, and will incur a cost without Department
- Minimise the risk of measles transmission within your
- 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 diagnosis is made
- leave vacant all consultation rooms used in the assessment
of suspected measles patients for at least 30 minutes after the
consultation (please note this is a recent update to the
previous recommendation of 2 hours’ wait to re-use a
room. This is in line with the current National Guidelines,
- Seek advice from the Communicable Disease Prevention and Control
Section regarding the management of susceptible hospital or clinic