Victoria Health warns of new measles case from returned traveller who visited Pakistan
In an alert issued on Tuesday, the department lists the Frankston Hospital emergency department waiting room on May 10 from 2.55pm to 3.55pm as the state's latest exposure site, along with the Frankston Medicare urgent care clinic on May 8 from 9.50am to 10.25am.
The Monash University Peninsula Campus at Frankston is also listed for May 5 from 12pm to 2pm.
'There is currently an increased risk of measles in greater Melbourne, with a number of public exposure sites identified,' the department's alert states.
'A significant number of recent measles cases have acquired their infection locally in Victoria.
'There is also an ongoing risk of measles being imported into Victoria by travellers returning from overseas or interstate.'
Measles is a contagious viral illness that causes rash and fever.
It can also cause serious health complications, including pneumonia and encephalitis.
Young infants and pregnant women are vulnerable to suffering serious complications if they contract the virus, the department warned.
The disease, which can be avoided with a vaccine, is spread through the air when someone who is infectious coughs or sneezes.
Symptoms of measles include fever, cough, sore or red eyes, runny nose, and feeling generally unwell, followed by a red maculopapular rash.
The rash usually starts on the face before spreading down the body and symptoms can develop between seven to 18 days after exposure.
People with measles are potentially infectious from 24 hours prior to the onset of initial symptoms until four days after the rash appears.
Global case numbers are also rising, potentially exposing Australian travellers to the virus, the department said.
'There are currently outbreaks reported in multiple countries and regions, including Pakistan, Indonesia, Vietnam, Thailand, India, Africa, Europe and the UK, the Middle East, and North America,' the alert states.
A full exposure site list has been posted to the health department's website.
'Vaccination is the best way to protect yourself and others,' the department states.
'Anyone who has attended a listed exposure site during the specified date and time or spent time in greater Melbourne from late April should monitor for symptoms and seek medical care if symptoms develop for up to 18 days after the exposure.
'Anyone who attended a listed exposure site and is not fully vaccinated for measles may be eligible to receive the MMR vaccine if they present within 72 hours of exposure.
'Anyone who is immunocompromised or pregnant and not fully vaccinated for measles should seek medical review if within six days of exposure to a measles case.
'Anyone who develops symptoms of measles should seek medical care and testing for measles.
'Call the health service beforehand to advise that you may have been exposed to measles and wear a face mask.'
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The rules may deter some from vaping at all and indeed the latest figures show vaping rates among those aged 14-24 are slowing. But evidence suggests some switch to cigarettes whether they were a tobacco smoker before or not. While expensive and heavily-taxed at least, the argument goes, cigarettes are easy to buy. Others are attracted to buying black market disposable vapes that often deliver a larger hit of nicotine, or to import a slick design from overseas, crossing their fingers that the goods make it through customs. Even as crackdowns spread to other countries — the UK banned disposable vapes in June — the market continues to evolve. Globally, the vape market is forecast to grow from $59.2 billion in 2025 to $159.95 billion by 2033, according to Straits Research. As one commenter on the subreddit AussieVapers puts it, rather than find a willing pharmacist and settle for a 20mg/ml dose, it's often cheaper and easier for someone to get their nicotine fix via black market disposable vapes bought from under the counter of a tobacconist who has decided to just factor fines into their profit margins. That calculation may be getting harder as states and territories adjust fines. In NSW for example, the penalty for illegally supplying vaping goods rose in November and now includes up to seven years imprisonment and a fine of up to $1.54 million. The actual penalty is likely to be far lower. Approved therapeutic vapes on a GP's prescription cost between $30 and $150, plus the cost of the doctor visit and refills for non-disposable models. A 5000-puff vape sold illegally might cost $50. 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Travis loads his reusable vape with 6 milligrams of nicotine that he gets on prescription, so that he can monitor his consumption, with the aim of eventually tapering off. "My doctor loves me doing this, rather than cigarettes, because he tells me cigarettes have thousands of chemicals and the best chemical is the nicotine," he says — though many GPs would vehemently disagree. "My use has increased," Travis admits. "I vape at work, at home, in the car. I'm vaping right now. But I've actually reduced my nicotine intake over the years. With a reusable vape I'm in control. I'm starting to think about stopping, because I'm at an age now where it's a bit silly, like I'm not a kid anymore," he says. "I could just not put the nicotine in and just smoke empty juice [carrier oil, made up of vegetable glycerine and propylene glycol] — that's my plan." Dr Lisa Juckes is a Sydney-based psychiatrist who has had a long career in the addiction sector. She believes the usual methods for treating nicotine dependence in combustible smokers don't easily apply to people who vape. "When I see somebody who's very nicotine dependent, and I say, 'Could we convert you over to having patches so you're not up in the middle of the night having to vape?' I'm having to completely guess the dose — whether it's three or four patches — because the person doesn't know how much they've been vaping," she says. "Some people have the equivalent of 30 or 40 packets of cigarettes a week of nicotine in their nervous system." 'A flashback to the '90s' Laws haven't stopped under the counter trade and they haven't stopped promotion of vapes either. Australia has strict legislation against tobacco and vaping advertising, but there are always loopholes. Marketing of vapes in Australia is most likely to rely on social media that uses a grey zone to navigate advertising bans. Professor Becky Freeman, from the University of Sydney's School of Public Health, believes the problem is transnational tobacco companies that have launched vape products to stay in the market as cigarette smoking declines globally. Freeman's research includes how online and social media influence public health. She doesn't believe influencers have that much clout in comparison with tobacco companies that have launched vape products. "To me, the big problem is these transnational tobacco companies have massive marketing budgets and are going back in time, doing exactly the same kind of marketing they used to do for cigarettes," she says. Health tech companies like China's ICCPP, that owns vape band Voopoo which make the DragX2, are also influential. DragX2 promises a "dense cloud experience" and also "endless pleasure". While 'pleasure' is a throwback term used by cigarette advertisers dating back to 1950 — in slogans for Churchman's No.1, Camel, Silk Cut, Player's, Peter Stuyvesant, Newport, Golden Lights, Benson & Hedges, Marlboro, Barclay and Kent — vape marketing tends to favour more reassuringly competent, lab-tested language, using words such as 'innovation', 'premium smart device', 'revolutionary' and 'pioneer'. Freeman draws my attention to the Instagram profile of Vuse, a disposable vaping product from the giant multinational cigarette, tobacco and e-cigarette manufacturer British American Tobacco. Posts include a 'day in the life of a DJ'; a collaboration between three hip-hop artists with a vape front and centre in the video; and lots on Formula 1 team McLaren, which is sponsored by Vuse. "It's frustrating that Meta claims to ban e-cigarette and tobacco advertising, and yet allows this because it doesn't meet the technical definition of an advertisement," Freeman says. "They talk out of both sides of their mouth. Vuse hires influencers to go to festivals and has youth ambassadors from the graphic arts, from fashion, from design. "Is this a flashback to the '90s? It's exactly the kind of thing we legislated the tobacco companies from not being allowed to do." The power of vape fashions Travis tells me he pays no attention to vape recommendations on social media — he chose his through word of mouth. "Mine's like a Tonka truck. They call it the tradie's vape because it's waterproof and you can drop it," he says. But if he were the type to be swayed by shiny new things, there's plenty out there to tempt him. The vape market is evolving at great speed, even with the addition of nicotine pouches and heated tobacco products to the landscape. One "old-time vaper" on the subreddit AussieVapers complains that vape fashions are too hard to keep up with. "The other day I was called a veteran, being seen with my dual battery mod and dual coil RTA," he writes. Vape influencers and brand ambassadors remain influential. They fetishise hardware and cloud size, underscoring the idea that vape mods are for a more sophisticated user than those of disposable vapes. A guest on The Joe Rogan Experience, media personality Adam Curry, wants to make that very clear. "This is organic juice," he says of the model in his hand. He also wound his own coil out of silver and uses American-made cotton — "not from China". Trends lean hard on novelty, providing plenty of content to influencers and brand ambassadors. On YouTube I find the FugginVapeBoys reviewing a Voopoo 'Roto' vape with a built-in fidget spinner for people with ADHD. "Hear me out, I don't think it's ass," drawls Nate, although he also ponders the "stigma" of having a fidget-spinning vape. "I don't know how many people that are over the age of 18 are super into fidget spinners." In 2023, Wired reported on Chinese disposable 'smart vapes', some with LCD screens that claim to show how many puffs are left, and others that play knock-off versions of games such as Tetris. In the reusable world, the glow-in-the-dark Xlim DNA has a flavour 'replay mode' so that if users particularly enjoyed one inhale, they can save it as their favourite. Even Etsy creators are getting in on the game, creating wearable vape accessories and covers. Since vape manufacturing is a wild west with innumerable shadowy players, it's impossible to slap regulatory health warnings on all products, so cute packaging is winning out over dead babies and gangrenous feet. David managed to sneak his chosen vape in through Australian customs, ordering it from an international website (even tourists to the country, who don't have a prescription, are allowed limited quantities or risk having their vapes found and seized). People who seek out vapes on what purport to be Australian sites will likely have a disappointing experience, as many have been reported by unhappy punters to be scam sites that take the money and evaporate. Influencers want you to believe nicotine is a 'smart drug' If social media campaigns and vape trends are not enough to lure new users then some believe nicotine as a health choice will cut through. If I search for 'nicotine' on Instagram, the 275,000 posts are hidden by Meta as "sensitive content". TikTok does show me the results, albeit with a warning titled "Be informed and aware". Posts tend to be either about quitting, or claims about nicotine being a "nootropic stimulant" or cognitive enhancer, and emphasising that it's "all natural", too. I find posts from a subculture of self-styled experts promoting the benefits of nicotine. There is biohacker Nate Belmar ("In my opinion most people should be taking nicotine … I think nicotine pouches are probably one of the best ways to do it") and US MD Lewis Clarke ("Are you still falling for that lie that nicotine is bad for you?") as well as Dr Bryan Ardis ("why do they continue to make us so scared of nicotine in tobacco if it's in our vegies?"). Dave Asprey claims nicotine is "the next big smart drug". He does not recommend smoking to get it but does promote lozenges and gum that he sells on his website for a discount. Health experts acknowledge that nicotine can have short term positive effects on things like attention and fine motor skills. But long term the story is not so good and can lead to difficulty processing information, remembering things and an increase in impulsivity. None of these proponents of nicotine address another obvious fear of health experts and policymakers: an individual will likely upgrade to vaping or cigarettes if they feel the dose from gum or lozenges is no longer activating their reward pathways. Even experts are sending mixed messages A group of 44 of Australia's leading drug and alcohol harm-reduction advocates, among them doctors, researchers, addiction medicine specialists and lecturers (with no links to tobacco or e-cigarette companies) signed a letter sent to Health Minister Mark Butler in 2023. The petition urged the loosening of restrictions around e-cigarettes. Psychiatrist Juckes was encouraged to sign but says she refused because of evidence young people are using vaping as a gateway to cigarette smoking. "At the time I was already reading some stuff, particularly around young people in North America, where young people who were never smokers had taken up e-cigarettes and then converted to cigarettes," she says. "In Australia we were world leaders at reducing onset of cigarette smoking, and so our young generations have been historically the lowest up-takers of combustible cigarettes." Nicotine's next big things Beyond pharmacies, treatment or reduction options can be a wild west, using novelty additions to increase allure. Some have dangerous consequences. There's now a wide range of smokeless inhalers — sold online, globally, although illegal to sell, buy or advertise in Australia — aimed at quitting vaping or smoking, some of which sub in caffeine for a familiar buzz. The Capnos range of devices comes with a 'bite cap' to tackle oral fixation. There's a range of flavour packs to choose from — or you can just use air — and a built-in fidget spinner. Then there's Cigtrus, which is one of a few products that offer a lungful of essential oils rather than nicotine. The site promises 'Natural ingredients. Only essential oils. No additives', but as Professor Freeman says firmly, "Our lungs are evolved to inhale fresh, clean air, so just to be very clear, I do not recommend inhaling essential oils." The Cigtrus site has a whole page devoted to being a product aimed at smoking cessation. And yet right there on the home page is another claim: "No need for any smoking experience." If the ALP and the Coalition were divided over vapes, that has nothing on the way nicotine pouches are dividing politicians in the United States. Pouches, which sit between the lip and the gum, are regulated under the Australian Register of Therapeutic Goods (ARTG) and can not be legally sold in Australia. They are heavily marketed in the US and are appealing to a young crowd who may never have smoked cigarettes, but who enjoy the stimulant buzz. Some brands sound positively healthy, like Lyfe Citrus. The most popular brand, Zyn, owned by Philip Morris International, contains from 3 milligrams right up to 150 milligrams of nicotine. 'Zynfluencers' promote the pouches on social media and podcasts as a healthier option to vaping, since there is no inhalation. There are some unintentional Zynfluencers, too: There was much media speculation as to whether or not Robert F Kennedy, the US Secretary of Health, popped a pouch in his mouth during his Senate confirmation hearing. The debate over pouches goes even further. They are at the centre of a culture war in the US, with Democrats cracking down and Republicans using this as a way to raise a rebellion, sending mixed messages about health impacts. Conservative commentator Tucker Carlson used to back Zyn, but then launched his own brand, Alp. He promotes nicotine as having health benefits including describing it as "a life-enhancing God-given chemical", and "a powerful work enhancer, and also a male enhancer". Despite some Australian influencers promoting pouches last year (and one being kicked off TikTok for his troubles), the product is yet to take off in Australia in a big way. The highest uptake, though, has been among 18- to 24-year-olds and it may be an issue coming down the pipeline for Australian politicians in the near future. Generation Vape is an Australian national research project into the growing use of e-cigarettes among young people. Data collected in October/November 2024 found that 12.9 per cent of this age group had tried nicotine pouches. "I think we need to be very aggressive in our prevention efforts," says Freeman, who oversees the Generation Vape project, "and not wait for this to become a problem, so that, in six years' time, I'm not having this exact same conversation with another journalist. It's just so frustrating to me. Can we not learn from history?" *David is a pseudonym Credits Words: Jenny Valentish Editor: Catherine Taylor Illustrations: Kylie Silvester, Adobe Stock Images
