CS7.046/Edition: 1
The Old and The New: Measles and MERS-CoV
Measles and Middle Eastern Coronavirus (MERS-CoV) are both highly transmissible
airborne infections spread through respiratory secretions. A timely public health response
is critical to limit transmission.
This overview outlines the initial steps to take in the diagnostic work-up of suspected cases
of Measles or MERS-CoV to ensure rapid testing and early initiation of infection control and
public health responses.
1. Contact the on-call clinical microbiologist (@TCH 62442222) to discuss appropriate
specimen collection, and to approve and co-ordinate urgent testing.
(i) Urgent Measles IgM can be performed at ACT Pathology 7 days a week
(ii) Urgent Measles and MERS-CoV PCR is referred interstate with result expected
within 24 hours
2. Notify Public Health (ACT 62052155): they will help to facilitate testing, and provide
advice on management of the case and contacts, pending confirmatory testing. Post
exposure prophylaxis is available for Measles, but is time critical.
3. Order/collect appropriate specimens using PPE (mask, eye protection, gloves, gown)
(i) For Measles: serum for measles IgM and IgG, and a viral throat swab for Measles
PCR (in case subsequently required)
(ii) For MERS-CoV: nasopharyngeal swab (flocked) and sputum (if available) for
MERS-CoV PCR. Testing for common respiratory viruses and bacteria may also be
performed initially to exclude other causes for the illnesses.
4. Notify the pathology collection centre (if required) in advance, to allow instigation of
appropriate PPE by the collection staff and to avoid contact with other vulnerable patients in
the waiting room. For ACT Pathology, the collection centres at the Canberra Hospital
(62442816) and Belconnen Health Centre (62051315) are used for airborne pathogens
such as Measles and MERS-CoV, as well as varicella-zoster. Patients should not attend
other ACT Pathology collection centres.
5. If the patient requires hospital admission, the emergency department should be
notified in advance to ensure the person is identified and promptly isolated on presentation.
*** Please refer to the second page for a brief overview of each virus***
Authorised by the Director of Microbiology
Last Amended: 31/07/2015
CS7.046/Edition: 1
Measles
Measles is uncommon in Australia due to vaccination and subsequent herd immunity.
However, in a non-immune population one case of measles can expect to result in 18
further cases. Most cases of measles in Australia occur in non-immune individuals either
returning from a measles endemic country or as a secondary case following exposure to a
known case in Australia. The incubation period is 10-14 days following exposure.
Measles should therefore be highly suspected in non-vaccinated individuals with a
compatible clinical presentation (coryza, cough, fever, conjunctivitis, rash) and a travel or
exposure history.
Acute infection is typically supported by the presence of measles IgM in serum and can be
confirmed by demonstration of measles IgG seroconversion on convalescent serum and/or
detection of measles RNA by molecular methods (PCR). Infection can occasionally occur
in vaccinated individuals, particularly if they have only received one vaccination or are
immunosuppressed. Interpretation of serology in these cases can be more difficult.
Infection can be prevented in exposed non-immune individuals using measles
immunoglobulin, however this MUST be given within 3 days of exposure to be effective.
MERS-CoV
MERS-Cov has been circulating in humans in the Middle East for almost three years. It is
associated with camel contact, however transmission within healthcare facilities is a
feature. The case fatality rate is 36%. There have been numerous cases outside of the
Middle East in travelers. The largest outbreak outside the Middle East has occurred in
South Korea, with 186 people infected from the incident traveler case and more than
16,000 contacts quarantined. This was primarily related to delays in identification of
suspected cases resulting in inadequate use of personal protective equipment within
healthcare facilities.
MERS-CoV should be suspected and testing facilitated when there is:
 clinical and/or radiological evidence of pneumonia/pneumonitis
AND
 a history of travel (>24hours duration) to the Middle East within the past 14 days
OR
 contact with a case with MERS-CoV within the past 14 days
Travel to South Korea is not a significant risk unless the person has had a known exposure
to a MERS-CoV case or has attended a healthcare facility with MERS-CoV cases.
MERS-CoV is confirmed by the detection of MERS-CoV RNA (PCR) in respiratory tract
specimens.
Karina Kennedy
FRACP FRCPA MPHTM MBBS
Ag/Dir Microbiology
ACT Pathology
Karina.kennedy@act.gov.au
62442105
Authorised by the Director of Microbiology
Last Amended: 31/07/2015