distributed by e-mail on June 18, 2013

This update provides information on the following:

1) Measles outbreaks and the need to be on the alert for patients with symptoms of measles
2) New recommendations for pneumococcal vaccination of immunosuppressed adults

1) Measles outbreaks:

There are a number of outbreaks of measles occurring around the world including in the Netherlands, the United Kingdom and New York City. There are also three cases of measles in a family in Burlington, Ontario, that appear to be related to travel outside the province.

The outbreak in the Netherlands is in a community with close connections with a community in Oxford County, Ontario. It was this connection that resulted in the rubella outbreak in Oxford County in 2005.

Please be on the alert for patients with signs and symptoms of measles. Diagnostic testing of suspected measles cases is outlined in the attached document. Please isolate the patient as soon as possible and contact the Health Unit if you suspect a patient may have measles (519-663-5317 ext. 2330).

Measles Diagnosis based on Public Health Ontario Alert to Clinicians –March 9, 2013

2) National Advisory Committee on Immunization (NACI) Guidelines on the Use of Conjugate Pneumococcal Vaccine (Prevnar 13) in Immunosuppressed Adults:

The National Advisory Committee on Immunization (NACI) has released the guideline document on the use of conjugate pneumococcal vaccine (Prevnar 13) in immunosuppressed adults. Prevnar 13 is recommended for adults (and children) with the following immunosuppressive conditions:

• Post hematopoietic stem cell transplant recipients;
• HIV positive patients;
• Asplenia (anatomical or functional);
• Sickle cell disease or other hemoglobinopathies;
• Congenital immunodeficiencies involving any part of the immune system, including B-lymphocyte (humoral) immunity, T-lymphocyte (cell) mediated immunity, complement system (properdin, or factor D deficiencies), or phagocytic functions
• Immunosuppressive therapy including use of long term corticosteroids, chemotherapy, radiation therapy, post-organ-transplant therapy, and certain disease modifying anti-rheumatic drugs;
• Malignant neoplasms including leukemia and lymphoma;
• Solid organ or islet cell transplant (candidate or recipient).

Except for hematopoietic stem cell transplant patients, adults with the above conditions should first receive one dose of conjugate pneumococcal vaccine (Prevnar 13), followed 8 weeks later by polysaccharide pneumococcal 23 vaccine (Pneumovax 23 or Pneumo 23). For adults, a single lifetime booster dose of polysaccharide pneumococcal 23 is recommended 5 years after the previous polysaccharide pneumococcal 23 dose.

If the patient has already received polysaccharide pneumococcal 23, then the Prevnar 13 is recommended to be given at least one year after the original polysaccharide pneumococcal 23 dose. In adults, a single lifetime booster of polysaccharide vaccine is recommended 5 years after the original polysaccharide pneumococcal 23 dose (and at least 8 weeks after the Prevnar 13).

The recommended schedule for stem cell transplant patients is three doses of Prevnar 13 followed by polysaccharide pneumococcal 23. The exact schedule is provided in Recommendation #1 in the attached statement.

Note that Prevnar 13 is not currently publicly funded for adults in Ontario.

NACI Statement on the Use of Conjugate Pneumococcal Vaccine-13 valent in Audlts (Pneu-C-13)