Measles Preparedness

Advisory Alert

February 22, 2023

*Cette information est seulement disponible en anglais.

To: Local Health System Partners

FOR IMMEDIATE ATTENTION

On February 14, 2023, Ontario’s Chief Medical Officer of Health (CMOH), Dr. Kieran Moore, recently shared strong for health care providers in the wake of the Pan-American Health Organization statement on February 8, 2023, concerning the increasing risk of measles in the Americas and globally. The COVID-19 pandemic has impacted all vaccine preventable disease coverage across the lifespan, including vaccine coverage for the highly transmissible measles virus.

This Advisory Alert includes the CMOH strong recommendations for health care providers and provides further details on measures to recognize, control, and prevent the spread of measles infection. These measures are of critical importance as there have been recent reports of travel-related measles in Ontario. Further, with the March break approaching, it is expected that the number of people travelling will rise substantially over the next few weeks.

Measles recognition

Be alert to include measles in your differential diagnoses for patients presenting with respiratory signs and symptoms that are clinically compatible with measles infection, including fever, rash, cough, runny nose, and conjunctivitis. This is particularly important in the context of clients who have a history of recent travel or who have had known contact with a case of measles.

Most cases of measles become apparent 10 to 14 days after exposure to the virus; however, symptom onset can occur between seven and 21 days from exposure. Cases are infectious from one day before the start of the prodromal period (about four days before rash onset), to four days after the onset of rash. A detailed is available for further reference.

Suspected measles cases should be immediately placed under airborne precautions (or if unavailable, the patient should wear a surgical mask and be placed immediately in a clinic room with the door closed) and tested.
Only staff with immunity to measles should enter the room. Health care workers who are not immune to measles infection should only enter the room in highly exceptional circumstances and must wear a fit-tested, seal checked, N95 respirator to provide care. Other PPE may be required based on risk assessment.
As measles virus can remain airborne for two hours. No further patients should be placed within the room for a two-hour period (however, this could be sooner depending on the number of air changes). Appropriate room cleaning is also required.

Testing information is outlined on the Public Health Ontario site: Measles – Diagnostic – PCR | Public Health Ontario. When measles infection is suspected – contact Public Health Ontario laboratory immediately to ensure that appropriate testing is being requested and that any urgency is conveyed. Also contact Public Health Sudbury & Districts (see below) to advise of all possible or suspect cases of measles.

Please mark the symptoms, date of symptom onset, exposure history, travel history (if any), and vaccination history on the requisition. The diagnostic tick box should also be marked as the reason for testing.

Measles prevention

Make sure health care workers are protected. Per the Canadian Immunization Guide, health care workers require documentation of two doses of a measles containing vaccine regardless of their year of birth or have documented laboratory evidence of immunity in order to meet the definition of measles immunity.

Actively offer the measles vaccine to all your eligible patients and ensure they are up to date with other routine vaccinations. This is especially important for those considering travel and the increased risk of exposure to measles and other diseases through the Americas and globally. Recommendations for measles vaccination can be found in the Canadian Immunization Guide based on age and risk factors, including travel.

Measles reporting

Measles is a reportable disease under provincial law. Any physician or practitioner who forms the opinion that the person under their care has or may have measles is to report this immediately to Public Health Sudbury & Districts at 705.522.9200, , or toll-free 1.866.522.9200 or after hours at 705.688.4366. Please also complete the communicable disease notification form (PDF) and fax to our confidential fax at 705.677.9618.

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

This item was last modified on February 22, 2023