Measles cases must be notified

Major advances have been made in measles control in recent years. Australia is moving toward measles elimination and therefore it is essential, and a requirement under the Public Health Act, that suspected measles cases are notified to the Public Health Unit as soon as possible (by telephone). This will enable a timely public health response.

Clinical features
For suspect cases the following three clinical features are present:
1. Morbilliform rash, and,
2. Fever present at the time of rash onset, and
3. Cough.
For photos of measles see: http://www.immunize.org/catg.d/pict001.htm

Laboratory confirmation
Due to the public health implications of a diagnosis of measles, confirmatory testing is desirable on all cases. A range of tests is available for blood, nose/throat swabs or urine; these are outlined in the table.

Public health response
Key components of a response to measles include:
1. Isolation of the case during the infectious stage
2. Confirmation of the diagnosis (laboratory)
3. Identification and protection of susceptible contacts
Since measles is spread by airborne means, anyone who has shared the same air as an infectious case for any length of time is defined as a contact. This includes people in the waiting room during the time the case was there and for the following two hours. Susceptible contacts require prophylaxis within seven days.

Because every diagnosis of measles has important public health implications, please phone the Northern Rivers Public Health Unit on 6620 7500 while you have the patient with you if measles is the provisional diagnosis or in the differential diagnosis.

Specimen	Test	Collection Method	Time Frame
Blood	Serology	1 ml clotted blood	IgM frequently positive at the onset of the rash and becoming increasingly sensitive up to 14 days after rash onset
Blood	PCR	5 mls whole blood EDTA tube at 4 degrees	Present from the beginning of the rash and decreasing
Nose/throat swab	PCR	Viral transport medium	Useful during the Nasopharyngeal prodromal period and aspirate within 72 hours of rash onset
Urine	PCR	10mls in sterile container stored at 4 degree	Present during the duration of the rash

Janet Terry is a public health nurse with the Northern Rivers Public Health Unit.

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