Clinician Alert | Measles
Measles outbreaks are occurring in a number of overseas countries, with cases notified in travellers to Victoria, New South Wales, Western Australia, Northern Territory, the Australian Capital Territory and now in Queensland.
The Australian Chief Medical Officer, Professor Anthony Lawler, has recently released a letter urging Immunisation Service Providers (ISPs) and colleagues to remind patients that the best protection against measles is vaccination.
Australia has recently seen a concerning increase in the number of confirmed measles cases. Specifically, in unvaccinated and under-vaccinated adults aged 20 to 49 years. Additionally, vaccination rates have declined across all cohorts and are below the 95% recommended for herd immunity.
It is important to remind people that measles is a serious disease and highly infectious. In Australia it is easily preventable with two doses of the combination measles vaccine providing 99% protection against infection.
Think measles in patients who present with:
- generalised maculopapular rash (usually begins on the face, before spreading to the rest of the body) and
- fever (usually at least 38oC) present at rash onset and
- cough or conjunctivitis or koplik spots.
Who is most at risk?
Infants under 12 months who are too young to be vaccinated against measles, other members of the community who are not fully vaccinated and people with a weakened immune system.
Measles transmission can occur in healthcare settings.
When a patient with suspected measles attends a healthcare facility, contacts (other patients/staff at the facility) are at risk of acquiring the infection.
The following recommendations will minimise the risk of transmission within facilities:
- Avoid keeping patients with fever and rash in shared waiting areas. Consider how the patient may be examined in an area that minimises exposure to others.
- Ensure the patient is wearing a surgical mask.
- Staff to use airborne transmission-based precautions for all patient care.
- Leave all rooms that were used to assess the patient vacant for at least 30 minutes afterwards.
- Ensure all staff in contact with the patient are fully vaccinated (2 documented doses of measles containing vaccine) or have serologically confirmed immunity to measles.
- Contact your local Public Health Unit (MNPHU) or your facility Infection Prevention and Control team for further advice.
Management
- Test for measles and isolate patient.
- Advise patients to call the pathology service prior to presenting.
- Notify the local Public Health Unit immediately on clinical suspicion to allow timely follow up of high-risk contacts.
- Non-immune people who have been exposed to measles should receive an MMR vaccine (or MMRV in some instances) for post-exposure prophylaxis, ideally within 72 hours of exposure.
- MMR-containing vaccines are contraindicated in pregnant women. Normal human immunoglobulin (NHIG) may be recommended by public health authorities.
Prevention
- Anyone born during or since 1966 are recommended to have two documented doses of measles containing vaccine four weeks apart.
- Travellers who are not immune or are unsure of their vaccination history should be vaccinated before they leave Australia. Consider an individual risk assessment for infants aged <12 months – vaccine can be given from 6 months of age for infants travelling to locations where measles is circulating.
- There is no need to check measles serology prior to vaccination.
For further information on Measles vaccination, please visit the Australian Immunisation Handbook website.
See measles alert locations for Brisbane, Gold Coast and Sunshine Coast. For more information about Measles, visit the Queensland Government website.
