Clinical alert – measles

The following information is from Health Protection NSW – view PDF here 

  1. Measles continues to be imported by travellers from many countries, including New Zealand.
  2. Some recent cases have had no history of travel or contact with known cases.
  3. Consider measles in returning travellers with fever, and in anyone with fever and a maculopapular rash.
  4. IMMEDIATELY isolate suspected measles cases and call your public health unit on 1300 066 055.

Measles in NSW

• There have been 52 measles cases notified so far this year compared to just 19 cases last year.
• Most cases have been in adults aged 20-44 years, including some who had been vaccinated.
• Some recent cases have had no history of overseas travel or links to known ca se s.
• Maintain a high index of suspicion for measles in returning travellers with fever, and in anyone with fever and maculopapular rash.

How does measles present?

• A 2-4 day prodromal illness with fever, cough, coryza, and conjunctivitis.
• A maculopapular rash then typically begins on the face and neck and becomes generalised.
• Measles in previously vaccinated people may present atypically, with milder symptoms and a slower progression to the rash.
• Cases are infectious from the day before the prodrome to four days after the rash onset.

How to manage suspected cases
Isolate – arrange to see suspected cases in their homes or at the end of the day.
Notify – inform your public health unit (PHU) immediately – don’t wait for test results before calling.
Test – collect a nose and throat swab, and a first pass urine sample for nucleic acid testing (PCR) and blood for measles serology (IgM and IgG).
• Mark the tests requested as URGENT. Your PHU can assist in expediting testing.

Advocate for immunisation
• Discuss vaccination with your patients – consultations prior to overseas travel are opportunities to encourage measles vaccination for any patients with uncertain vaccination histories.
• Children aged from 6 months to under 12 months can have an MMR vaccination early if travelling overseas (they will still need doses at 12 and 18 months of age).
• Measles containing vaccines (MMR) are free in NSW for those born during or after 1966 who have not previously had two documented doses.
• Health care workers are at increased risk – ensure that you and your staff are vaccinated.

Further information:
• Measles travel posters and other resources for your clinic are available from the NSW Health measles page: www.health.nsw.gov.au/Infectious/measles
• Contact your local public health unit on 1300 066 055