Increased risk of measles in greater Melbourne area

What is the issue?

There is an increased risk of measles in the greater Melbourne area. The number of measles cases who acquired their infection in the greater Melbourne area is increasing. In addition, there is an ongoing risk of measles importation in Victoria in travellers returning from overseas or interstate. These recent measles cases have been infectious while in public settings at multiple locations around greater Melbourne area and Gippsland.

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

Measles vaccination coverage rates in Australia, while comparatively high, have declined to below the 95% national target since the COVID-19 pandemic. Almost all recent cases have arisen in people who have not had two documented doses of the MMR vaccine, showing the highly infectious nature of measles. In one instance, transmission occurred in a primary care waiting room, highlighting the importance of immediate isolation of people with fever and rash who present to healthcare settings.

Global case numbers of measles are rising and any overseas travel could also lead to exposure to measles. There are currently outbreaks reported in multiple countries and regions, including Vietnam, Thailand, India, Africa, Europe and the UK, the Middle East, and North America.

A number of populations in Victoria are susceptible to measles, including anyone who is unvaccinated, infants under 12 months of age, immunocompromised people and adults who were born between 1966 and 1992 who may not have received two MMR vaccines in childhood.

Active public exposures sites in Victoria for recent cases are listed in the table below.

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

In addition, anyone who presents with signs and symptoms compatible with measles should be tested and notified to the Department of Health immediately. There should be an especially high level of suspicion if they have travelled overseas or visited any of 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. This is also known as being susceptible to measles.

Unvaccinated infants are at particularly high risk of contracting measles. Victorians born between 1966 and 1992 may not have received two doses of vaccine, which are required to provide immunity.

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 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 date and time or spent time in the greater Melbourne area from mid-March should monitor for symptoms and seek medical care if symptoms develop for up to 18 days after the exposure. 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. Check if you’re protected against measles today. If you're unsure of your immunisation status, you can get a booster MMR vaccine now.
• The MMR vaccine is free for all Victorians. Vaccination is available from a wide range of immunisation providers in Victoria including GPs, pharmacies, local councils, Aboriginal Health Services.
• There are growing measles outbreaks around the world, and anyone traveling overseas should make sure they have received appropriate travel vaccinations, including the MMR vaccine.

For health professionals

• For persons who have attended an exposure site, 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 should be alert for measles in patients presenting with a compatible illness, irrespective of their travel history.
• Anyone who presents with signs and symptoms compatible with measles 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.
• Test for measles via PCR and serology in any patients with compatible symptoms. Label PCR samples as ‘urgent’ and sent 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.
• 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.