What is the issue?
A confirmed case of measles has spent significant time in the following places while infectious.
- April 16 2018 - Qantas Flight QF36 Singapore - Melbourne (Tullamarine) arriving 6.40am
- April 16 2018 - Melbourne Tullamarine Airport arrivals, baggage claim and shuttle bus area 6.40-7.30am
- April 21 2018 - Wildcats Basketball Stadium located at Eltham High School from 4.45-6.00pm.
There has been no identified link to other cases from Melbourne in early March. The case, an adult male, was in both Australia (8 days) and Thailand (10 days) during the exposure period (18 days). However, it is most likely that the infection was acquired in Thailand as the incubation period is generally 7-18 days from exposure, usually around day 10.
Unfortunately, the notification was made late to the department, so it is only now that passengers are being warned via media release and some may already be showing early symptoms. It is critical that diagnosing doctors and laboratories notify the department as soon as they are aware of cases to enable immediate follow-up.
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 attended any of the areas stated above and are unvaccinated or partially vaccinated for measles.
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. Individuals, especially children, are typically unwell.
The most important clinical predictors are the following features:
- 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, coryza or conjunctivitis.
Measles is transmitted by airborne droplets and direct contact with discharges from respiratory mucus 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 up to two hours.
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 roughly five days before, to four days after, the appearance of the rash.
Use the most appropriate tests for diagnosis depending on timing of symptoms and presentation:
- Take blood for serological confirmation in all suspected cases. If a patient has measles, IgM is reliably positive if the rash has been present for three or more days. IgG in the absence of IgM indicates the patient is protected and means measles is unlikely.
- Nose and throat swabs for PCR diagnosis are best for early diagnosis (including prior to rash); you must contact the Department prior to taking swabs to gain approval for these to be tested at the Victorian Infectious Diseases Reference Laboratory. PCR testing for measles does not attract a Medicare rebate.
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
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 PCR diagnosis.
- 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.
- Seek advice from the Department of Health and Human Services Communicable Disease Prevention and Control Section regarding:
- the management of susceptible hospital or clinic contacts
- prevention of measles in susceptible 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.
- Check your staff vaccination records.
- Earlier outbreaks have affected health care workers, including some who have not been involved in the direct care of measles cases and have only been in the same ward, clinic, or department as a case. All staff born during or since 1966 should have documentation of two doses of measles-containing vaccine, or laboratory-confirmed evidence of past measles infection.
The Australian Immunisation Handbook; 10th edition, 2013
The Blue Book - Guidelines for the control of infectious diseases - measles
Better Health Channel - measles
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).
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