Issue 16 / 30 April 2012

AUSTRALIA must ensure it does not become complacent about measles, despite large global reductions in measles mortality, according to a public health expert.

Research published in The Lancet estimated that global measles mortality decreased 74% from 535 300 deaths in 2000 to 139 300 in 2010, not quite meeting the 90% reduction target endorsed by the WHO in 2008. (1)

The reduction target had not been achieved because of continued outbreaks in Africa and delayed disease control measures in India, the study found.

Professor David Durrheim, a member of the WHO Western Pacific Measles Elimination Regional Verification Commission, told MJA Insight that although progress in eliminating measles in the Western Pacific Region had been remarkable, large recent outbreaks in Europe and Africa, as well as more locally in New Zealand, Singapore and Malaysia showed there should not be complacency in Australia.

“Now that we are approaching regional measles elimination, it is essential to maintain high, timely coverage with two doses of MMR [measles, mumps and rubella] in Australian children”, Professor Durrheim said. “This past year has seen a number of local outbreaks of measles in Australia introduced from overseas.”

Clinicians should notify local public health authorities about every suspected measles case so the source could be investigated and outbreaks prevented or contained, he said.

Children and adults born during or since 1966 who did not have documented evidence of receiving two doses of MMR vaccine or evidence of measles infection must be provided with an MMR vaccine before travelling.

“Large international sporting or cultural events like the Olympics in the UK and EUFA Cup in the Ukraine pose particular risks”, he said.

An article accompanying The Lancet research said measles was one of the best indicators for problems in vaccination programs because of its high communicability and recognisable rash. (2)

According to the article, measles eradication was biologically feasible, although no formal eradication goal had been set.

Associate Professor Heath Kelly, head of the epidemiology unit at the Victorian Infectious Diseases Reference Laboratory, told MJA InSight that although elimination has never been claimed for Australia, evidence suggested it had been eliminated here since 2005.

“Elimination means we do not have a single measles genotype circulating in Australia, but it does not mean we have no measles in Australia … we continue to see imported cases of measles and imported cases often result in clusters in Australian communities. Most cases are now among young adults but some occur in unimmunised children”, he said.

He said measles could again become endemic in Australia if measles vaccination coverage fell, as occurred in England and Wales a few years ago.

“Measles has become a rare disease in Australia and clinicians always need to think of it, even if only to exclude it, when seeing a patient with a rash and fever”, he said.

“The threshold of suspicion should be lowest for unwell young adults with fever and a rash, even more so if they have travelled recently.”

He said a laboratory test is recommended for all suspected cases, with either a blood test for measles IgM or a nasal swab to test for measles virus by PCR (polymerase chain reaction).

– Amanda Bryan

1. Lancet 2012; Online 24 April
2. Lancet 2012; Online 24 April

Posted 30 April 2012

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