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
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,
- fever (at least 38°C, if measured) present at the time of rash
- 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
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
- 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
- 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
- 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 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
- 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
- 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.
- 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
Eligibility criteria for free vaccines
for more information.
Australian Immunisation Handbook; 10th edition, 2013
The Blue Book – Guidelines for the control of infectious
For updated case numbers view DHHS Media releases
For further information please contact Communicable
Disease Prevention and Control at the Department of Health and Human
Services on 1300 651 160 (24/7).