What is the issue?
A large outbreak of measles continues to affect Asia, the Pacific Islands, Europe and America. New Zealand is currently experiencing a widespread outbreak of measles with over 2000 cases notified this year. The most recent case arrived from Samoa where there is also a current outbreak. Virtually any overseas travel could lead to exposure to measles at the current time.
The table below is a summary of all public exposure sites for all current measles cases in Victoria.
||Onset of symptoms up to
|Sunday, 27 October
||Fiji Airways flight FJI931 from Nadi to Melbourne, arriving 11.35pm
||Thursday, 14 November 2019
|Sunday, 27 October
||11.35pm to 1.30am Sunday, 28 October
||Melbourne Tullamarine Airport, Terminal 2
|Friday, 15 November 2019
In 2019 there have now been 40 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 travelled overseas or visited any of the areas listed above and are unvaccinated or partially vaccinated for measles.
Who is at risk?
Anyone planning overseas travel should ensure they have received vaccinations appropriate to that travel.
Free measles-mumps-rubella (MMR) vaccine is now available for people susceptible to measles. A person is considered susceptible to measles 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. Serology is not required before vaccinating.
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
- Identify patients who are susceptible to measles, especially those planning travel overseas, and offer free measles-mumps-rubella (MMR) vaccine.
- 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.
- Call the department to discuss the need for nose and throat swabs for PCR diagnosis 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.
- 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 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.
- Offer free measles-mumps-rubella (MMR) vaccine to all eligible people born during or since 1966. Patients unsure of their vaccination status, or who are aged over 18 months and have only had one measles-containing vaccine, should be vaccinated.
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).