Measles

About measles

Measles is a highly contagious viral illness that causes a skin rash and fever. It can lead to serious and potentially life-threatening complications.

Measles is rare in Australia because of widespread measles vaccination in the community.

In the past, measles was a common childhood illness in Australia. Most people born before 1966 would have been infected with measles as a child and are likely to be immune.

However, measles is still common in many parts of the world and large outbreaks occur from time to time. People with measles arriving from overseas can potentially spread measles in Australia to those who are not immune. Worldwide, measles is a leading cause of illness and death in children.

To help you protect yourself and your family, the Victorian Department of Health has produced videos featuring the Victorian Deputy Chief Health Officer Dr Angie Bone on:

• measles
• measles booster vaccine
• measles and travelling.

Symptoms of measles

The first symptoms of measles can include:

• fever
• feeling generally unwell (malaise) or tiredness
• cough
• runny nose
• sore and red eyes (conjunctivitis)
• diarrhoea (especially in infants)
• swollen lymph nodes
• Koplik spots (red and bluish spots inside the mouth).

A few days later, a red, blotchy, non-itchy rash appears. The rash usually starts on the face and neck, spreads down the body and lasts for 4 to 7 days.

The first symptoms usually start about 10 days after being exposed to the virus but can sometimes take as few as 7 days or as many as 18 days to appear. The rash usually appears around 14 days after exposure.

Complications of measles

Measles can cause serious illness and can be potentially life-threatening. Up to a third of people with measles have complications and may need to go to hospital.

Complications include:

• ear infections
• diarrhoea
• pneumonia (infection of the lungs)
• other respiratory infections
• encephalitis (inflammation of the brain) which occurs in about one in every 1,000 people with measles.

Measles increases the risk of complications during pregnancy such as:

• miscarriage
• premature labour
• low birth weight infants.

Extremely rarely, in about one in every 100,000 people who have had measles, subacute sclerosing panencephalitis (SSPE) can occur. SSPE is an extremely rare progressive inflammation of the brain that causes brain degeneration and is always fatal. SSPE usually begins about 7 years after the measles infection.

Spread of measles

Measles is one of the most contagious infections.

It is mainly spread when a person breathes in the virus that has been coughed or sneezed into the air by an infectious person. It can also spread through nose or throat secretions and by touching contaminated surfaces or objects.

People with measles are infectious from 24 hours before symptoms appear until 4 days after the rash appears.

The measles virus can survive up to 2 hours in the air or on surfaces. Just being in the same room as someone with measles can result in infection.

People at risk of measles

People who are not fully immunised or have not had a previous measles infection are at increased risk of measles.

While measles is rare in Australia due to widespread vaccination, it is still common in many countries. People travelling overseas to countries where measles cases or outbreaks are occurring are at increased risk.

Some people are at increased risk of severe illness and complications from measles, such as:

• people with a weakened immune system
• children younger than 5 years
• pregnant women.

It is important to remember that all susceptible people can become infected and have severe illness or complications, including adults.

Prevention of measles

Vaccination

The best protection is to get vaccinated against measles. Two doses of a measles-containing vaccine provides long-term protection in 99% of vaccinated people.

Two types of measles-containing vaccine are available in Australia:

• the combined measles, mumps and rubella (MMR) vaccine
• the combined measles, mumps, rubella and varicella (chickenpox) (MMRV) vaccine – not recommended for people aged 14 years and over.

To check if you have been vaccinated against measles:

• find your immunisation records on the Australian Immunisation Register (AIR) – a national register that records vaccines given to people of all ages in Australia
• contact your doctor or immunisation provider for your immunisation records (if you were vaccinated by them).

Read more information on how to find your immunisation records.

It is safe to receive the measles-containing vaccine more than twice, so people who are unsure should get vaccinated.

People who should be vaccinated

Children are recommended to be given the MMR vaccine at 12 months of age and the MMRV vaccine at 18 months of age as per the National Immunisation Program Schedule.

Anyone born during or after 1966 who has not received 2 doses of measles containing vaccine should have a catch up MMR vaccination. Especially those who work in healthcare, aged care or correctional facilities or those planning an overseas trip.

Catch up vaccination is recommended and is available free-of-charge for most people through the National Immunisation Program. This includes refugees and humanitarian entrants (including asylum seekers who may not be eligible for Medicare).

Measles importation after international travel is the most significant source of measles cases in Australia. All people planning overseas travel should speak to their GP or immunisation provider about vaccination, to check that their vaccinations are up to date, and make sure they are fully vaccinated against measles before leaving Australia.

Infants travelling overseas to countries where measles occurs can be vaccinated with an MMR vaccine from 6 months of age, based on case-by-case assessment. However, if an infant receives the MMR vaccine when they are younger than 11 months of age, they still need to also receive the 2 further doses of measles-containing vaccine after 12 months of age, usually at 12 and 18 months of age as per the National Immunisation Program Schedule.

People who should not be vaccinated

Measles-containing vaccines are not recommended for:

• pregnant women
• people with a weakened immune system (confirm with your doctor if you are in this category).

Women who are planning pregnancy and do not have immunity to measles should be vaccinated before becoming pregnant or delay vaccination until after the birth of their child.

Vaccinated women should avoid pregnancy for 28 days after vaccination.

If you are pregnant (or planning on becoming pregnant) or have a weakened immune system, contact your doctor or immunisation provider to discuss what options might be available.

Read more about the combined measles, mumps, rubella, and varicella (chickenpox) vaccination or visit the Australian Immunisation Handbook for more information on measles. Contact your doctor or immunisation provider for advice.

Diagnosis of measles

People with symptoms of measles should seek urgent medical care. Call the doctor or healthcare facility before attending and wear a mask to prevent spreading infection to others.

Measles is diagnosed based on symptoms, physical examination and medical history (including immunisation status and travel history) and the diagnosis is confirmed by tests such as:

• nose and throat swab
• urine sample to check for the presence of the measles virus
• blood test to check for antibodies.

Confirmation of the diagnosis is important as it allows for public health follow-up of people who may have been exposed to the virus and are at risk of infection.

Suspected cases should stay at home until they’ve been advised whether or not they are a confirmed case of measles. Suspected cases should not go to work, school or grocery shopping.

Treatment of measles

There is no specific treatment for measles. A case of measles without complications usually lasts about 14 days and most people make a full recovery. Antibiotics don’t work because the illness is viral.

People with measles are advised to:

• isolate at home
• rest
• drink plenty of fluids
• take paracetamol to treat the fever.

People with severe illness may require hospitalisation and treatment of complications.

Public health response for measles

People with measles

People with measles should stay at home until they are no longer infectious, which is usually 4 days after the onset of rash, and they are feeling well, to reduce the possibility of spreading it to other people. They should not go to work, school or grocery shopping while they are infectious.

While infectious, it is important to avoid contact with anyone outside your home, particularly people who are at increased risk of serious illness. These include people with a weakened immune system, young children and pregnant women.

Children with measles must not attend primary school and children’s services until at least 4 days after the rash appears.

People who have been exposed to measles

People who have had contact with someone with measles and are not fully immunised or have not previously had measles are at risk of infection.

It is important to monitor for symptoms.

People who develop symptoms of measles should seek urgent medical care.

People with symptoms of measles should call ahead when attending healthcare facilities (such as an emergency department, GP or pathology provider), to inform staff of their symptoms and travel history where relevant, so that they can be isolated upon arrival to prevent spreading the virus to others. They should also wear a mask to prevent spreading infection to others.

People who have had contact with an infectious person may be given preventive treatment to reduce the risk of infection. This can be a dose of measles-containing vaccine or an injection of immunoglobulin.

The recommended preventive treatment depends on the time since first contact with an infectious person with measles:

In general, immunoglobulin is reserved for people who cannot have a measles-containing vaccine or who are at increased risk of serious illness such as infants, pregnant women or people with a weakened immune system. People who have immunoglobulin cannot have a measles-containing vaccine for at least 5 months. Children may need to have their vaccinations adjusted as per the National Immunisation Program Schedule.

Discuss preventive treatment options with your doctor as soon as possible.

Children who have had contact with an infectious person with measles and are not fully immunised or have not had previous measles infection must not attend primary school and children’s services until at least 14 days after the rash appeared in the last case of measles. However, they may return if:

• vaccinated within 3 days (72 hours) of exposure to measles OR
• they receive immunoglobulin within 6 days (144 hours) of exposure to measles.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor)
• Local government immunisation service
• Maternal and Child Health Line Tel. 13 22 29 (24 hours, 7 days)
• NURSE-ON-CALL Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• National Immunisation Information Line Tel. 1800 671 811
• Pharmacist
• SAEFVIC Tel. 1300 882 924 – to report an unexpected or serious reactions to vaccination