Dr Paul Effler, A/Director, Communicable Disease Control Directorate has recently advised that visitors and residents of the Perth metropolitan area may have been exposed to measles and more cases may occur over the coming weeks. At 18 October there was 26 confirmed measles cases in the Perth metropolitan area since mid September, with the number of cases in WA this year now reaching 52. Over the past five years there has been eight to 43 cases reported in WA each year.
All suspected or confirmed cases are to be notified immediately to the Communicable Disease Control Directorate on 9222 0255 (9328 0553 A/H) or to the local Public Health Unit in regional areas. GPs are also advised to:
- Consider measles in a febrile patient with a compatible clinical picture
- Treat suspected measles cases with immediate isolation with airborne precautions
- Be alert for further locally acquired cases of measles
- Offer the MMR vaccine to people aged 53 years and under who do not have documented evidence of two doses of MMR (see “Immunisation – Adult” HealthPathway).
Signs and symptoms
Patients with measles usually look and feel very unwell. Prodrome generally consists of two to four days of fever and malaise, AND one or more of:
- Cough
- Coryza
- Conjunctivitis or Koplik spots on buccal mucosa (not commonly observed).
This is followed by the onset of a rash two to seven days after prodrome, usually characterised by:
- Fever present at time of rash onset
- Commencing on face/head then descending
- Maculopapular, becoming confluent.
Infection and prevention control
Patients with symptoms and signs consistent with measles should be:
- Identified promptly at reception
- Fitted with a surgical mask
- Isolated in a room (negative pressure, where available) separate from other patients, with the door shut.
Only staff who are immune to measles should attend the patient and airborne precautions should be used, including the wearing of appropriate PPE. All equipment in contact with the patient should be single use or reprocessed before use on another patient. The examination room should also be left vacant for at least 30 minutes after the patient has left and all touched surfaces thoroughly cleaned.
The Department of Health have developed a series of posters to display at the front door of general practices and in clinical areas.
Laboratory testing
Formal diagnosis should be supported by the following patient testing:
- Throat or nose swab, or nasopharyngeal swab or aspirate, for measles PCR, in viral transport medium, and
- Urine for measles PCR, and
- Serology for measles IgG and IgM.