New measles case in Victoria

What is the issue?

A new case of measles has been identified in a returned overseas traveller who attended multiple public exposure sites in Victoria whilst infectious. There have now been 14 cases of measles reported in Victoria since 1 January 2024.

Measles is a highly infectious viral illness that can lead to uncommon but serious complications, such as pneumonia and brain inflammation (encephalitis).

Any overseas travel could lead to exposure to measles at the current time. Outbreaks of measles have been been reported in Asia (including Indonesia, Vietnam and India), Africa, Europe and the UK, the Middle East and the USA this year.

Active public exposures sites in Victoria for this case are listed in the table below.

Anyone who has attended a listed exposure site during the specified date and time should monitor for symptoms and seek medical care if symptoms develop for up to 18 days after the exposure. Anyone who presents with signs and symptoms compatible with measles should be tested and notified to the Department of Health. There should be an especially high level of suspicion if they have travelled overseas or visited any the sites listed above and are unvaccinated or partially vaccinated for measles.

Who is at risk?

• Anyone born during or since 1966 who does not have documented evidence of having received two doses of a measles-containing vaccine, or does not have documented evidence of immunity, is at risk of measles.
• Unvaccinated infants are at particularly high risk of contracting 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.

Initial symptoms of measles may be similar to those of COVID-19 and influenza. If a symptomatic person tests negative for COVID-19 and/or influenza but develops a rash, they should be advised to continue isolating and be tested for measles.

People with measles are potentially 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: Examples of a typical measles rash.

Recommendations

For the general public

• If you attended a listed exposure site during the specified date and time and are not fully vaccinated for measles you may be eligible to receive the MMR vaccine as preventative treatment if you present within 72 hours (3 days) of exposure (up to 12:10pm, 7 December 2024).
• If you are immunocompromised or pregnant and not fully vaccinated for measles you may be eligible to receive normal human immunoglobulin (NHIG).
• You should see seek medical care as soon as possible if you meet these criteria.
• Anyone who has attended a listed exposure site during the specified date and time should monitor for symptoms and seek medical care if symptoms develop for up to 18 days after the exposure.
• Symptoms of measles can initially resemble a cold or flu and include fever, cough, sore or red eyes (conjunctivitis), runny nose, and feeling generally unwell, followed by a red rash. The rash usually starts on the face before spreading down the body.
• Anyone who develops symptoms of measles should seek medical care. Call the health service beforehand to advise that you may have been exposed to measles and wear a mask.
• The measles-mumps-rubella (MMR) vaccine provides safe and effective protection against measles. The MMR vaccine is available for free:
  • on the National Immunisation Program, routinely given at 12 months and 18 months of age.
  • for anyone born during or after 1966 who have not already received two doses of measles-containing vaccine, are unsure of their vaccination status, or do not have evidence of immunity to measles.
  • for young infants aged 6 to 12 months prior to overseas travel to countries where measles is endemic or where outbreaks of measles are occurring. If an infant receives an early dose of MMR vaccine prior to travel, they should still receive routine doses at 12 months and 18 months of age as per the National Immunisation Program schedule.
  • For further information, speak to your immunisation provider.
• Anyone planning overseas travel should make sure they have received appropriate travel vaccinations.

For health professionals

• Anyone who 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 may be eligible to receive normal human immunoglobulin (NHIG) if they present up to 144 hours (6 days) after close exposure to a measles case.
• Clinicians are advised to be alert for measles in patients presenting with compatible illness, particularly those with overseas travel or who attended a listed exposure site during the specified dates and times or who are not fully vaccinated against measles.
• Anyone who presents with signs and symptoms compatible with measles should be tested and notified to the Department of Health. There should be an especially high level of suspicion if they have travelled overseas or visited any the site listed above and are unvaccinated or partially vaccinated for measles.
• Suspected cases should be tested, isolated, and notified to the Department of Health immediately by calling 1300 651 160 and connecting to the relevant Local Public Health Unit.
• Discuss the need for PCR testing using nose and throat swabs with the Local Public Health Unit (PCR testing for measles does not attract a Medicare rebate).
• Take blood samples for measles serology in all suspected cases.
• Minimise the risk of measles transmission within your practice/department:
  • 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 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.
• Offer 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. Serology is not required before vaccinating. People who are not Medicare eligible can also receive the free MMR vaccine. Refer to the Australian Immunisation Handbook – Measles for further guidance on immunisation.