NSW is on track for its worst measles outbreak in five years after two young travellers from the North Coast became the latest to fall victim to the highly contagious disease.
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The "unusual" figures have sparked a warning from health authorities and vaccination advocates, who have stressed that measles can have serious and sometimes fatal complications.
The travellers in their 20s, who had not been vaccinated, are believed to have been exposed while holidaying in the Philippines last month.
The pair were unwell and infectious during Scoot flight TR6 from Singapore to the Gold Coast on March 29.
They later visited shops in Pottsville and Cabarita, a medical centre in Murwillumbah and Tweed Hospital emergency department.
The North Coast Public Health Unit is urging people at those locations to be alert for symptoms of measles - fever, sore eyes and a cough, followed by a blotchy red rash - over the next fortnight.
Preventive injections can be given up to six days after exposure.
It comes as figures show NSW Health is tracking for a busy year, with 33 cases of measles reported in the state in the period since Christmas.
Last year there were 19 residents diagnosed across the state, compared to 30 in 2017, 18 in 2016 and nine in 2015. "We have had an unusual number this year," said Dr Jeremy McAnulty, the director of health protection at NSW Health.
The spike has been blamed on travellers getting infected overseas and bringing the disease back to Australia. Recently, there have been outbreaks across the US, New Zealand and the Philippines.
Dr McAnulty warned that people travelling overseas during the upcoming school holidays were vulnerable unless they had received two shots of the measles vaccine during their lives.
"You can't really say any overseas country is safe because people on the airplane could be travelling to different parts of the world," Dr McAnulty said.
"Measles is probably the most infectious disease there is - you don't have to be close to someone to get it."
The vaccine is free and effective even if administered on the day of departure. Babies can receive a shot from nine months of age if their parents are planning to travel, even though vaccination usually occurs at 12 months.
For Cecily Johnson, a former paediatric nurse from the NSW North Coast, every outbreak of measles is upsetting. Her daughter, Laine, contracted measles at 10 months old.
Seven years later it caused her to develop subacute sclerosing panencephalitis (SSPE), a terminal disease that left her blind and unable to walk or talk. She died in 1995 at the age of 12.
"It was horrific," Ms Johnson recalled. "One of her last lot of words were: 'mum, just let me see one more time'".
Ms Johnson said most people were unaware that measles could be a "time bomb", with SSPE lying dormant for an average of seven years in the body.
"Up here on the North Coast ... this is the worst area in Australia for not getting vaccinated," she said. "They go: 'it won't be my kid'. But you know what? I wouldn't have thought that either. This healthy, beautiful child - I never, ever, expected this."
