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Measles for health professionals

Measles is an illness caused by infection with the measles virus. Early in the infection, symptoms may include fever, tiredness, cough, sore throat, runny nose, sore eyes and photophobia. These symptoms usually worsen over three to five days, then a blotchy rash begins on the head and over the next day or two spreads down the entire body. The rash lasts four to seven days. Measles illness usually lasts about 10 days. The cough may be the last symptom to disappear.

Measles is often a severe disease, frequently followed by middle ear infection (7% of cases) or bacterial pneumonia (6% of cases). In as many as one in every 1000 cases, encephalitis occurs, often resulting in death or permanent brain damage. Sometimes brain damage may not appear until many years later. Complications from measles are more common and more severe in the chronically ill and in very young children.

Incubation period

The incubation period is about 10 days (range 7 to 18 days) to the onset of prodromal symptoms and about 14 days to the appearance of the rash.

Infectious period

The infectious period is from 24 hours prior to the onset of the prodrome to four days after the appearance of the rash. If the prodrome is poorly defined, the infectious period is considered to commence four days before the appearance of the rash.

Transmission

Measles is a highly contagious viral infection transmitted via respiratory aerosols which remain a risk to others for up to at least 30 minutes after the person has left the area.

Measles is spread by breathing infected airborne droplets caused by coughing and sneezing, and by contact with hands, tissues and other articles soiled by nose and throat discharges.

Diagnosis

The diagnosis is suspected from clinical examination and is best confirmed by detection of the virus (by PCR) in urine, throat, blood or eye specimens; or alternatively by serology.

Infection control

Clinicians should:

  • Examine patients suspected of having measles in their own homes wherever possible.
  • Have the suspected case avoid using the waiting room and conduct the consultation in a room that can be left vacant for at least 30 minutes afterwards.
  • Treat all people who attend the rooms within at least 30 minutes of the infectious patient as contacts.

Additionally, if not taking pathology specimens at your rooms, inform the pathology collection centre prior to sending in a potentially infectious case, or use the SA Pathology home visiting service.

Immunity

A person who is not immune suppressed is likely immune to measles if:

  • he or she was born in Australia before 1966 (unless serological evidence indicates otherwise) OR
  • he or she was born during or since 1966 and has documented evidence of receiving 2 doses of a measles-containing vaccine, with both doses given at ≥ 12 months of age and at least 4 weeks apart (unless serological evidence indicates otherwise) OR
  • he or she has documented evidence of immunity (i.e. a detectable measles-specific IgG) OR
  • he or she has documented laboratory definitive evidence of prior measles.

Vaccination

Measles is best prevented by receipt of two doses of measles containing vaccine. For further details see:

Notification

Measles is a notifiable condition under the South Australian Public Health Act 2011. Notify any suspected or confirmed cases to the South Australian Communicable Disease Control Branch on 1300 232 272 (24 hours/7 days).

Resources

The following types of resources are available: 

Flowcharts

Measles: Management Guidelines for General Practice (PDF 434KB)

A resource for General Practitioners outlining steps to be undertaken with respect to the Clinical and Public Health Management of Measles.

Flow Chart for Follow up of Measles Contacts in a General Practice Setting (PDF 300KB)

Flow chart for follow up of measles contacts in a general practice setting: lists urgent actions, helps determine the immune status of contacts and advises on the appropriate post-exposure response.

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Templates

Letter to measles contacts from General Practice (DOCX 28KB)

Letter to Measles Contacts: for distribution by the general practice to all people (including staff, patients, any persons accompanying them and other visitors) who were identified as being present in the practice (same waiting room and consultation room) at the same time as the case and for at least 30 minutes after the case left the practice.

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Sample communication scripts

Sample script: for Measles waiting room contacts (DOCX75KB)

Sample script for waiting room contacts of a measles case: provides guidance for practice staff when communicating with patients and any other people who have been identified as measles contacts.

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Post exposure guidelines

Within 72 hours of first exposure to infectious case (PDF 378KB)

Measles National Guidelines for when a patient has been exposed to measles within 72 hours of first exposure to an infectious case.

Within 73 to 144 hours after first exposure to infectious case (PDF 385KB)

Measles National Guidelines for when a patient has been exposed to measles within 73 to 144 hours of first exposure to an infectious case.

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Patient fact sheets

Measles You’ve Got What? 

Measles Factsheet: for distribution to all people identified as contacts of the case at your practice and for distribution to others who are seeking further information about Measles infection.

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Posters

Emergency Department Staff be alert for Measles (PDF 651KB)

A resource for emergency department clinicians.  This poster details the symptoms and signs of Measles and steps to be undertaken with respect to the Clinical and Public Health Management of Measles”

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