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Special College Fax 20 June 2007

RACGP disease alert: Measles outbreaks in Japan

Update 21/06/2007 - clarification regarding the recommended timing for the routine second dose of measles vaccine in children

The RACGP has received the following alert from the Australian Government. I would urge you to please take immediate note of its contents.

Many thanks,

Dr Vasantha Preetham
RACGP President

Dear Doctor,
I am writing to advise you of a measles outbreak in Japan and to ask you to be vigilant for symptoms of measles in visitors and returning travellers from Japan. To help protect Australians travelling abroad I am also providing you with information that should be provided to people wishing to visit Japan during the current measles outbreak.

Background

An outbreak of measles originated in Tokyo in February 2007 and has spread through central and northern Japan. Over 1000 cases have been reported in Japan this year and the number of new cases is continuing to rise. The current outbreak in Japan is not confined to only children. A third of the reported cases are aged 15 years old or above.

Taiwan and the United States have both reported cases of measles imported from Japan. Although single dose measle vaccine has been used in Japan for many years, the routine use of a second booster dose was only introduced in 2006 for primary school children. Japanese people of secondary school age and older will not therefore have routinely received two doses of measles vaccine. Low second dose vaccine coverage rates may be contributing to the current outbreak in Japan. Authorities in Japan are actively managing this outbreak, increased surveillance is in place and community vaccination campaigns have begun.

Need for increased vigilance in Australia

Measles has been essentially eradicated in Australia. In 2007, Australia reported only 11 cases of measles and most of these were associated with overseas travel. Australia maintains very high measles vaccination rates, with 93.6% coverage in 24–27 month-old children and 88.9% in 72–75 month-olds (31 March 2007 figures).

However, measles still poses a threat to certain population groups in Australia, and the early detection and management of suspected measles cases is required to ensure that local transmission does not occur.

The current outbreak in Japan and its close proximity to Australia increases the need for vigilence for symptoms of measles particularly in visitors, of all ages, from Japan and those returning from visits in Japan. A list of other countries with high prevalence of measles is provided for your general information.

I take this opportunity to remind you that, as a notifiable disease, all suspected cases of measles should be reported to your local health authority. A list of your State public health contact numbers and an information sheet on measles is attached for your information.

Advice to travellers visiting measles endemic areas

Those born during or since 1966 should be encouraged to complete the measles-mumps-rubella (MMR) vaccination schedule before embarking on international travel if they do not have evidence of receipt of two doses of MMR vaccine.

Note that Australians aged between 23 and 40 years of age are unlikely to have received two doses of measles vaccine as the two dose regime was not part of their childhood immunization programme and it would be unlikely that they were included in any catch up campaigns.

Infants travelling to endemic countries may be vaccinated with MMR between nine and 12 months of age. In these cases, another dose of MMR should be given at 12 months of age or four weeks after the first dose, whichever is later. This should be followed by the routine administration of the next dose of MMR at 18 months of age. This is because maternal antibodies to measles are known to persist in many infants until 11 months of age and may interfere with active immunisation before 12 months of age.

Until the outbreak in Japan is controlled, it would be appreciated if this advice could be provided to all persons wishing to travel to Japan.

Further information on the situation in Japan will be provided in due course.

Thank you for your assistance with this issue.

Dr Julie Hall MBE
Acting Australian Government Chief Medical Officer
Department of Health & Ageing
Phone 61 2 6289 8408
Fax 61 2 6285 1994

Update 21/06/2007

On 20 June 2007 I issued advice to doctors about an outbreak of measles in Japan. It has been suggested that some confusion may arise regarding the recommended timing for the routine second dose of measles vaccine in children.

Current recommendations for childhood measles vaccination under the National Immunisation Program:

1. Routine vaccination
Two doses of MMR (Measles, Mumps, Rubella) are required, at least 4 weeks apart. MMR vaccine is recommended for all children at 12 months of age and at 4 years of age, unless there is a genuine contraindication.

2. Vaccination of children younger than 12 months of age
Infants travelling to endemic countries may be vaccinated with MMR between nine and 12 months of age. In these cases, another dose of MMR should be administered in line with the routine schedule. That is, another dose should be given at 12 months of age or four weeks after the first dose, whichever is later. This should be followed by the standard dose of MMR at four years of age. This is because maternal antibodies to measles are known to persist in many infants until 11 months of age and may interfere with active immunisation before 12 months of age.

Publication Date: 20 June 2007
Authorised By: Office of the CEO and President