New measles cases in Victoria

What is the issue?

Public exposure sites

Anyone who has attended a listed exposure site during the specified dates and times above should monitor for symptoms for up to 18 days after the exposure and follow the recommendations below.

Victoria has seen a significantly higher than usual number of measles cases in the past year.

There is an ongoing risk of measles being imported by travellers returning from overseas or interstate.

Measles cases have recently been reported in other Australian jurisdictions. Globally, measles cases continue to be reported across multiple regions including Asia, Europe, North America, Africa and the Middle East. Outbreaks are reported in multiple neighbouring countries such as Indonesia including Bali, Vietnam, Thailand, Cambodia, the Philippines, Malaysia, Pakistan and India.

Any overseas travel could lead to measles exposure.

Measles vaccination coverage in Australia is below the 95% national target and most recent measles cases in Victoria have occurred in people who have not had two doses of the measles-mumps-rubella (MMR) vaccine.

Who is at risk?

People who are not vaccinated against measles are at increased risk.

Many Victorians born between 1966 and 1992 may not have received two doses of the MMR vaccine and may be susceptible to measles.

Young infants, pregnant women and people with a weakened immune system are at increased risk of serious complications from measles.

Symptoms and transmission

Symptoms of measles include fever, cough, sore or red eyes (conjunctivitis), runny nose, and feeling generally unwell, followed by a red maculopapular rash. The rash usually starts on the face before spreading down the body. Symptoms can develop between 7 to 18 days after exposure.

People with measles are considered infectious from 24 hours prior to the onset of initial symptoms until 4 days after the rash appears. Measles is highly infectious and can spread through airborne droplets or contact with nose or throat secretions, as well as contaminated surfaces and objects. The measles virus can stay in the environment for up to 2 hours.

Figures: Example of a typical measles rash

Recommendations

For the general public

• Anyone who has attended a listed exposure site during the specified dates and times should monitor for symptoms for up to 18 days after the exposure and seek medical care if symptoms develop.
• Anyone who attended a listed exposure site and is not fully vaccinated for measles may be eligible to receive the MMR vaccine if they present within 72 hours (3 days) of exposure. Anyone who is immunocompromised or pregnant and not fully vaccinated for measles should seek medical review if within 6 days of exposure to a measles case.
• Anyone who develops symptoms of measles should seek medical care and testing for measles. Call the health service beforehand to advise that you may have been exposed to measles and wear a face mask.
• Vaccination is the best way to protect yourself and others against measles and is free for all Victorians born during or since 1966. The MMR vaccine is available from a wide range of immunisation providers across Victoria including GPs, pharmacies, local councils and Aboriginal Health Services.
• Anyone who has not had two doses of the MMR vaccine, or are unsure, should speak to their immunisation provider about catch-up vaccination.
• You can check your vaccination history through the myGov webpage at Proof of vaccinations | myGov.
• Local Public Health Units are rolling out local campaigns to help people access the MMR vaccine by providing free vaccination to people aged 20 to 59 years who have not been vaccinated. For more information visit the Local Public Health Unit websites.
• People planning to travel overseas should make sure their routine vaccinations, including measles, are up to date. Infants from 6 months and before 11 months of age can receive a state-funded dose of MMR vaccine prior to overseas travel through their GP or Aboriginal Health Service. Vaccination is recommended at least two weeks before departure.

For health professionals

• For persons born during or after 1966 who have attended an exposure site and are not fully vaccinated, offer MMR vaccine within 72 hours of measles exposure to prevent illness. Normal human immunoglobulin (NHIG) within 6 days may be suitable for young infants, pregnant or immunocompromised people who are not fully vaccinated.
• Be alert for measles in patients with fever, cough, coryza, conjunctivitis and rash, especially if they are not vaccinated, partially vaccinated or unsure of their vaccination status and have attended an exposure site or recently returned from international travel.
• Anyone who presents with signs and symptoms compatible with measles should be tested, isolated and notified to the Local Public Health Unit by calling 1300 651 160.
• Test for measles via nasopharyngeal swab PCR and serology in any patients with compatible symptoms. Label PCR samples as ‘urgent’ and send to VIDRL via your primary pathology provider.
• Minimise the risk of measles transmission within your practice/department/community:
  • avoid keeping patients with fever and rash in shared waiting areas (send to a separate room).
  • if measles is suspected, give the patient a single use, fitted face mask and isolate under airborne precautions until a measles diagnosis can be excluded.
  • leave all rooms that were used to assess the suspected case vacant for at least 30 minutes after the consultation.
  • if returning home, patients should isolate at home until test results are available.
• Ensure on time vaccination for infants under the National Immunisation Program, at 12 months of age MMR (measles-mumps-rubella) and 18 months of age MMRV (measles-mumps-rubella-varicella).
• Offer a state-funded MMR vaccine to infants from 6 months of age who are travelling overseas. Infants who receive an MMR dose prior to 11 months will still need to receive two further doses at 12 and 18 months.
• Offer state-funded MMR vaccine to people born during or after 1966 who do not have documented evidence of receiving two doses of a measles-containing vaccine or documented evidence of immunity. A Medicare card is not required for state-funded MMR vaccine.
• Serology is not required before vaccinating.
• Refer to the Australian Immunisation Handbook – Measles for further guidance on immunisation.