Measles is an acute and highly communicable disease caused by a morbillivirus. It is characterised by fever, malaise, conjunctivitis, coryza and cough in the prodromal stage followed by appearance of Koplik spots on the buccal mucosa before the onset of maculopapular rash. Complications include otitis media, pneumonia, diarrhoea, post-infectious encephalitis, subacute sclerosing panencephalitis (rare) and death. The risk of serious complications and death is increased in children <5 years of age and adults >20 years of age.3

Relevant vaccine history

1975

  • Measles vaccine funded for all Australian infants at 12 months of age.

1984

  • MM* vaccination of Aboriginal and Torres Strait Islander children in the Northern Territory changed from 12 months to 9 months of age.

1989

  • MMR vaccine recommended and funded on the national schedule at 12 months of age (9 months for Aboriginal and Torres Strait Islander infants in the Northern Territory).

1994

  • MMR funded as second dose of measles-containing vaccine for adolescent females.

1996

  • MMR funded as second dose of measles-containing vaccine for all adolescents.

1998

  • Recommended age for first dose of MMR vaccine for Aboriginal and Torres Strait Islander children in the Northern Territory increased from 9 months to 12 months of age.
  • Recommended age for second dose of MMR vaccine lowered to 4–5 years.

2013

  • Second dose moved forward to 18 months of age, given as MMRV.

Key points

Australia’s population is generally well immunised against measles and does not have endemic measles virus transmission. However, measles outbreaks continue to occur with most cases able to be linked to travel or exposure to returned travellers.

* MM: measles and mumps

† MMR: measles, mumps and rubella

‡ MMRV: measles, mumps, rubella and varicella

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Disease trends

Notification data are presented for all jurisdictions for the period 2007–2010. Hospitalisation data are presented for six jurisdictions (all except Tasmania and the Australian Capital Territory) by financial year for the period July 2005 to June 2010.

A total of 251 notifications and 139 hospitalisations for measles were recorded during these reporting periods; of these, 3 (1.2%) notifications and 6 (4.3 %) hospitalisations were reported in Aboriginal and Torres Strait Islander people (Table 2.5.1 and Table 2.5.2). Different time periods and jurisdictions were covered by the two datasets (4 years and 6 jurisdictions for notifications, 5 years and 8 jurisdictions for hospitalisations), so direct comparisons of absolute numbers are not possible. However, the disparity between the percentages of notifications and hospitalisations reported as Aboriginal and Torres Strait Islander may be due to these children being less likely to seek healthcare for mild disease, compared to non-Indigenous children. The proportions of notifications and hospitalisations occurring in Aboriginal and Torres Strait Islander people were lower than the proportions (4% and 7%, respectively) in the previous reporting period (2003–2006).

Table 2.5.1: Measles notifications, all Australian states, 2007 to 2010, by age group and Indigenous status
Age group
(years)
Indigenous status Notifications* (2007–2010)
n Rate Rate ratio

* Notifications where the date of diagnosis was between 1 January 2007 and 31 December 2010.

† Average annual age-specific rate per 100,000 population.

‡ Includes cases with age unknown.

§ Indicates statistically significant, 95% confidence intervals do not overlap 1.0.

0–4
Indigenous
1
0.4
0.6
Other
31
0.6
5–14
Indigenous
1
0.2
0.3
Other
64
0.6
15–24
Indigenous
0
0.0
0.0§
Other
65
0.6
25–49
Indigenous
1
0.1
0.5
Other
85
0.3
>50
Indigenous
0
0.0
0.0
Other
3
0.0
All ages
Indigenous
3
0.1
0.5
Other
248
0.3

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Table 2.5.2: Measles hospitalisations, selected Australian states, 2005 to 2010, by age group and Indigenous status
Age group
(years)
Indigenous status Hospitalisations* (2005–2010)
n Rate Rate ratio

* Hospitalisations (New South Wales, Northern Territory, Queensland, South Australia, Victoria, Western Australia only) where the date of separation was between 1 July 2005 and 30 June 2010.

† Average annual age-specific rate per 100,000 population.

‡ Includes cases with age unknown.

§ Indicates statistically significant, 95% confidence intervals do not overlap 1.0.

0–4
Indigenous
4
1.3
2.2
Other
35
0.6
5–14
Indigenous
2
0.3
4.1
Other
10
0.1
15–24
Indigenous
0
0.0
0.0
Other
26
0.2
25–49
Indigenous
0
0.0
0.0
Other
56
0.2
>50
Indigenous
0
0.0
0.0
Other
6
0.0
All ages
Indigenous
6
0.2
1.8
Other
133
0.1

Notification rates have remained low in Aboriginal and Torres Strait Islander people between 2007 and 2010, with no cases recorded in 2008 and only 1 case each in 2009 and 2010. Notification rates were lower in Aboriginal and Torres Strait Islander people than in other people across all age groups. The highest rate among Aboriginal and Torres Strait Islander people occurred in the youngest age group (0.4 per 100,000). The overall Indigenous to non-Indigenous rate ratio for notifications was 0.5:1 (not statistically significantly different to 1:1).

With respect to hospitalisation rates, higher rates were recorded in Aboriginal and Torres Strait Islander children 0–14 years of age than in other children of the same age, but there were no hospitalisations recorded for Aboriginal and Torres Strait Islander people ≥15 years of age. The overall Indigenous to non-Indigenous rate ratio for hospitalisations was 1.8:1, with the highest ratio (4.1:1) in the 5–14 years age group (neither of these ratios was statistically significantly different to 1:1).

There were 5–8 deaths reported in Australia between 2006 and 2010 with measles as a contributing cause (the ABS provides ranges when absolute numbers of deaths are low). None of these deaths had measles recorded as the underlying cause. Of these deaths, 1–4 occurred in the five jurisdictions for which data on Aboriginal and Torres Strait Islander people were available (New South Wales, the Northern Territory, Queensland, South Australia and Western Australia), and none were reported in Aboriginal and Torres Strait Islander people.

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Comment

Australia’s population is generally well immunised against measles and does not have endemic measles virus transmission. The data presented here show that measles rates are low in Aboriginal and Torres Strait Islander people and are no different to those in other people.

Before the introduction of measles vaccine, and even until the introduction of a second pre-school dose in 1998, measles epidemics were a feature of Australian life, including severe cases and some deaths.24 Aboriginal and Torres Strait Islander communities were more severely affected, leading to an accelerated vaccination schedule in the Northern Territory.42 Today, the elimination of endemic measles transmission may have already been achieved in Australia.43 Measles cases do still occur, but most are able to be linked to travel or exposure to returned travellers.44

Many clusters and some large outbreaks have occurred in New South Wales,45 Queensland and Victoria in recent years.46 However, a study of clusters occurring in early 2009 found that they met the World Health Organization elimination criterion of ≥80% of outbreaks having transmission of fewer than 10 cases.46 Recent measles epidemics in Europe and Africa have led to an increase in the importation of cases into Australia.

Australian adults born between 1966 and 1984 may not have immunity to measles due to them having less exposure to wild measles and receipt of only 1 dose of measles-containing vaccine (the 2-dose schedule was only introduced in Australia in 1984). Identification of adults in this cohort and offering them a dose of measles-containing vaccine, particularly prior to travel to measles-endemic countries, may play an important role in minimising the importation of wild measles virus.44

The success of measles immunisation demonstrates the value of universal vaccination programs that include both Aboriginal and Torres Strait Islander and other Australians.