Dr Vicki Slinko (Public Health Physician WMPHU)

West Moreton measles outbreak

Acknowledge the traditional

owners of the land we meet

on today and pay my

respects to the elders: past,

present and emerging

Art work: Sally Harrison https://www.artpal.com/saharrison#i8

One of the most contagious diseases

• Transmission

o Airborne droplets and direct contact with discharges

o Highly infectious

• Incubation period

o 7 to 18 days

• Infectious period

o 24 hours prior to onset of prodromal symptoms or 4 days before

rash onset

o Until 4 days after rash onset

Measles: overview

• Fever (>38oC at time of rash onset)

• Morbilliform rash

o Face → rest of body

• The three C’s

o Cough

o Coryza

o Conjunctivitis

• Koplik spots

Recent vaccination → vaccine-strain measles

Partially vaccinated → modified measles

Measles: clinical presentation

Outbreaks declared in 2019

• New Zealand

– 2154 cases; 752 hospitalisations (35%)

• Samoa

– 4693 cases; large proportion hospitalised, 70 deaths

• American Samoa

– 9 confirmed cases

• Fiji– 18 confirmed cases

• Philippines, USA, Europe

• An the list goes on…

Measles outbreaks overseas

Measles: Australia

• Metro South area has been dealing with an outbreak since early

October 2019 centred around the Pasifika community

• WM first case diagnosed 21 November 2019

Measles outbreak in West Moreton area

Measles outbreak in West Moreton area

MEASLES

SPREADS!

• Measles disease is not common and not understood by community

• Clinicians have often not seen measles: late diagnosis

• Often out of time for when any specific interventions can occur

• Case where no source identified

• Infectious cases in many public areas (including medical services)

• “Considered” immune is not a 100% guarantee that will not become

a case

• Exclusion enforcement

• Getting vaccination: barriers

Issues with measles in WM

• Staff immune to measles

• Education of all staff

• Identification of measles cases

• Infection control

• Timely notification

• Appropriate testing

• Contact tracing: Public Health Unit support

• Opportunistic vaccination

• Patient messaging: Resources (PHN support)

Measles issues for GP

• Required for accreditation

• Time for your practice manager to make sure everyone is up to date

– Medical

– Nursing

– Reception

– Allied health

– Cleaning staff etc

• “Considered” immune

– Documented MMR x 2

– Evidence of previous infection/vaccination (IgG)

– Born before 1966

• Everyone

Staff immune and educated about measles

Suspect measles if the person has:

• Fever, and

• Conjunctivitis or cough or coryza or Koplik spots; and

• Generalised maculopapular (non-itchy) rash - usually begins on the

face before spreading to the rest of the body; appears 2 to 7 days

after initial symptoms so may not assist diagnosis in early disease.

N.B. The clinical presentation may be modified with milder symptoms if

a person has partial immunity

Remember vaccine strain “measles”

Contact with a measles case: check

https://www.health.qld.gov.au/news-events/health-alerts/measles or

Google “measles alert Queensland Health”

Measles: identification

• Educate your patients to phone ahead

before attending if measles symptoms

• Signage about symptoms/wearing masks

• Symptomatic patients

– Those who phoned ahead, examine them

• at home or

• in a separate area outside of your usual practice space e.g.

patient’s car

– Those presenting unannounced:

• triage patients quickly with fever and rash to a room that can be left

vacant for 30 minutes after consultation

• ensure patient wearing surgical mask for the entire time

in practice/health facility, particularly if they need to walk

through the practice or shared areas

Infection control

West Moreton Public Health Unit

• Working hours

– Mon-Fri: 08:30 – 17:00

– 3818 4700

• After hours

– PAH Switch: 3176 211

– Ask to speak with public health

Timely notification

PCR

• Nasopharyngeal or throat swab (NOT nasal or skin)

• Urine (does not need to be sterile catch)

Serology

• IgG for immunity

• IgM for recent illness/vaccination (remember cross reactions)

Appropriate testing

• Huge amount of work

• PH will provide

– contact tracing pack

– phone support

• Will require extra staffing

– preferably nursing staff

– competent in Excel

• According to CDNA guidelines: file:///C:/Users/SlinkoV/AppData/Local/Microsoft/Windows/INetCache/IE/QCN0XY9Q

/Measles-2019.pdf

Contact tracing

• Who is a contact?

‒ Household, sharing communal facilities

‒ Early childhood education and care services

‒ School, university etc

‒ People who shared a waiting- /consult room with the case, or

who were in the same waiting- /consult room within 30 minutes

after the case had left

‒ Work settings

‒ Community (buses, trains, cinemas, events, airport …)

• Who carries out contact tracing?

– Hospital: for patients, visitors

– Public Health; GPs; Pathology companies

Measles: contact tracing

• Time of entry to facility (patient interview)

• Route of entry into facility (patient interview)

• Time of registration at clinic (admin)

• Time given surgical mask and entered separate room

(ideally with separate air conditioning

• May include other businesses sharing waiting space eg.

pathology, pharmacy, allied health, specialists etc.

• NEED STAFF LISTS / PATIENT LISTS for affected

areas

Measles: identifying contacts

• IMMUNE if: MMRx2 OR IgG OR Born <1966 (documented!)

– 2 doses MMR vaccine = 97% effective

– 1 dose MMR vaccine = 93% effective

• FOR ALL OTHERS– MMR vaccine within 72h of 1st exposure to case

• NB: Contra-indications!

• Susceptible contacts >72h → Information + exclusion if high

risk (HCW, CCW)

– NHIG within 144h (6 days)

• Too young for vaccine AND susceptible

• Pregnant or immunocompromised

– EXCLUSION (CCC, primary school, care care

services) if > 6 days

• Outbreak – community mass vaccination (?)

Measles: contact management

• MMR usually given at 12 months; MMRV at 18 months

• New Australian recommendations

– From 6 months if travelling to outbreak area

– Will still require usual 12 and 18 month vaccines

• Queensland Immunisation Program (QIP) stock can be

used for “other identified at-risk individuals/populations”

• If require further stock will need to order as usual through

QIP; QIP closed for orders 18 Dec 2019 - 2 January 2020

• All vaccines need to be recorded on AIR

Opportunistic vaccination

Resources

• Many developed by Metro South PHU

• Rebranded by QH (with permission)

Messaging for patients

Messaging for GP