A decade of data shows most measles cases in Australia are now among unvaccinated adults aged 20 to 49 returning from overseas, as slipping vaccination rates and global outbreaks fuel a renewed risk at home.
A decade of national surveillance data has revealed a clear and concerning pattern in who is most at risk of contracting measles in Australia, with young and middle-aged adults, unvaccinated individuals and overseas travellers emerging as the most vulnerable groups.
The report, which analyses measles notifications from 2014 to 2024, recorded a total of 1095 cases over the 10-year period, with significant spikes in 2014 and 2019 when 339 and 284 cases were reported respectively.
The report was released on 31 March by the Australian Centre for Disease Control and published in Communicable Diseases Intelligence.
Health authorities said the overwhelming majority of infections were linked to international travel, either acquired overseas or transmitted locally from someone who had recently returned to Australia while infectious.
Adults aged between 20 and 49 accounted for 57% of all reported cases, highlighting a shift away from the traditional perception of measles as primarily a childhood disease.
Vaccination status also played a critical role, with nearly half of all cases occurring in people who were unvaccinated, while a further 30% had an unknown vaccination history and 14% had received only a single dose of the vaccine.
“The age distribution of cases is in stark contrast to that of endemic countries, where most cases, with attendant morbidity and mortality, are among children under five years of age,” the researchers wrote.
“The findings of this report indicate that the greatest contributors to measles notifications in Australia in 2014 to 2024 were young adults who were either unvaccinated or were unaware of their vaccination status and who likely imported their infection to Australia when they returned from seasonal overseas travel.
“These importations pose a threat to vulnerable populations such as immunocompromised people, pregnant people, and children who are too young to receive the MMR vaccine.”
The findings also align with more recent trends, as measles continues to re-emerge in Australia despite being previously declared eliminated. There were 181 cases reported in 2025, and 2026 has already seen 85 cases, including several clusters linked to travel and community transmission.
The researchers warned that declining childhood vaccination rates were compounding the risk.
National coverage has dropped from 94% in 2020 to just over 91% in 2024, weakening herd immunity and increasing the likelihood of outbreaks.
This decline places particular pressure on vulnerable groups who rely on community protection, including infants too young to be vaccinated, pregnant people, those who are immunocompromised and individuals unable to receive vaccines for medical reasons.
Measles is one of the most contagious infectious diseases and can lead to serious complications, especially in high-risk groups. Authorities emphasise that vaccination remains the most effective safeguard, not only for individuals but for the broader community.
The report underscored the ongoing risk posed by international travel and declining vaccine coverage, reinforcing the need for vigilance as Australia faces the persistent threat of measles reintroduction.
Meanwhile, in Bangladesh…
At least 38 children have died in a fast-spreading measles outbreak in Bangladesh, as health authorities scramble to expand vaccination to younger infants and contain a crisis that is overwhelming hospitals and exposing gaps in immunisation coverage.
More than 2300 children have been admitted to hospital with suspected measles in 2026, with 684 cases confirmed so far – an alarming jump from just 68 cases reported over the same period last year and 125 in all of 2025.
Officials warned the true toll was likely higher, with many cases going undiagnosed or deaths attributed to complications such as pneumonia, The BMJ reported earlier this month.
The outbreak began on 4 January in a Rohingya refugee camp in Cox’s Bazar before accelerating sharply through March. The capital, Dhaka, has been hit hardest, with the city’s Infectious Disease Hospital recording 21 deaths.
In response, the government has announced an emergency expansion of its vaccination programme, lowering the eligible age for measles shots from nine months to six months and launching a nationwide campaign in June targeting children aged up to five years.
The move came as more than a third of infections were being reported in infants younger than nine months, who would normally not yet qualify for routine vaccination, the researchers revealed.
Officials said they were struggling with shortages of vaccines and syringes, with existing supplies already allocated to routine immunisation. Authorities have appealed to Gavi, the Vaccine Alliance for additional doses.
Health adviser to the prime minister Ziauddin Hyder said the scale of the outbreak demanded urgent intervention, noting that while 38 deaths have been confirmed, the number linked to measles could be as high as 46 when complications were included.
He warned that falling vaccination rates – from around 90% in 2020 to about 57% in 2025 – combined with cancelled mass immunisation campaigns had left a large cohort of children vulnerable.
Bangladesh has not conducted a nationwide measles-rubella campaign since 2020, with a planned follow-up in 2024 abandoned amid political unrest. Health officials said the lapse had allowed immunity gaps to widen, enabling the virus to spread rapidly among unprotected children.
The decision to vaccinate infants at six months followed guidance from the World Health Organization, which permits early dosing during outbreaks despite lower immune response compared with the standard schedule.
Most cases were occurring in unvaccinated children, underscoring the consequences of disrupted immunisation efforts.
Experts said the outbreak reflected deeper systemic issues, including policy failures and weak implementation, that have compounded over time.
The crisis in Bangladesh is part of a broader global resurgence of measles, with outbreaks reported across multiple countries.
The trend has been linked to declining vaccination rates and the spread of anti-vaccination misinformation, raising fears that hard-won progress against one of the world’s most contagious diseases could be beginning to unravel.
Diagnostic surge masks a three-way crisis in mental health, ADHD and autism
Rising psychological distress among young people is colliding with surging demand for diagnoses of ADHD and autism, with a major UK government-backed review warning that underdiagnosis, misdiagnosis and overdiagnosis are all occurring at once and reshaping access to care.
The interim findings highlight a complex and increasingly strained clinical landscape in which prevalence of anxiety, depression, and broader psychological distress appears to be increasing, according to a news article in The BMJ this month.
Recorded diagnoses and referrals, particularly for neurodevelopmental conditions, have risen far more sharply than could be fully explained by epidemiology alone, the review’s interim report revealed.
Rather than pointing to a single cause, the review concluded that multiple forces were acting simultaneously, including improved recognition of previously unmet need, changing patterns of help-seeking, evolving professional and public understanding, and system-level incentives that tie access to support to formal diagnosis.
Diagnostic labels have become both gateways to care and potential sources of contention, as services struggle to keep pace with demand.
Waiting lists for ADHD assessments have escalated dramatically, reflecting both increased awareness and limited specialist capacity.
At the same time, the review underscored that stable underlying prevalence estimates for ADHD and autism sat alongside rapidly rising identification rates, reinforcing the need for careful clinical judgement in differentiating true incidence from shifts in detection and reporting.
The report cautioned against framing the issue as a binary debate over “real” versus “overstated” illness. Instead, it positioned diagnostic trends within a broader socio-clinical context shaped by rising socioeconomic pressures, including financial insecurity, housing instability and social isolation, all factors that were contributing to genuine increases in mental health need.
For health professionals, this reinforced the importance of comprehensive assessment that considers both clinical symptoms and contextual drivers of distress.
The review suggested that historical gaps in recognition and access may coexist with newer risks of over-identification in some settings, particularly where educational or social support was contingent on diagnostic confirmation.
Reactions from across the sector reflected the tension inherent in these findings. Some clinicians and academics have welcomed the review’s acknowledgement of data limitations and its attempt to move beyond polarised narratives, while others raised concerns that emphasising uncertainty around diagnosis risks undermining recognition of genuine unmet need, particularly in already underserved populations.
The review is continuing.
Peptide crackdown: TGA warns clinicians on risks of unapproved products
The Therapeutic Goods Administration has raised concerns about the growing importation, compounding and supply of unapproved peptide products, warning that patient harm and regulatory breaches are already emerging.
In a statement released this week, the regulator said peptides – short chains of amino acids that can influence biological processes such as metabolism, tissue repair and growth – were increasingly being promoted online for uses ranging from weight loss and muscle gain to anti-ageing and cognitive enhancement, despite lacking formal evaluation for safety, quality or efficacy.
Under the Therapeutic Goods Act 1989, peptide products are regulated as therapeutic goods, and only those listed on the Australian Register of Therapeutic Goods have been assessed for use.
A number of established peptide medicines, including insulin therapies, meet this threshold, but a growing cohort of substances such as BPC-157, GHK-Cu, TB-500, retatrutide and CJC-1295 do not, placing them outside the approved framework.
The TGA warned that uncertainty around manufacturing standards, sterility, composition and pharmacological effects significantly elevates patient risk, particularly with injectable products where contamination, infection and tissue damage were credible threats.
Reports to the regulator to date have included severe allergic reactions requiring hospitalisation, systemic inflammatory responses, widespread hypersensitivity, and a spectrum of adverse effects ranging from insomnia and fatigue to musculoskeletal injuries.
For prescribers and pharmacists, the advisory underscored that involvement with unapproved peptides, whether through prescribing, compounding or supply, demanded strict adherence to regulatory exemptions and professional standards.
“Generally, a compounded good is only exempt from the requirement to be included on the ARTG where the good is dispensed or extemporaneously compounded for a particular person for application to that person; or the good is compounded in a hospital by a relevant pharmacist in anticipation of being needed for therapeutic application to patients of the hospital,” said the TGA statement.
Advertising presented another compliance flashpoint. The TGA reiterated that promotion of unapproved peptide products, particularly via social media or influencer channels, was likely unlawful, and that even indirect advertising through health services could trigger regulatory oversight.
Public advertising of prescription-only medicines remains prohibited unless specifically authorised.
The Personal Importation Scheme is also under scrutiny, with the regulator cautioning that poorly labelled or deliberately obscured peptide products would not meet release criteria and may be intercepted.
Claims that products were for “research use only” did not alter their regulatory status or exempt suppliers from legal obligations, the TGA said.
With compliance and enforcement activity ramping up, the TGA has called on clinicians to remain vigilant, prioritise evidence-based prescribing and report adverse events or suspected breaches, as scrutiny intensifies on a rapidly expanding and largely unregulated segment of the therapeutics market.
For more see the TGA advice here.
TGA weighs ban on Andrographis after anaphylaxis reports
In more news from the TGA, the regulator has opened consultation on a proposal to remove Andrographis paniculata from the list of permitted low-risk ingredients in listed medicines, following a series of reports linking the herbal ingredient to anaphylaxis.
Andrographis is widely used in over-the-counter complementary medicines marketed for relief of cold and flu symptoms and is readily available through pharmacies, supermarkets and health food stores.
Its current inclusion in the Permissible Ingredients Determination allows sponsors to use it in listed medicines without pre-market evaluation for efficacy.
The regulator’s proposal is driven by safety concerns, with post-market data identifying cases of anaphylaxis that can be rapid in onset, unpredictable and potentially life-threatening.
Reported reactions have occurred both on first exposure and after prior uneventful use, including in individuals with no known history of allergies. Symptoms have been documented within 30 minutes of ingestion and have required urgent emergency treatment.
The TGA has published an updated safety review incorporating adverse event data to 31 December 2024, alongside a supplementary analysis extending to the end of 2025. The reviews provide a detailed assessment of the frequency, severity and clinical characteristics of reported reactions, and underpin the current risk–benefit reconsideration.
Stakeholders including health professionals, sponsors, consumer groups and industry bodies have been invited to provide feedback before a final regulatory decision is made.
For clinicians, the consultation signals a potential shift in the risk profile of a commonly used complementary medicine ingredient and reinforces the need to consider herbal products in medication histories, particularly in patients presenting with acute allergic reactions.
For more information see here.
