Medical Advisory: Measles Preparedness

Action Required

Given the anticipated increase in seasonal travel, it is strongly recommended:

• Ensure your patients are up to date with all routine vaccinations including Measles, Mumps and Rubella (MMR) vaccination and request they report the vaccines they’ve received to their local public health unit.
  • Hamilton residents can report their vaccines
  • If travelling to an area where measles is spreading, infants between 6 and 11 months can receive a single dose of MMR vaccine before travel. They will still be required to receive two doses after their first birthday to be considered to have completed the vaccination series.
• To include measles as a differential diagnosis for patients with respiratory symptoms particularly with a history of recent travel
• Hospital Occupational Health & Safety and health care provider offices should ensure all staff are up to date with either 2 doses of documented measles vaccination OR documented laboratory evidence of immunity, regardless of age, as per the Canadian Immunization Guide.

Measles Information

• Symptoms may include prodromal fever, coryza, cough, conjunctivitis and small spots with white or bluish-white centres on an erythematous base on the buccal mucosa (Koplik spots). Then, 3 - 7 days after the onset of symptoms a red, blotchy (maculopapular) rash appears on the face, progressing to the trunk of the body and then to the arms and legs.
• Transmission is airborne by droplet nuclei, close personal contact or direct contact with nasal or throat secretions of a case. Measles is highly communicable. Transmission can occur as a result of the persistence of the virus in the air or on infected environmental surfaces for at least 2 hours.
• Incubation period (from exposure to fever) is about 10 days with a range of 7 – 21 days. Rash onset averages 14 days.
• Period of Communicability is one day before the start of the prodromal period, which is usually 4 days before rash onset, to 4 days after the onset of rash

Diagnosing Measles

If you suspect a case of Measles, please call Hamilton Public Health Services prior to collecting specimens.

Tests Required:

• Nasopharyngeal swab or aspirate and/or a throat swab should be collected within seven days after onset of rash, AND
• Urine should be collected within 14 days of onset of rash and submitted in a sterile container, AND
• Serology for measles IgG and IgM* (both are needed for diagnosis).

Detailed testing information can be found at: Public Health Ontario Laboratory Test Information Sheet for measles

NOTE: The General Test Requisition Form should *indicate reason for testing, travel history, vaccination history, relevant signs/symptoms, clinical history, and onset date. If this information isn’t provided on the requisition the Ontario Public Health Laboratory will not complete the Measles IgG and IgM testing for diagnosis.

Infection prevention and control (IPAC) recommendations for suspected measles

• Routine practices and airborne precautions are recommended.
• ONLY staff known to be immune to measles should provide care.
• Health care providers should wear a fit-tested N95 respirator upon entry to the room.
• Patients who phone for an assessment should be screened at time of booking for signs/symptoms of measles. See symptomatic patients at the end of the day, as clinical status allows, when no other patients are present. If the patient requires assessment at an emergency department, health care providers should pre-arrange this visit by calling the hospital so appropriate IPAC measures can be put in place.
• If possible, have the patient enter and exit through a separate entrance and go directly in and out of the exam room.
• Ask the patient to wear a medical mask upon entry to the building and to wear the mask until they leave the building. If client arrives without a medical mask, provide a medical mask.
• Have tissues and alcohol-based hand rub available at entrance to clinic to promote respiratory etiquette and hand hygiene.
• Immediately isolate the patient in an exam room; patients should not wait in the common waiting room. The exam room door should be closed. Place an alert at the entrance to the room. DO NOT use the room for 2 hours after the patient leaves to allow for the appropriate number of air exchanges to remove the virus.
• For patients requiring private lab testing, please call the lab ahead of time to arrange for appropriate IPAC measures. Instruct the patient to wear a mask while at the lab. Only lab staff known to be immune to measles should provide patient services.
• Routine cleaning and disinfecting using a hospital-grade disinfectant for the room or equipment is sufficient, after examining a patient under Airborne Precautions.
• If testing a patient for suspected measles, patient should be placed in home isolation for 4 days after the onset of rash (onset of rash is considered day 0). Immunocompromised persons should remain in isolation for the duration of the illness.

Reporting measles to Hamilton Public Health Services: Please report all suspected or confirmed cases of measles by calling the Infectious Disease Program at 905-546-2063, Monday through Friday, 8:30 am to 4:30 pm. After-hours, on weekends and holidays please ask to speak with the on-call Public Health Nurse.