In This Issue - March 2025

Program Updates
• Measles Information
• Vaccine Preventable Disease Program
• Nurse Family Partnership Program
• April is Oral Health Month
• Infant Child Development Program

Announcements
• Respiratory Surveillance

Educational Opportunities
• Breastfeeding: Making a Difference Level 2 Training

Measles Information

Ontario is currently experiencing a significant measles outbreak, primarily in under-vaccinated communities. At this time, we have seen 10 measles cases in Niagara – all of these infections are epidemiologically linked. We are continuing to monitor the situation.

Session Recording

On March 21, Ontario Health in collaboration with the Chief Medical Officer of Health and Public Health Ontario held a measles information session for hospitals, primary care and public health units in the Central and West regions. Access the session recording for more information and common Q&A on measles epidemiology, vaccination and schedules, local case and contact managements, testing, post-exposure prophylaxis, and IPAC.

Health Care Provider Action

Testing

When assessing patients, consider measles testing for patients presenting risk factors for measles, and clinical compatible signs and symptoms:
- Fever ≥ 38.3 degrees Celsius (oral), and
- Generalized maculopapular, erythematous rash for at least three days, and
- At least one of: cough, runny nose (coryza), or red eyes (conjunctivitis)
- Koplik spots (tiny blue-white spots on the buccal mucosa) may also be present
To facilitate timely testing, please ensure specimen collection supplies are stocked and readily available in your offices and use the public health lab requisition (see table below)
Measles virus detection (PCR) is preferred to serology for diagnostic testing
- For nasopharyngeal swab, order #390082 virus respiratory kit. Collect within 7 days of rash onset
- For throat swab, order #390081 virus culture kit. Collect within 7 days of rash onset
- For urine, use a sterile 50 mL container. Collect within 14 days of rash onset
For diagnosis using serology, use blood, clotted-vacutainer tubes (SST) to collect whole blood (5.0 mL) or serum (1.0 mL). Convalescent 7-10 days after the acute; preferably 10 to 30 days after acute

PEP for contacts

The updated At A Glance Measles: Post-Exposure Prophylaxis for Contacts summarizes existing measles post-exposure prophylaxis (PEP) guidance.
Although serology is not routinely recommended for immune status assessment amongst the general public, it may play a role in guiding PEP decisions:
- For pregnant individuals with unknown vaccination history or those with one dose of measles-containing vaccine
- For immunocompromised individuals, refer to the OIAC statement on measles PEP for individuals who are immunocompromised

Reporting

Please report all suspected and confirmed cases to Niagara Region Public Health, Infectious Disease program immediately at 1-888-505-6074 or 905-688-8248 ext. 7330, Monday to Friday 8:30 a.m. to 4:30 p.m., after hours 905-984-3690
Remind parents/legal guardians and children 16 years of age and older that they are responsible for reporting their vaccines directly to Public Health. The fastest and most convenient way to report is to use Immunization Connect (ICON).

More Information

Measles information for health care providers – Public Health Ontario
For vaccine related inquiries, call 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 so that your call will be prioritized during times of high call volume.

Vaccine Preventable Disease (VPD) Program

Prevnar 20® Storage Requirements

Although storage requirements have not changed, Public Health will no longer be sending the following Prevnar 20® storage requirements with vaccine orders. As a reminder, the requirements are:

Boxes of syringes should be stored horizontally, laying flat on shelf, to minimize the re-dispersion time (refer to the diagram on the box)
Do not use the vaccine if it cannot be re-suspended
Do not use the vaccine if large particulate matter or if discoloration is found

For more information about Prevnar 20® storage, handling, and administration, please refer to the product monograph.

Pentacel® Requires Reconstitution

Pentacel® vaccine presentation contains both an Act-HIB® lyophilized vial powder and a separate Quadracel® (liquid).

Act-HIB® will need to be reconstituted with Quadracel® at time of administration.
- Refer to page 6 of product monograph for reconstitution instructions.
The Quadracel® component is not intended to be administered without the HIB component.

For questions about either of these options, please contact the Vaccine Preventable Program at 905-688-8248 ext. 7425.

Nurse-Family Partnership Program

The Nurse-Family Partnership program offers free home visits from a public health nurse to support families from pregnancy through to the child’s second birthday.

The aim of this program is to improve prenatal health, child health and development, and the self-sufficiency of the family. Screening, assessment, and referrals to community services are provided.

Eligibility for this program includes:

Pregnant individual is under 25 years of age
28 weeks gestation or less
Preparing to parent for the first time
Economically and socially disadvantaged

If you have a patient who would benefit from a home visit, complete the Family Health Referral form online or download and fax. Patients can also self-refer by contacting Niagara Parents at 905-684-7555 or 1-888-505-6074 ext. 7555.

April is Oral Health Month

Infant Feeding and Early Childhood Caries

Infants are susceptible to early childhood caries as soon as their teeth begin to erupt. Early childhood caries is a severe form of tooth decay in primary teeth.

Infants may be at an increased risk of early childhood caries when put to bed with a bottle that contains milk, juice or formula. Nighttime unrestricted at-will breastfeeding may also increase the risk of early childhood caries due to sugar found within breastmilk.

Recommendations for well-baby visits:

Conduct a visual assessment of the infant's tongue, teeth, cheeks and gums looking for any chalky white, brown or black spots
Encourage only water in nighttime bottles
Suggest wiping infant's gums and teeth with a damp clean cloth after feeding
Once the first tooth appears, advise parents to brush twice a day for two minutes using a rice grain size of fluoridated toothpaste
Infants should visit a dental professional as soon as their first tooth erupts

The Dental Program at Public Health offers FREE dental clinics for children and youth 17 years of age and under. Through these clinics, fluoride varnish is available free of charge. Fluoride is not added to the drinking water in Niagara, so fluoride varnish application offers several benefits for dental health, particularly in strengthening enamel and preventing tooth decay. Fluoride varnish is safe and effective for children and reduces their risk of carries.

How to Refer Families:

Visit the health care professional webpage to access the Family Health referral form. Please select "oral health" as the reason for referral.

Infant Child Development Program

This update is in follow-up to the announcement made in November 2024 which stated that the provincially funded early child development home visiting program, Infant Child Development Program (ICDP) will transition from Niagara Region Public Health and be led by Niagara Children Centre beginning April 1, 2025. Niagara Children’s Centre is the Provincial Smart Start Hub for Niagara families, which is the entry point to access services for growth and development needs.

The Infant & Child Development Program (ICDP) supports children who live in the Niagara Region from birth to school entry who:

Were born prematurely
Have a diagnosis that could impact their child’s development
Were multiple births such as twins, triplets
Experienced challenges at birth or early in life
Are experiencing developmental differences

Health care professionals can refer through the Niagara Children’s Centre’s New Infant & Child Development Program Referral Portal.

Note: If the online referral system is down, please fax a completed Niagara Children’s Centre/Smart Start Hub Physician/Primary Care/Healthcare Providers Referral Form to 905-688-9181.

Respiratory Surveillance

Public Health Ontario’s most recent respiratory laboratory surveillance data indicates activity for influenza is high
Provincially, Influenza A is the most commonly circulating virus (based on percent positivity)
In Niagara, there have been 1,204 cases of influenza this season; 29,867 across Ontario from November 23, 2024 to March 14, 2025.

Niagara reports flu activity surveillance information weekly on Fridays. For more detail on the 2024 to 2025 respiratory season, please visit Public Health Ontario’s page for the Ontario Respiratory virus Tool.

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

FREE TRAINING: Breastfeeding "Making a Difference" Level 2

Niagara Region Public Health is hosting a 2-day virtual (LIVE) workshop series for community health care professionals and hospital staff practicing in Niagara who currently work with expectant or new parents and families.

Dates: April 29 & 30 | Time: 8:30 a.m. - 4 p.m.

Location: Zoom (online)

Keynote Speaker:

Kathleen O’Grady is a registered nurse and an International Board Certified Lactation Consultant (IBCLC). Please visit Breastfeeding: Making a Difference Level 2 Workshop - Niagara Region, Ontario for her additional credentials.

Key topics:

Effective assessment and management skills by applying current research, using complex case studies and group problem solving to formulate care plans to deal with challenging situations
Effective breastfeeding promotion in a multi-cultural society
Infant-parent attachment
Ethics
Evaluating research, training materials and research

Requirements:

Completion of the Breastfeeding Level 1 training (or an equivalent) within the past 3 years
Must be a health care practitioner practicing in the Niagara region

Note: Participants must attend both session dates and may be eligible to receive IBLCE CERPS (Continuing Education Recognition Points).

Registration is open until April 15.

Medical Advisories & Memos

MEDICAL ADVISORY: March 5 - Measles Cases in Niagara, Update 2

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