Measles Alert

Metro North Public Health Unit (MNPHU) has confirmed a case of measles in a two-year-old boy in the Brisbane area.

The child is believed to have visited the following locations while unknowingly infectious:

• Flight TG346 Lahore to Bangkok Saturday 7 – Sunday 8 December
• Flight TG 461 Bangkok to Melbourne Sunday 8 December
• Melbourne International Airport Sunday 8 December 2100 - 2200
• Melbourne Domestic Airport Monday 9 December 0500 - 0730
• Flight JQ562 Melbourne to Brisbane Monday 9 December
• Brisbane Domestic Airport Monday 9 December 0820 – 0930
• The Prince Charles Hospital Paediatric Emergency Department Tuesday 10 December 0800 – 0940
• The Star Brisbane, QUT graduation ceremony Tuesday 10 December 1640- 2200
• Nundah Family Practice, Nundah Thursday 12 December 1230-1315
• Lumus Imaging, Nundah Thursday 12 December 1300-1350
• The Prince Charles Hospital Paediatric Emergency Department Thursday 12 December 1820 – Friday 13 December 0015

Key points

1. Measles outbreaks are occurring in a number of overseas countries, with cases notified in travellers to Victoria, Western Australia and Queensland.                              
2. There have been two cases of measles in returning overseas travellers to Queensland in recent weeks. Further cases may present in Queensland.                     
3. Clinicians should be alert for signs and symptoms of measles, particularly in 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, other members of the community who are not fully vaccinated and people with a weakened immune system.

Management 

• Test for measlesand 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.                            

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 or your facility Infection Prevention and Control team for further advice.

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.                                                                                                                      
• There is no need to check measles serology prior to vaccination.

Further information                                                                              

• 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.                                                                                                                                       
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