Status:
Resolved
Health alert:
160002
Date Issued:
23 Feb 2016 updated 17 March 2016
Issued by:
Dr Roscoe Taylor, Acting Chief Health Officer, Victoria
Issued to:
General Practitioners and Hospital Emergency Departments

Key messages

  • Cases of measles are continuing to be diagnosed in individuals living in Melbourne. For updated case numbers go to FAQs - Measles outbreak in Melbourne.
  • Consider the possibility of measles in any person who is susceptible to measles and develops a compatible illness.
  • Be alert for measles in patients presenting with a fever and rash, or with a prodrome (fever followed by coryza, conjunctivitis or cough) after an established exposure.
  • Minimise the risk of transmission within your department/practice through immediate isolation of suspected cases.
  • Notify Communicable Disease Prevention and Control at the Department of Health and Human Services (DHHS) of suspected and confirmed cases immediately on 1300 651 160. This is a requirement under the Public Health and Wellbeing Act 2008, and is important as delayed notification hampers initiation of public health actions to prevent further spread of disease.
  • For patients who meet the clinical case definition, take blood for serological confirmation and nose and throat swabs for PCR diagnosis (call DHHS for authorisation before ordering PCR on 1300 651 160).
  • Encourage all people in your practice - patients and staff alike - who were born after 1966 and who have not yet had TWO doses of measles containing vaccine, to consider this now to help stop further spread.

What is the issue?

The Department of Health and Human Services continues to be notified of confirmed cases of measles in people residing in Melbourne. The majority of cases have been in un- or under-vaccinated younger adults.

In the initial outbreak cases resided in Brunswick and surrounding areas, however a broader range of suburbs is now affected and ongoing clinical vigilance is required across Greater Melbourne.

In all cases the disease has been acquired locally with no history of overseas travel. This constitutes a community outbreak with local transmission.

As measles is highly infectious through airborne transmission, other cases could occur in susceptible people. Measles has an incubation period of between 7 and 18 days (average 14 days from exposure to rash) so should be considered in any susceptible person who presents with a compatible illness now or up until late-March 2016.

It is important that clinicians consider measles as a differential diagnosis in any susceptible patients with a clinically compatible illness. These patients need to be identified early and isolated to minimise the risk of transmission of this highly contagious virus to others. Measles must be notified to the Department of Health and Human Services immediately upon suspicion (which includes testing for measles or referring for further medical assessment) on 1300 651 160, to allow the Department to instigate urgent public health measures such as contact tracing. Delayed notification of cases (for example waiting for serological confirmation, when strong clinical features are already present) in this outbreak hinders the public health response aimed at preventing the spread of disease. Refer to the Recommendations section below for more information.

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 documented evidence of laboratory-confirmed measles immunity are considered to be susceptible to measles.
  • People who are immunocompromised are also at risk.

Symptoms and transmission

Measles initially presents with a prodrome of fever, cough, conjunctivitis, and coryza. A generalised maculopapular rash develops two to five days after the onset of the prodrome, coinciding with fever. Koplik spots on the buccal mucosa may be present for three to four days prior to rash onset but not at time of rash. Individuals, especially children, are typically unwell.

Clinical case definition: the following clinical features must be present to meet the case definition for measles:

  • generalised maculopapular rash, usually lasting three or more days, AND
  • fever (at least 38°C, if measured) present at the time of rash onset, AND
  • cough or coryza or conjunctivitis.

Measles is transmitted by airborne droplets and direct contact with discharges from respiratory mucous membranes of infected persons and less commonly by articles freshly soiled with nose and throat secretions.

Measles is highly infectious and can persist in the environment for at least 30 minutes.

The incubation period is variable and averages 10 days (range: 7 – 18 days) from exposure to the onset of fever, with an average of 14 days from exposure to the onset of rash. The infectious period of patients with measles is five days before, to four days after, the appearance of the rash.

measles_boy 

This picture is typical of rash on the face. This is a rash on day three in a young boy.
Picture courtesy of U.S. Centers for Disease Control and Prevention

Recommendations

  • Be alert for new measles cases – ensure all staff, especially triage staff, have a high index of suspicion for measles in patients presenting with a fever and a rash.
  • Use the measles waiting room poster to alert patients to the symptoms and signs of measles
  • Utilise the measles triage poster to ensure triage staff are alert to the symptoms and signs of measles.
  • Notify clinically suspected cases of measles immediately to Communicable Disease Prevention and Control at the Department of Health and Human Services via telephone on 1300 651 160.
  • In patients who meet the clinical case definition (see above), take blood for serological confirmation and nose and throat swab for PCR diagnosis (please discuss with DHHS for authorisation prior to ordering PCR).
  • Minimise the risk of measles transmission within your facility:
    • 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 measles is excluded.
    • Leave vacant all consultation rooms used in the assessment of patients with suspected measles for at least 30 minutes after the consultation.
  • Seek advice from Communicable Disease Prevention and Control regarding the management of susceptible hospital, clinic, household or other contacts.
  • On advice, follow up all persons who attended the Emergency Department or clinic at the same time as a case and for 30 minutes after the visit. These people are considered to be exposed to the measles virus.
  • The first dose of MMR vaccine is currently scheduled at 12 months of age. At this stage there is no indication to provide the first dose earlier, unless there is specific advice from the Department of Health and Human Services confirming contact with an infectious case.
  • If parents request an early second dose for their child (for example, because they are aged between 13 months and 4 years), a second dose can be provided at least one month after the initial dose. Please note that the 4 year old dose of DTPa-IPV must not be administered before 3.5 years of age.
  • There is no need to actively recall patients for measles vaccinations earlier than specified on the immunisation schedule.

Prevention

  • Promote timely vaccinations in your patients.
  • Encourage all patients in your practice who were born after 1966 and who have not yet had TWO doses of measles containing vaccine, to do so now and help reduce secondary transmission of cases.
  • Check your staff vaccination records. All health facilities should ensure that staff who are born during or since 1966 should have documentation of two doses of measles-containing vaccine, or laboratory-confirmed evidence of measles immunity. Non-immune staff should receive MMR vaccine, unless contraindicated.
  • Free measles vaccine is available for all children between the ages of one year and 10 years, routinely given at 12 months and 18 months of age. Others eligible for free measles vaccine include:
    • Young people aged 10 to 19 years
    • Refugee and asylum seekers and Aboriginal and Torres Strait Islander people born since 1966
    • Vulnerable citizens born since 1966
    • Women planning pregnancy or post-partum with low or negative rubella antibody
See Eligibility criteria for free vaccines for more information.

More information

Clinical information

The Australian Immunisation Handbook; 10th edition, 2013.

The Blue Book – Guidelines for the control of infectious diseases

For updated case numbers view DHHS Media releases

Consumer information

Better Health Channel

Contacts

For further information please contact Communicable Disease Prevention and Control at the Department of Health and Human Services on 1300 651 160 (24/7).