Measles for Healthcare Providers

Measles is a highly contagious viral infection that spreads through the air when an infected person breathes, coughs or sneezes.

Measles can result in complications such as pneumonia, ear infections, brain infections, other infections and infrequently, death can occur.

Inclusion of measles in differential diagnosis

With rising global cases, the need to include measles in your differential diagnosis, particularly in returning travellers with respiratory symptoms or rash, has become even more important.

For more information, please visit Infectious Diseases Protocol: Appendix 1 – Case Definitions and Disease - Specific Information: Measles from the Ministry of Health.

Isolation guidelines for suspected cases

Suspected measles cases should be placed under airborne precautions and tested. The Public Health Ontario Measles: Information for Health Care Providers provides practical guidance on infection prevention and control practices for handling suspected cases of measles on page four of the document.

Testing for measles

With the rise in cases, there has been an increase in testing and testing errors have been identified. Serology alone is unable to confirm current measles infection. A nasopharyngeal or throat PCR and a urine PCR are also required.

See specimen requirements in Public Health Ontario Laboratory Test Information Sheet For Measles for more information.

Treatment

There is no treatment for this viral illness. Supportive measures can be taken to relieve sore throat, cough, and fever. Care should be taken not to expose others to infection by staying home and not allowing others to visit for at least four (4) days after the start of the rash. Immunization prior to exposure is the best defense against infection.

Vaccination

Continue to reinforce that vaccines are highly effective in preventing disease transmission.Support patients in receiving all routine vaccinations (including measles) according to the Publicly Funded Immunization Schedules for Ontario found on the Ministry of Health’s Vaccine Resources for Professionals website.

It is important to ensure that school-aged children who were due for their 2nd dose of measles-containing vaccine during the COVID-19 pandemic years receive this dose as soon as possible as it may have been missed due to disruptions to the delivery of immunization services during the COVID-19 pandemic.

MMR Vaccine recommendations for individuals who are NOT travelling:

• Individuals born before 1970 are generally considered to be immune due to the high likelihood of having had measles
• Individuals born after 1970 who have not yet received 2 doses of MMR should receive a total of 2 doses
• Infants in between 6-12 months do not require an early dose of vaccine if not travelling

Travel Immunization

Individuals travelling to destinations outside of Canada should ensure they are adequately vaccinated against measles prior to travel. Measles-containing vaccine should be given at an earlier age than the routine immunization schedule for children travelling outside of Canada where the disease is of concern or travelling to locations experiencing measles outbreaks.¹

The following table provides a summary of the Canadian Immunization Guide (CIG) recommendations for measles vaccination prior to travel outside of Canada:¹*

*Doses outlined above are publicly funded in Ontario for travel to areas where disease is of concern. Refer to the Government of Canada’s Travel health notices to access up to date information on measles outbreaks occurring outside of Canada.
**MMR or MMRV can be used (note: age indications differ)
† If a dose given for travel is administered after the first birthday and is separated from any previous live attenuated accine by at least 28 days, the dose is valid and will meet school-entry immunization requirements in Ontario.

Immunization of Individuals with Missing Immunization Records

If a patient’s immunization records are unavailable, immunization with measles-containing vaccine is preferable to ordering serological testing to determine immune status.¹ This avoids the potential for false positive and/or false negative results, reduces the risk of missed opportunities for immunization and is consistent with advice from the CIG. It is safe to give additional doses of MMR vaccine to those who are already immune. Routine serological testing to determine immunity in healthy individuals is not routinely recommended.¹ (Cited from: Measles: Information for Health Care Providers (Public Health Ontario))

References

1. Public Health Agency of Canada; National Advisory Committee on Immunization; Committee to Advise on Tropical Medicine and Travel. Measles vaccines: Canadian immunization guide [Internet]. Evergreen ed. Ottawa, ON: Government of Canada; 2020 [modified 2020 Sep; cited 2023 Jul 30]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-12-measles-vaccine.html

Resources

• Measles: Information for Health Care Providers, Public Health Ontario
• Measles: For Health Professionals, Government of Canada
• Measles, Public Health Ontario
• Measles communication toolkit, Public Health Agency of Canada
• About Measles, Centers for Disease Control and Prevention
• Interim IPAC Recommendations and Use of PPE for Care of Individuals with Suspect or Confirmed Measles, Public Health Ontario

For general information about the measles virus, how it is spread, signs and symptoms, travel health advice, and other information geared towards the public, please visit our measles webpage.