Pathologists urge GPs not to forget about measles amid common rashes & cold-like symptoms following confirmed Auckland cases

Pathologists are urging GPs to keep measles at the forefront of their minds when patients present with rashes and cold-like symptoms, after two unrelated cases of measles were recently confirmed in Auckland.

Measles is a viral disease that shows with a distinctive red rash, which may be mistakenly attributed to other, less severe conditions.

Cases of measles can go unnoticed or misdiagnosed, leading to delayed treatment and increased risk of transmission to vulnerable communities.

“Measles is not a disease of the past, it continues to pose a significant public health threat due to its contagious nature,” said Pathology Awareness Aotearoa ambassador and Microbiologist Dr Juliet Elvy.

In 2019, Aotearoa experienced its worst measles outbreak since 1997. A total of 2,174 confirmed measles cases were reported across New Zealand with a total of 765 hospitalisations.

Prior to the two most recent cases, three other cases of measles had been confirmed in Auckland in 2023, one in February and two May, all cases were linked to overseas travel. Due to the hard work of Aotearoa’s healthcare teams, none of these cases resulted in a larger outbreak.

Measles is an airborne pathogen and is highly contagious, even in the early stages of the infection.

The virus can cause severe illness, particularly in vulnerable populations such as children under the age of five, pregnant women, and immunocompromised individuals.

Dr Elvy urged GPs to consider measles in the differential diagnosis of patients with rash and a history of recent travel or potential exposure to measles cases, particularly if not known to be vaccinated with two doses of measles, mumps, rubella (MMR) vaccine.

She commented, "If any GP suspects a patient may have measles, it is crucial to refer them for PCR testing, instruct them to isolate immediately, and report the case to local health authorities. Early diagnosis and containment can prevent further transmission and protect vulnerable groups from severe illness."

Recognising the signs of measles is the first step. Symptoms typically include:

• A distinctive red rash, which usually starts on the face and spreads to the rest of the body
• Koplik rash (small white spots with a bluish-white centre) inside the mouth
• High fever
• Cough
• Runny nose
• Red, watery eyes (conjunctivitis)

Dr Elvy believes vaccination is key to measles eradication.

“There is quite a bit of work to do to try and bring our vaccination rates up in Aotearoa to where they need to be to prevent our most at risk, particularly our tamariki (young children) under the age of 5, which are the most vulnerable group for serious illness and death from measles. To ensure herd immunity, we really need vaccination rates in excess of 95%. Currently, vaccination rates are in the 80-85% region, which is lower than we need.” Dr. Elvy added.

Vaccination remains the most effective strategy to prevent measles, and GPs are encouraged to reinforce the importance of routine vaccinations with their patients.

Due to declining childhood vaccination rates since the beginning of the COVID-19 pandemic, the country is at serious risk of another major measles outbreak. According to Dr Elvy, people are considered immune to measles if they have received two doses of MMR, have previously recovered from measles infection, or were born before 1969. Two MMR vaccines are free for everyone eighteen years or younger and for New Zealand residents aged over eighteen. As of 1st April 2023, immunisation coverage for children in New Zealand at two years of age is 83.2% percent. This is more than 10% lower than it needs to be to keep all communities in Aotearoa safe from future devastating measles outbreaks.

Public health officials are closely monitoring the resurgence of measles following the two most recent cases, with several recent outbreaks reported globally this year.

For any GPs with doubts or concerns related to measles, Dr Elvy advises speaking to a microbiologist or public health professional to get more information and advice on what to do in the instance of a suspected case.