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.

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 former Victorian Deputy Chief Health Officer Dr Angie Bone on:

• measles
• measles vaccine - 2 doses required
• 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 (tiny white, grey, red or 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.

Subacute sclerosing panencephalitis (SSPE) can occur in extremely rare cases, affecting about 1 in every 100,000 people who have had measles. SSPE is a 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 provide 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. Visit your GP or pharmacy for a catch-up MMR vaccine if you are unsure if you are immune.

Victorian funded MMR vaccine

In Victoria, free MMR vaccine is available for all people born during or since 1966 without evidence of receiving 2 documented doses of valid MMR vaccine, or without blood test results showing evidence of immunity.

Infants travelling overseas can receive the MMR vaccine from 6 months of age. If vaccinated before 11 months, they still need two additional doses at 12 and 18 months as per the National Immunisation Program Schedule.

No Medicare card is needed for state-funded MMR vaccines.

International travel is the main source of measles cases in Australia. All travellers should check their immunisation status with a GP or immunisation provider and ensure they are fully vaccinated before departure.

The MMR vaccine is free and available at GPs, community pharmacies, Aboriginal Health Services, and local council immunisation services.

Read more information on Who provides immunisations in Victoria.

People who should be vaccinated

Measles containing vaccine is free under the National Immunisation Program Schedule for

• children at 12 months of age (MMR vaccine)
• children at 18 months of age (MMRV vaccine).

The combination MMR vaccine is safe, and provides protection against several diseases at once, which helps reduce the number of separate vaccinations needed. Children cannot get separate vaccines for measles, mumps, and rubella because they are not available in Australia.

Free catch up measles containing vaccine is available for:

• people aged up to 20 years who have not been fully vaccinated
• refugees and humanitarian entrants aged 20 and over

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 your options.

Contact your doctor or immunisation provider for advice.

MMR vaccine side effects

Some children may experience mild effects such as a slight fever, tiredness, or redness and swelling where the vaccine was given. A small number of children may develop a mild rash or swelling near the jaw about a week later. These effects are usually short-lived and not serious. More serious reactions like seizures or anaphylaxis can occur, but these are extremely uncommon.

Vaccines do not cause autism

Vaccines do not cause autism. This has been confirmed by many large scale, high quality studies involving over a million children worldwide. For more information, see Sharing Knowledge About Immunisation – What about autism?

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
• blood test.

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 public places (such as supermarkets).

Treatment of measles

There is no specific treatment for measles. It can take a few weeks to fully recover from measles. 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 public places (such as supermarkets) 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

Visit the measles public exposure sites in Victoria page on health.vic to see the locations that have been visited by a person while potentially infectious with 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 for up to 18 days after you have had contact with someone with measles.

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
• Virtual Emergency Care
• Urgent Care Clinics – when immediate healthcare is needed but it's not life-threatening
• Your GP (doctor)
• Nurse-on-Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
• Local government immunisation service
• Maternal and Child Health Line Tel. 13 22 29 (24 hours, 7 days)
• Immunisation Program, Victorian Department of Health
• National Immunisation Information Line Tel. 1800 671 811
• Pharmacist
• SAEFVIC Tel. 1300 882 924 – to report an unexpected or serious reactions to vaccination