What is it?

Measles, also known as rubeola, is a highly contagious viral illness. It is caused by the measles virus which belongs to the Morbillivirus family.

What to look for

Infection usually begins with 3-4 days of fever, malaise, cough, coryza (runny nose) and conjunctivitis. Small white spots, known as Koplik spots, are also present on the buccal mucosa (mucosal surface of the cheeks) of an infected person.

3-4 days later a maculopapular rash (red with a combination of flat and raised areas) then develops, often beginning on the face before becoming more generalised and can last up to 7 days. Very rarely does a measles infection occur in the absence of a rash.

Complications of a measles infection include pneumonia and otitis media (ear infection). Approximately 1 in 1000 people will develop encephalitis (brain inflammation) which carries a mortality rate of 10-15%. Sub-acute sclerosing panencephalitis (SSPE) is a rare progressive neurological disorder that can develop 2-10 years after an initial measles infection. It is characterised by encephalitis and demyelination (loss of the protective covering of the nerve fibres) causing behaviour changes, seizures and muscle rigidity. SSPE is fatal in all cases.

Measles infections during pregnancy can result in miscarriage and prematurity.

How is it transmitted?

Measles can be spread by an infected person coughing or sneezing respiratory droplets or through the direct contact with infected nasal or throat secretions. An environment can remain infectious for up to 2 hours after an infectious person has been present.

The incubation period is 7 to 18 days (more commonly 10 days), with a person able to transmit disease for up to 5 days prior to the onset of the rash, and as long as 4 days after the rash develops.

Humans are the only reservoirs for the measles virus.

Epidemiology

Prior to the introduction of vaccination in 1963, measles infections contributed to 2.6 million deaths globally each year. Despite extensive vaccination campaigns worldwide, measles infection still carries a significant burden in some countries contributing to 142 000 deaths globally in 2018.

Within Australia, however, high rates of vaccine coverage led to the WHO declaring Australia “measles-free” in 2014. Measles infections are still seen in non-immune individuals travelling internationally, placing unimmunised Australians at risk of infection.

Prevention

Live-attenuated measles-containing vaccines are highly effective in protecting against disease. A 2-dose course of vaccination is routinely provided on the National Immunisation Program (NIP) for children as combination vaccines at:

  • 12 months of age – Priorix®/M-M-R®II (measles- mumps- rubella (MMR))
  • 18 months of age – Priorix-Tetra®/ProQuad® (measles-mumps-rubella-varicella (MMRV))

In addition, babies aged between 6 months and 11 months travelling overseas, non-immune women planning pregnancy or non-immune women after delivery, and any person born since 1966 who does not have evidence of 2 doses of vaccination/is seronegative is eligible to receive funded measles-containing vaccines.

Due to high rates of circulating measles virus in the years preceding 1966 and the life-long immunity invoked by natural infection, those born during this time are considered already immune and generally do not require vaccination.

Contraindications

Live-attenuated vaccines such as measles-containing vaccines are contraindicated in individuals with immune compromise due to the risks of adverse events and the chance of developing vaccine-related disease.

Additionally, pregnant women should not receive measles-containing vaccines due to the potential risks to the unborn baby. Instead, vaccination at least 4 weeks prior to pregnancy or vaccination in the postnatal period is recommended.

Precautions

Specific intervals between the administration of immunoglobulins or other blood products and administration of measles-containing vaccines are recommended. This is due to the potential for any circulating donated antibodies affecting the immune response to vaccination.

Side effects

7-10 days following MMR vaccination, individuals may experience fever, malaise, and a non-infectious rash lasting 2-3 days.

MMRV vaccines are not recommended as a first dose of a measles-containing vaccine in children < 4 years of age due to the increased risk of fever and febrile seizures.

Post-exposure prophylaxis

If a non-immune individual is exposed to measles, immunisation with MMR or MMRV is recommended to occur within 72 hours of exposure to reduce the likelihood of infection (provided immunisation is not a contraindication).

Infants ≤ 5 months of age born to non-immune mothers or mothers with < 2 documented doses of measles vaccination, individuals of any age with immune compromise, and pregnant women, may be recommended to receive Normal Human Immunoglobulin (NHIG) if exposed to disease [refer to resources].

Resources

Author: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)

Date: December 8, 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.