The Pan-American Health Organization issued a statement on February 8, 2023 regarding the increasing risk of measles in the Americas and globally. Measles coverage for both 1st and 2nd doses across the Americas and elsewhere globally has dropped, including in Canada. With reduced border measures and increased travel anticipated over March break, it is strongly recommended that health care providers include measles in their differential diagnoses, particularly in returning travelers with respiratory symptoms.
Clinical Presentation: Symptoms of measles begin 7-21 days after exposure to a case of measles and include fever, runny nose, cough, drowsiness, irritability, and conjunctivitis. Small while spots (Koplik’s spots) can appear on the inside of the mouth and throat but are not always present. Within 3-7 days of the start of symptoms, a maculopapular rash appears on the face and then progresses down the body.
Notification: As a disease of public health significance, clinicians are required to report all suspected and confirmed cases of measles to the health unit immediately. Please fully complete the Measles Investigation and Reporting Form found on the Windsor-Essex County Health Unit (WECHU) website (www.wechu.org/forms), and fax to 226-783-2132.
Diagnosis and Management of Measles Cases
Laboratory Evidence: Ensure that all of the following tests are completed to confirm diagnosis:
- Nasopharyngeal swab/aspirate or throat swab
- Collect within 7 days after onset of rash, using a universal transport medium (UTM) collection kit
- Request “Nasopharyngeal, Measles Virus Detection”, or “Throat, Measles Virus Detection”, including symptoms and onset date
- Acute blood specimen
- Collect within 7 days after rash onset
- Request “Blood, Acute Measles IgG/IgM Diagnosis”, indicating acute/recent infection, vaccination history, relevant signs, symptoms, and/or clinical history, and onset date
- Convalescent blood specimen
- Collect 7-10 days after the acute sample
- Request “Blood, Convalescent Measles IgG/IgM Diagnosis”, indicating acute/recent infection, vaccination history, relevant signs, symptoms, and/or clinical history, and onset date
- Collect within 14 days of onset of rash, using a sterile container
- Request “Urine, Measles Virus Detection”
Public Health Ontario Laboratory is available for consultation on laboratory testing with health care providers as needed at (toll free) 1-877-604-4567.
Management: Suspected measles cases should be placed under airborne precautions and advised to self-isolate from: child care settings, schools, post-secondary educational institutions, work places, sporting events, healthcare and other group settings; and away from non-household contacts for 4 days after the appearance of the rash.
Health care providers are encouraged to support their patients in remaining up to date with all routine vaccinations (including measles), especially in advance to any upcoming travel and to inform their patients to report vaccines received to the WECHU. Given the upcoming March break travel and increased risk of exposure through the Americas and globally, patients intending to travel should be advised to get immunized as soon as possible.
If you have any questions or concerns, please call the Infectious Disease Prevention Department, Monday to Friday, between 8:30am and 4:30pm, at 519-258-2146, ext. 1420.
For more information:
- Canadian Immunization Guide: Measles Vaccine
- Ministry of Health Measles Case Definitions and Disease-Specific Information
- Public Health Ontario Laboratories: Measles
- Windsor-Essex County Health Unit: Measles