Measles Outbreak Japan

Need for increased vigilance in Australia

Measles has been essentially eradicated in Australia. In 2007, Australia reported only 11 cases of measles and most of these were associated with overseas travel. Australia maintains very high measles vaccination rates, with 93.6% coverage in 24-27 month-old children and 88.9% in 72-75 month-olds (31 March 2007 figures).

However, measles still poses a threat to certain population groups in Australia, and the early detection and management of suspected measles cases is required to ensure that local transmission does not occur.

The current outbreak in Japan and its close proximity to Australia increases the need for vigilance for symptoms of measles particularly in visitors, of all ages, from Japan and those returning from visits in Japan. A list of other countries with high prevalence of measles is provided for your general information.

I take this opportunity to remind you that, as a notifiable disease, all suspected cases of measles should be reported to your local health authority. A list of your State public health contact numbers and an information sheet on measles is attached for your information.

Dr Julie Hall MBE
A/g Australian Government Chief Medical Officer
Department of Health & Ageing
Ph: 61 2 6289 8408
Fax: 61 2 6285 1994

Vaccines

One measles-mumps-rubella (MMR) vaccine is currently available in Australia. Measles immunity induced by single-dose vaccination provides long-term immunity in most recipients. However, approximately 5% of recipients fail to develop immunity to measles after one dose. Following a second vaccine dose, approximately 99% of subjects overall will be immune to measles.

Persons born before 1966:

No vaccination is required (unless serological evidence indicates otherwise) as circulating virus and disease were prevalent before this time suggesting most persons would have acquired immunity from natural infection. However, recent confirmed cases of measles have occurred in persons born before 1966 and, if doubt exists, it may be more expedient to offer vaccination than serological testing.

Persons born during or since 1966:

Infants ≥12 months to 18 months of age should have documented evidence of one dose of MMR; or serological evidence of protection for measles. Persons ≥18 months of age should have documented evidence of two doses of MMR administered at least four weeks apart, with both doses administered at or over 12 months of age; or serological evidence of protection for measles, mumps and rubella. Catch-up vaccination of children who have not received MMR at 18 months of age should occur at the four-year-old schedule point, until all the relevant children have reached four years of age. There are no increased adverse events from vaccinating those with pre-existing immunity to one or more of the vaccine components.

ADVICE TO TRAVELLERS VISITING MEASLES ENDEMIC AREAS

Those born during or since 1966 should be encouraged to complete the measles-mumps-rubella (MMR) vaccination schedule before embarking on international travel if they do not have evidence of receipt of two doses of MMR vaccine.

Note that Australians aged between 23 and 40 years of age are unlikely to have received two doses of measles vaccine as the two dose regime was not part of their childhood immunization programme and it would be unlikely that they were included in any catch up campaigns.

Infants travelling to endemic countries may be vaccinated with MMR between nine and 12 months of age. In these cases, another dose of MMR should be given at 12 months of age or four weeks after the first dose, whichever is later. This should be followed by the routine administration of the next dose of MMR at 18 months of age. This is because maternal antibodies to measles are known to persist in many infants until 11 months of age and may interfere with active immunisation before 12 months of age.

Public Health Contact List

Commonwealth
Chief Medical Officer " 02 6289 8408
Communicable Diseases Network of Australia Secretariat " 02 6289 3832

State and Territory Public Health and Communicable Disease Units
The following numbers should be contacted by medical practitioners for the reporting of communicable disease cases and for assistance in the management of disease outbreaks:

New South Wales

The reporting of communicable disease cases in New South Wales is facilitated by the individual Public Health Units listed below: