Measles linked to RMIT University graduation prompts health warning

The Victoria Department of Health in Australia has been notified of two confirmed cases of measles in individuals not vaccinated for measles who became ill after attendance at an RMIT graduation ceremony at Melbourne’s Etihad Stadium on 17 December 2014.

Health authorities advise the public to consider the possibility of measles in any person who is susceptible to measles and develops a compatible illness and who attended the RMIT graduation ceremony at Etihad Stadium on 17 December 2014. In addition, be alert for measles in patients presenting with a fever and rash, or with a prodrome after an established exposure.

Measles has an incubation period of up to 18 days (average 14 days from exposure to rash) so illness acquired from this event could begin up to 4 January 2015, and remain infectious for many days after that.

Measles is highly infectious (airborne transmission) and one probable case has been identified at one of these venues. Other secondary cases are likely to occur.

The Victoria Department of Health says measles initially presents with a prodrome of fever, cough, conjunctivitis, and coryza. A generalized maculopapular rash is then seen two to five days after the onset of the prodrome. Koplik spots on the buccal mucosa may be present for three to four days prior to rash onset but not at time of rash. Individuals, especially children, are typically unwell.

The most important clinical predictors are the following features:

• generalised maculopapular rash, usually lasting three or more days, and
• fever (at least 38°C, if measured) present at the time of rash onset, and
• cough or coryza or conjunctivitis.

Measles is transmitted by airborne droplets and direct contact with discharges from respiratory mucous membranes of infected persons and less commonly by articles freshly soiled with nose and throat secretions.

Measles is highly infectious and can persist in the environment for at least 30 minutes.

The incubation period is variable and averages 10 days (range: 7 – 18 days) from exposure to the onset of fever, with an average of 14 days from exposure to the onset of rash. The infectious period of patients with measles is five days before, to four days after, the appearance of the rash.