Measles for Healthcare Providers

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.

Immunization

In recent years, there has been increased measles activity globally. Through travel, this has resulted in seeing more measles cases locally in Ontario as well. To prevent the spread of measles, providing two doses of MMR vaccine provides close to 100% efficacy in children. Healthcare providers should continue to reinforce that vaccines are safe and 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.

A Note to Our HCP Colleagues:

• Be aware of these outbreak recommendations to ensure individuals are vaccinated appropriately; and,
• Continue to offer routine or catch-up immunizations as per Ontario’s Publicly Funded Immunization Schedules (the Immunization Schedules).

Due to the current limited supply of MMRV, we ask that MMRV be used primarily for routine or catch-up immunizations for those 4 to 12 years of age for routine or catch-up purposes, as per the publicly funded schedule. The Health Unit has a sufficient supply of MMR, which can be ordered through the Public Health Ordering System.

As indicated in Table 16 of the Immunization Schedules and the Immunization of Schools Pupils Act, should accelerated MMR schedules be required, please follow the recommended spacing below:

Note: MMR and Var may be given on the same day or separated out on different days, using the recommended intervals listed in the chart above.

*MMR and MMRV are live virus vaccines. Two live vaccine doses can be given on the same day or at separated as per recommendations (e.g., MMR and VAR).
Preschool children who are given their 2nd dose of measles vaccine prior to age 4 yrs should receive MMR (not MMRV), according to Ontario’s Publicly Funded Schedule. A single antigen VAR vaccine can then be given between 4-6 years of age if a 2nd MMR dose was administered earlier. MMRV is only publicly funded for individuals who are 4-12 yrs of age in Ontario. At other ages, these antigens must be given separately as MMR and VAR vaccines.

Pregnancy and Breastfeeding

Measles-susceptible individuals who are pregnant should wait until after giving birth to get vaccinated with MMR vaccine. Susceptible individuals who are breastfeeding can be vaccinated with MMR vaccine. If planning for pregnancy, it is ideal to delay pregnancy for at least four weeks following vaccination with MMR vaccine.

Immunization of Individuals with Missing Immunization Records

If a patient’s immunization records are unavailable, immunization with measles-containing vaccine is preferable over ordering serological testing to determine immune status. 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.