MEDICAL ADVISORY: Testing Reminders for Measles, and other Vaccine News

Issued by: Dr. Jessica Jackman, MD MPH FRCPC FACPM DipABLM, Associate Medical Officer of Health

Date: April 15, 2024

Public Health is reminding health care providers of all required laboratory tests and specimens for suspected measles cases. Additionally, please be aware of the following updates regarding COVID-19, Mpox, Hepatitis B, RSV and pneumococcal vaccines, as well as product and packaging updates.

Measles testing reminders

Diagnostic laboratory testing is essential for all suspected measles cases. If you suspect measles in a patient:

1. Report immediately to Public Health. Contact the Infectious Disease Program at:

905-688-8248 ext. 7330
Toll free: 1-888-505-6074
After-hours: 905-984-3690

2. Call Public Health Ontario’s Laboratory Customer Service Centre:

416-235-6556 or 1-877-604-4567

3. Collect all required specimens for testing (polymerase chain reaction (PCR) in nasopharyngeal/throat swab AND urine, as well as diagnostic serology). All three specimens should be collected and tested. We ask that you continue to mark the outer package STAT and send samples separate from routine. Do not submit specimens for measles testing with expired collection kits as these will be rejected for testing.

PCR Testing (Nasopharyngeal / Throat Swab AND Urine)

Nasopharyngeal swab / throat swab (collect within 7 days after the onset of rash) AND
Urine sample (collect within 14 days of rash onset and submit in a sterile container)
See more information about measles PCR testing

Serology Testing (IgG / IgM)

Acute (collect within 7 days after the onset of rash)
Convalescent (collect 7 to 10 days after acute; preferably 10 to 30 days after acute)
See more information about measles serology testing

Vaccine news

Informational updates on COVID-19, RSV, pneumococcal, Mpox, and Hepatitis B vaccines.

COVID-19 vaccine spring 2024 campaign

On April 8, 2024 the Ministry of Health updated their COVID-19 Vaccine Guidance and indicated that individuals who are at increased risk of severe illness from COVID-19 may receive an additional dose of an XBB COVID-19 vaccine in Spring 2024
The Ontario spring COVID-19 vaccine campaign will run from April to June 2024
If your practice does not administer COVID-19 vaccine, refer patients to participating walk-in clinics and pharmacies. Public Health vaccination clinics offer COVID-19 vaccine, particularly for those who are high risk and children under two years of age.

Mpox vaccine

An increase in mpox activity has been observed in Ontario since mid-January 2024 with a total of 26 confirmed cases in 2024 to-date (compared to only 33 confirmed cases in all of 2023)
Toronto Public Health is experiencing an increase in mpox cases, with evidence suggesting local community transmission of the virus
Only 34.5% of individuals who have received one dose of an Imvamune^®vaccine in Ontario have received their second dose. Health care providers should continue to promote a two-dose vaccination series to those eligible. Individuals with a previous history of laboratory-confirmed mpox infection or history of completing a two dose vaccine series do not require a booster.
Mpox vaccine is only available to Niagara residents at Public Health vaccination clinics. Eligible individuals can book an appointment for their first or second dose by calling at 905-688-8248 ext. 7425 or 1-800-263-7248.

Hepatitis B vaccine for children under 7 years of age

If your office is seeing children under 7 years of age whose family has immigrated to Canada, they may be eligible to receive Hepatitis B vaccine (HBV). The eligibility criteria from Table 3 (page 8) of the Publicly Funded Immunization Schedules for Ontario states:
- Children under 7 years old whose families have immigrated from countries of high prevalence for HBV and who may be exposed to HBV carriers through their extended families (3 doses)
See High Risk Release Order Form to place a HBV order

Pneumococcal conjugate 15-valent and 20-valent vaccines are not publicly funded

Although Health Canada extended the authorized age to include children six weeks to 17 years of age and the National Advisory Committee on Immunization released new pneumococcal vaccine recommendations for children, the 15-valent and 20-valent conjugate vaccines are not currently included in the Publicly Funded Immunization Schedules for Ontario
Prevnar^® 13 is indicated for individuals 50 years of age and older who meet the high-risk criteria. To access the high-risk eligibility criteria, refer to Table 3 (page 8) of the schedule.
Pneumovax^® 23 is publicly funded for adults 65 years of age and older as part of the routine vaccine program. To access the high-risk eligibility criteria for individuals 2 to 64 years of age, refer to Table 3 (page 8) of the schedule.

RSV

The 2023-2024 RSV season and publicly funded vaccination programming is winding down for high-risk groups
- Any previously planned RSV vaccination clinics can be continued (unless they are required to be cancelled for external reasons)
- No new clinics should be planned, unless they are under previous agreement
- Eligible individuals who did not receive a dose during the 2023-2024 RSV season should wait until the next RSV campaign to receive their vaccine
Details on vaccination for the 2024-2025 RSV season will be provided closer to Fall 2024

Vaccine product and packaging update

Vaccine manufacturers are updating their product packaging. In the coming months, you may find some of your vaccines look different from previous orders.

Pentacel^®

The Ministry of Health will be transitioning to Pentacel^® before the end of the year. This change is a result of Sanofi Vaccines Canada discontinuing Pediacel^®.
Both Pediacel^® and Pentacel^® are pentavalent vaccines (DTaP-IPV-Hib) used to protect against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib) in children from the age of 2 months up to 6 years of age (prior to their 7^th birthday).
- These products are equivalent and interchangeable. Please see the product monograph for specific ingredients.
- If an infant has received one or two doses of Pediacel^®, the primary series can be completed with Pentacel^®
- Health care providers can continue to use the doses of Pediacel^® they receive in 2024 until the expiration date listed on the vaccine packaging
During this change, you may see both products in your vaccine orders. Please use Pediacel^® first.
The packaging is changing from:
- 5 single-dose vials of Pediacel^® vaccine (old packaging) to
- 5 single-dose vials of Quadracel^® vaccine and 5 single-dose vials of lyophilized Act-HIB^® vaccine (new packaging)
- Pentacel^® requires reconstitution: Act-HIB^® will need to be reconstituted with Quadracel^® at time of administration. Refer to the product monograph for details.
- Package dimensions (5 doses per pack): LxWxH - 3.35" x 1.81" x 2.01"
Since DTaP-IPV (Quadracel^®) is no longer used in the province’s publicly funded immunization schedule and has been replaced by Tdap-IPV (Adacel^®-Polio or Boostrix-Polio), Quadracel^® and Act-HIB^® should not be administered as separate vaccines. Continue to use Adacel^®-Polio or Boostrix-Polio where indicated and only use Quadracel^® and Act-HIB^® for the purpose of Pentacel^® administration.

Priorix

New larger packaging
The packaging is changing from:
- 10 single-dose vials of lyophilized vaccine and 10 single-dose vials of diluent (in each separate box) to
- 10 single-dose vials of lyophilized vaccine and 10 single-dose pre-filled syringes of diluent (together in one box). Start at page 12 of the Priorix product monograph for reconstitution instructions.
- Package dimensions (10 doses per pack): LxWxH - 3.05cm x 17.78cm x 13.97cm
This product will require 5/8” needle tips for administration
It is anticipated that there will be more product packaging changes, specifically from GSK Vaccines Canada, for Priorix-Tetra and Varilrix

For more information

Call the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396
Visit Immunization, Vaccine for Health Professionals