MEDICAL ADVISORY: Recent Travel-Related Measles Cases in Ontario

Issued by: Dr. Emily Groot, MD MPH FRCPC, Associate Medical Officer of Health

Date: March 10, 2023

On Feb. 8, 2023, the Pan-American Health Organization issued an alert regarding increased risk of measles. Measles vaccine coverage for both first and second doses has dropped globally, including in Canada. While no cases of measles have been identified in the Niagara region, there have been two recent lab-confirmed cases in Ontario.  Both of these cases are travel related. 

Measles is a highly transmissible, airborne virus.  With reduced border measures and increased travel anticipated over March break, health care providers should consider measles in their differential diagnoses, particularly in returning travelers with fever and generalized rash or respiratory symptoms.

Reporting Requirements for Health Care Providers

Under the Health Protection and Promotion Act (HPPA), suspected or confirmed measles cases must be reported immediately to Niagara Region Public Health. Do not wait for lab confirmation. Contact the Infectious Disease Program at:

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

Airborne Precautions

• Suspected measles cases should be placed under airborne precautions
• Measles virus can remain airborne for up to two hours. No further patients should be placed within the room for a two-hour period following use by an individual suspected to have measles.
• If possible, patients suspected to have measles should be assessed at the end of the day and placed in a separate room upon arrival
• Only immune staff should provide care to suspect cases of measles

Testing for Measles

• Recommended testing for acute measles infection includes:
  • Nasopharyngeal or throat swab for PCR (within seven days of rash onset) AND
  • Urine for PCR (within 14 days of rash onset) AND
  • Acute and convalescent diagnostic serology

Immunization

• Ensure all staff have either two doses of documented measles immunization OR documented laboratory evidence of immunity. This includes for individuals born prior to 1970, as per the OHA/OMA Measles Communicable Diseases Protocol and the Canadian Immunization Guide
• Support patients in remaining up-to-date with all routine immunizations, especially in advance of upcoming travel. See the publicly funded immunization schedule.
• In the Niagara region, the current measles vaccination coverage rate for students in JK – Grade 12 is 78% compared to the national goal of 95%
  • Check immunization status when you are seeing a student for any reason and offer vaccine if needed
  • Remind parents to report vaccines received to Public Health (only for students 0-17 years of age)
• Ensure your office has enough supply of MMR-containing vaccine  

More Information

• Measles testing indicators - Public Health Ontario
• Travel health notices - Government of Canada