The Royal New Zealand College of General Practitioners

Measles is very unusual in people born in New Zealand before 1969 but a diagnosis of measles should be considered in people younger than 42 years who do not have a record of two MMR vaccinations.

With the present increase in imported cases, measles should be considered as part of the differential diagnosis of febrile illness in children (especially with a rash) and younger adults especially those who have not been vaccinated. Many general practitioners may be unfamiliar with the clinical presentation of the illness.

Classic measles presents with a two to three day history of high fever (38°+), before the development of Koplik spots and then the generalised maculo-papular rash which starts on the head and neck and progresses down the body. About one in 10 cases gets pneumonia, ear infection or diarrhoea.

Measles is highly contagious. A person with measles is infectious from about five days before the development of the rash until five days after the appearance of the rash.

Practices should try to identify patients who may be developing measles before they arrive in the waiting room and have a place in which they can be isolated from other patients.

When the patient is first seen, it is essential to take a naso-pharyngeal or throat swab for PCR testing as well as blood for serological testing for measles IgM and IgG.

When there are sporadic cases, or in the early stages of community spread and cases are linked to primary cases, PCR gives an early result but serology is also required.

All cases of measles should be notified on suspicion to the local Medical Officer of Health.

The patient should be advised to stay at home until at least 5 days after the onset of the rash. Unvaccinated people who have been in contact with an infectious case within the previous 72 hours may benefit from a dose of MMR. However they should also be advised to stay away from work, school or contact with other people for at least 14 days from their last contact with the case because they may be in the incubation period and become infectious.

People planning overseas travel should be advised that measles outbreaks regularly occur in some countries and they would be well advised to have a booster of MMR before travelling.

Parents should check their children are up-to-date with their immunisations and adults should check their immunisation status.