Your monthly update from Niagara Region Public Health 

Welcome to Public Health Pulse! Formerly known as the Physicians’ Newsletter, we gave the publication a fresh name in January 2025 to better reflect our commitment to supporting Niagara’s physicians, primary care providers, and allied health professionals with essential public health updates.

We value your feedback—your insights help us ensure the content remains useful and impactful. If you have suggestions or topics you’d like us to cover, just hit reply and let us know!

As we wrap up May, I’m pleased to share key updates and resources to support your clinical practice and public health efforts.

This month’s issue highlights the latest on measles activity and serves as a reminder that the annual child care immunization record review is now underway, an essential step in protecting our youngest patients.

With warmer weather on the horizon, we’re also sharing timely resources on tick identification and Lyme disease clinical guidance to help you manage seasonal risks with confidence.

Finally, as we recognized Mental Health Week earlier this month, I encourage you to continue working to dismantle mental health stigma and fostering compassionate, supportive care for all.

Thank you, as always, for your dedication to improving the health of our communities.

Dr. Azim Kasmani
Medical Officer of Health
Niagara Region Public Health and Emergency Services

In this issue - May 2025

Program Updates
• Update on measles activity
• The annual child care immunization record review begins 
• Tick identification and Lyme disease clinical guidance resources
• Mental health week - unmasking mental health

Educational Opportunities
Recent Medical Advisories and Memos

Update on measles activity

Ongoing measles transmission in Ontario is impacting multiple areas of the province. The continued increase in the number of outbreak cases and geographic spread is predominantly due to ongoing exposures and transmission among individuals who have not been immunized.

Since the beginning of March, Niagara has reported 13 measles cases. All have been epidemiologically linked, meaning each case is connected to a known source, and there is no evidence of widespread or unlinked community transmission.

Thanks to our high local vaccination rates and the continued efforts of the community to protect one another’s health, the risk of measles spreading in Niagara remains low.

Measles vaccine recommendations for Niagara

At this time, the measles vaccine recommendations remain unchanged for Niagara. Please continue to offer routine or catch-up immunizations for measles.

Measles outbreak immunization strategy for Ontario

Based on current risk levels, Niagara has not been identified by the Ministry of Health as a region requiring enhanced measles immunization measures. However, we continue to actively investigate all reported cases, monitor for any new activity, and are ready to respond quickly if the situation changes. If there is increased transmission and identified local transmission without known sources, these recommendations can change.

As part of the outbreak response, Public Health Ontario (PHO) has created a chart comparing routine versus outbreak vaccine recommendations in the province. Page 2 pf the PHO document features a map of public health units that have implemented the measles outbreak vaccine recommendations. As of May 2025, measles vaccine eligibility includes individuals who live, work, travel (e.g., family visit), worship or spend time in the affected regions and communities that continue to see increased transmission and community exposures.

For comprehensive information on measles, including guidance on testing, post-exposure prophylaxis (PEP), and case reporting, please refer to the March newsletter.

The annual child care immunization record review begins

Public Health is currently reviewing the immunization records of all children attending licensed child care centres and licensed home child care agencies in Niagara (Child Care and Early Years Act (CCEYA), 2024). These children should receive vaccines according to their age as per the Publicly Funded Immunization Schedules for Ontario. Immunization Reminder Notices are being mailed to parents and legal guardians in batches until end of June. Approximately 2,000 notices are scheduled to be mailed over this time period.

Health Care Provider Action

• Please support families seeking vaccine appointments for their children in licensed child care and ensure your office has enough vaccine to accommodate demand
• Order resources for your office
  • Notification tear-off pads to support the parent or legal guardian in reporting their child’s vaccine to Public Health
  • Publicly funded immunization schedule for health care providers interested in having an “at a glance” copy of the required vaccinations under the CCEYA

More Information

• Contact the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396. Please state that you are a health care provider and we will prioritize your call during times of high call volume.

Tick identification and Lyme disease clinical guidance resources

According to Public Health Ontario’s 2024 annual Blacklegged Tick Established Risk Areas Map (formerly the Ontario Lyme Disease Map: Estimated Risk Areas) Niagara region remains a risk area for blacklegged ticks. Blacklegged ticks are the primary vector of four reportable tick-borne diseases - Anaplasmosis, Babesiosis, Lyme disease and Powassan virus. 

How can ticks be identified?

• Clients can submit a tick photo via the eTick mobile app or by visiting the eTick.ca website. Trained personnel will identify the tick, with results typically returned in 1-2 business days.
• It is important to remind all patients that there is no cost for the tick identification, however, ticks submitted are not tested for the bacteria that causes Lyme disease

Lyme diseases clinical guidance resources 

Patients with a single erythema migrans skin lesion can be seronegative at the time of initial presentation. A lesion greater than five centimetres in diameter consistent in appearance to erythema migrans in individuals exposed to blacklegged ticks in risk areas, such as Niagara, is considered confirmation of early localized Lyme disease and should be treated without laboratory confirmation. 

For guidance on the management of tick bites and investigation of early localized Lyme disease refer to Ontario Health's clinical guidance resource. 

Public Health Ontario and Ontario Health have also developed an assessment and prescribing algorithm for community pharmacists when prescribing antibiotic prophylaxis to prevent Lyme diseases following a tick bite.

For more information, please visit the Ticks and Lyme disease webpage or call the Environmental Health Duty Officer at 905-688-8248 ext. 7590.

Mental health week – unmasking mental health

May 5 to 11 marked Mental Health Week in Canada. This annual campaign aims to educate the public, shift beliefs and perceptions about mental health and encourage behaviours that promote positive mental health for everyone. This year’s theme was “Unmasking Mental Health” and invited everyone to look past the surface and see the whole person.

“Masking” involves suppressing or hiding something about ourselves and is a coping mechanism to stay safe, hide in plain sight or to fit in. People mask for a variety of reasons and unfortunately individuals experiencing mental health and addiction issues can suffer worsened health concerns due to constant masking.

Physicians play a crucial role in dismantling mental health stigma by normalizing discussions about mental health, promoting open dialogue and sharing. This includes educating yourself and others about mental health, fostering a culture of wellness within your practice, and encouraging help-seeking behaviours. 

More information and resources

• Canadian Mental Health Association (CMHA) resources to help build a more psychologically safe workplace and equip staff with practical skills to improve their own well-being
• Mental health and self-care resources tailored to support health care professionals

Visit the Professional Development Opportunities page for in-person and online opportunities available to health care professionals in Niagara.

Medical Advisories and Memos

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