Measles Update and Resources for Health Care Providers

- Feb 12, 2025

To: Ottawa Physicians and Nurse Practitioners
Date: February 12, 2025
From: Dr. Michelle Foote, Associate Medical Officer of Health
Subject: Measles Update and Resources for Health Care Providers

Dear Colleagues,

On January 29, 2025, the Chief Public Health Officer (CPHO) of Canada released a statement indicating that Canada is experiencing an increase in measles activity, with recent cases reported in Quebec and Ontario that are associated with ongoing outbreaks. These outbreaks are primarily affecting unvaccinated individuals, including children and infants. Weekly updates by public health unit are available from Public Health Ontario’s enhanced epidemiological summary, Measles in Ontario. In Ottawa, there have been nine confirmed cases of measles in the last ten years, the most recent in 2019.

This Public Health Alert compiles relevant measles resources in one place. Included are the following:

Updated Public Health Ontario Resource

Public Health Ontario has a resource for health care providers called Measles: Information for Health Care Providers (updated September 2024) that outlines the identification and management of individuals suspected to have measles and information about measles prevention through immunization.

Routine Immunization for Measles (Prevention)

Clinical Presentation of Measles

  • The incubation period from exposure to prodromal symptoms of measles averages 10-12 days. The time from exposure to rash onset averages 14 days (range: 7 to 21 days). Measles is considered contagious from 1 day before symptom onset (or 4 days before rash onset, whichever is longer) to 4 days after rash onset.
  • Key features include fever and a maculopapular rash.
  • Initial prodromal symptoms can include: fever (≥ 38.3◦C - oral), cough, runny nose and conjunctivitis (non-purulent). Koplik spots (tiny blue-white spots on the buccal mucosa) may be present in the prodromal period.
  • The rash typically appears 3-7 days after prodromal symptoms begin, and starts on the head at the hairline, then involves the face and upper neck, and spreads downward and outward to hands and feet.

Risk factors for measles include being under-vaccinated or immunocompromised and/or having a potential exposure risk, including: recent travel, known contact with a case of measles, or residing in an area where measles cases have recently been identified.

For patients who are clinically suspected to have measles, laboratory testing is required, as the diagnosis requires lab confirmation.

Assessment of Suspect Measles Cases in Community Offices

Patients who have been exposed to measles or where there is a concern of measles should ideally be seen at the end of the day. (*See additional details in sections that follow.)

If measles is suspected in a patient:

  • Provide the patient with a medical mask.
  • In the absence of a negative pressure room, place the patient in a single patient room with the door closed. The door must stay closed and the room must not be used for 2 hours after the patient leaves the room.
  • Obtain specimens for testing (see Measles Testing section below).
  • Contact Ottawa Public Health immediately to report the suspect case:
    • Notify OPH at 613-580-2424 ext. 24224 from Monday to Friday 8:30 am to 4:30 pm or dial 3-1-1 after hours and ask for Public Health on-call.
    • Reporting a suspect measles case should not be delayed pending lab results.
  • Provide isolation guidance to the patient while results are pending.

Measles testing can be performed on out-patients in community offices and does not have to be done at a hospital. If a suspect measles case is ill enough to require assessment at a hospital, before sending the patient to hospital contact the hospital in advance. The hospital must be prepared so that the patient can be put on airborne precautions immediately upon arriving and will provide directions on how/where the patient should present themselves so as not to become a risk to others.

Pediatric Patients with Suspected Measles

If you need to send a patient to CHEO Emergency for evaluation, call 613-737-7600 x0 and ask for the Infectious Diseases physician on call. To minimize exposure, DO NOT send a child you suspect has measles to CHEO without prior notification.

The CHEO Infectious Diseases team is available for referrals for patients needing clinical evaluation (not testing alone) and to discuss whether testing is indicated for a more complex patient situation that does not meet above criteria. Contrary to prior practice, it is no longer expected that providers speak with an Infectious Diseases provider prior to sending measles testing from their offices.

Measles Testing

  • Diagnostic laboratory testing* is essential for all suspected measles cases and should include measles virus detection by polymerase chain reaction (PCR) in nasopharyngeal and/or throat swab AND urine.
    • A nasopharyngeal and/or throat swab collected using Viral Transport Media obtained as soon as possible, within 7 days after rash onset, AND
    • 50 mL of urine, collected within 14 days after the onset of rash.
  • Diagnostic serology (Measles IgM and IgG) can be considered but is not required. Collection of samples for PCR testing is the most important component for diagnosing measles.
  • Specimens submitted in an expired collection kit will be rejected for testing.
  • Serology done in the absence of PCR testing is NOT sufficient to diagnose measles.

*Please refer to Table 2 in *Measles: Information for Health Care Providers for specimen collection kit numbers and additional details on specimen collection.

Additional information about measles testing can be found on PHO’s Measles – Diagnostic – PCR and Requisition for Specimen Containers and Supplies webpages, or by calling PHO’s Laboratory Customer Service Centre at 1-877-604-4567, or by email at CustomerServiceCentre@oahpp.ca.

Specimen Documentation and Transportation

  • On each PHOL requisition clearly mark “suspect case of measles” and include: patient’s symptoms, date of onset of symptoms, exposure history, travel history (if any), and vaccination history. The “diagnosis” box should also be checked.
  • Specimens should be stored at 2-8°C following collection.
  • Contact PHO’s Laboratory Customer Service at 416-235-6556 or 1-877-604-4567, or the After-Hours Duty Officer at 416-605-3113 to request STAT testing or if you have questions about specimen collection.

Isolation Instructions for Patients

Patients who are suspected of having measles should be advised to:

  • Isolate while laboratory results are pending (this applies to anyone being tested for measles). Individuals with confirmed measles need to isolate until the end of the infectious period, which is 4 days prior to rash onset through to 4 days after rash onset (9 days total).
  • Avoid contact with non-household contacts.
  • Avoid contact with high-risk individuals (pregnant individuals, infants < 12 months of age and immunocompromised individuals).
  • Call ahead if attending any essential medical appointments so that appropriate IPAC precautions can be implemented to avoid exposures.
  • If urgent assessment is required such that they cannot call ahead, alert triage immediately of the suspect or confirmed measles diagnosis so that immediate IPAC measures can be put in place.

Infection Prevention and Control (IPAC) Practices

  • All health care workers, including non-clinical and office staff that may pass through areas where patients are present, require documented immunity to measles (2 doses of measles vaccine or a history of anti-measles IgG antibody on serologic testing).
  • A fit-tested, seal-checked N95 respirator should be worn when entering the room of and when assessing a patient with suspect/confirmed measles, or when entering the room in the 2 hours after the patient has left. Droplet and Contact Precautions are to be used for patients presenting with respiratory symptoms and/or undifferentiated viral symptoms.
  • Conduct routine cleaning of the room and equipment once sufficient time has elapsed (2 hours in community offices) to ensure adequate air exchange has occurred in the room.

Additional Resources and Information about Measles

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