Clinician Alert - Measles

The case was unknowingly infectious while travelling on a flight from Perth to Brisbane. Further cases may present in Queensland. Clinicians should be alert for signs and symptoms of measles, particularly in returning overseas travellers or those potentially exposed to measles.                                                        

Suspected cases should be tested, advised to isolate, and notified to the local public health unit.

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 
• members of the community who are not fully vaccinated
• people with a weakened immune system.

Measles transmission can occur in healthcare settings. To minimise the risk of transmission within facilities:  

• Patients with fever and rash should avoid shared waiting areas.
• Ensure that any suspected patient is wearing a surgical mask.
• Staff to use airborne transmission-based precautions for patient care where measles is suspected.
• 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 or your facility Infection Prevention and Control team for further advice.

Management 

• Test for measles and isolate patient.
• The treating clinician or patient should notify the pathology service prior to testing for suspected measles.
• 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. These doses are government funded.
• 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 - vaccination is recommended and funded for infants from 6 months of age travelling to any region where measles is endemic or outbreaks are occurring (in Australia or overseas). 

  ---

Further information 

• Gold Coast Hospital and Health Service Public health alert - confirmed case of measles
• QH fact sheet Measles (health.qld.gov.au)
• Measles | The Australian Immunisation Handbook (health.gov.au) - provides clinical guidelines for health professionals on the safest and most effective use of vaccines in their practice.
• Homepage | Smartraveller