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Department of Health

URGENT PUBLIC HEALTH ALERT

Statewide Measles Alert Bali transmission risks


14 October 2013
Medical officers and health staff are asked to be alert for measles cases in travellers returning from Bali. There have been five confirmed and one probable case of measles diagnosed in the past 10 days from Australian residents who were exposed to measles while travelling in Bali. One of these cases visited Queensland while infectious. There have also been 21 measles cases notified in Queensland this year, particularly focussed within southeast Queensland. Please ask about overseas travel, particularly to Bali, in all suspected measles cases. Be prepared for people with measles presenting Measles transmission occurs readily in medical and associated settings. When a patient with suspected measles attends a medical facility, contacts (other patients/staff at the facility) are at risk of acquiring the infection. This has occurred several times in Queensland in the last two years. To minimise the risk of transmission within facilities: triage patients with fever and rash directly to a room that can be left vacant for 2 hours after consultation. Where practicable, examine cases of suspected measles at home. ensure all practice staff born in or after 1966 who could have contact with measles cases are either fully vaccinated (2 doses of a measles vaccine) or have serological evidence of measles immunity. Management of measles in a clinical setting 1. Check that the symptoms satisfy all of the clinical criteria: generalised non-itchy maculopapular rash usually beginning on the face or upper neck; and fever of at least 38 degrees still present at the time of rash onset; and cough or coryza or conjunctivitis or Kopliks spots. Ask if the patient has been overseas or in contact with a confirmed case in the last 3 weeks (note that lack of history of travel does not exclude measles). If the case does not satisfy the clinical criteria, or if the person has received 2 doses of a measles vaccine, measles is less likely. 2. If the case satisfies all of the clinical criteria, order the appropriate laboratory tests. Mark request form as URGENT. 0-3 days after rash onset: urine and throat or nasopharyngeal swab for PCR 3-7 days after rash onset: urine and throat or nasopharyngeal swab for PCR and/or blood for IgM more than 7 days after rash onset: blood for IgM 3. Notify your local public health unit immediately of any case satisfying the clinical criteria. The public health unit will liaise with the testing laboratory to ensure that appropriate infection control measures are taken to avoid exposure of other clients and staff, and will advise you whether any additional measures are required in your practice e.g. vaccination of exposed staff/patients. Pre-travel vaccination Medical officers are encouraged to check the vaccination status of anyone intending to travel to Bali (or any other country with known measles cases circulating) and to provide measles vaccination to those not fully vaccinated. Travel to Bali is particularly common during the summer months, especially during schoolies week. A measles fact sheet and other measles resources are available at: www.health.qld.gov.au/cdcg/index/default.asp Please also consider opportunistic vaccination for any unimmunised patients attending for any reason. Authorised by Dr Stephen Lambert, Senior Director Communicable Diseases Unit