Healthcare Professionals

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Measles

With the sharp increase in measles cases in Canada, including outbreaks in southwestern Ontario and multiple cases being confirmed in our region, we would like to urge all health care facilities to review the immunization status of their health care workers (HCW) to ensure they are protected against measles.

Immunizing Healthcare Workers

According to the Canadian Immunization Guide, all healthcare workers should be immune to measles. Regardless of birth year, the criteria for measles immunity includes:

Documentation of vaccination with two doses of measles-containing vaccine on or after their first birthday

laboratory evidence of immunity

Documentation of lab confirmed infection.

By ensuring all healthcare workers are immune to measles, your facility can reduce the possibility of staff exclusion following exposure which will help maintain adequate staffing levels and minimize disruption in patient/resident care.

Routine serologic testing to determine the immunity of healthcare workers without immunization records is generally not practical. If a healthcare worker reports incomplete immunization or lacks adequate documentation of immunization, they should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors.

Measles-containing vaccine may be given regardless of possible previous receipt of the vaccine because additional adverse events associated with repeated immunization have not been demonstrated.

Measles-susceptible healthcare workers should receive 2 doses of measles-containing vaccine (i.e., Measles Mumps Rubella vaccine), administered with a minimum interval of 4 weeks between doses.

If a healthcare worker is exposed to a confirmed case of measles, and they do not meet the criteria for measles immunity, exclusion from the workplace is required up to 28 days after their last exposure until proof of immunity or documentation of previous infection is provided.

Should you require further information, please contact your facility’s Public Health Nurse or the Health Unit’s Communicable Disease Control program at 705-474-1400, ext. 5229.

Infection Prevention and Control

The measles virus is spread by contact with respiratory particles through inhalation or contact with mucous membranes at short and long range (e.g., airborne). These particles can remain suspended and contagious in the air for up to two hours, depending on the number of air changes.

Screen patients upon arrival to your health care setting for symptoms of acute respiratory illness including rash. Sample Signage for Passive Screening from PHO's Best Practices for the Prevention of Acute Respiratory Infection Transmission in All Health Care Settings document.
Patients suspected of having a measles infection should be managed under Routine Practices and Airborne Precautions.
Schedule the patient visit for the end of the day to minimize exposure of others.
Limit patient movement unless absolutely necessary. Use transport routes that minimize contacts and clear all hallways and elevators along the route.
Ensure the patient wears a medical mask (if no contraindications) and is placed in an appropriate room immediately upon arrival.
Place the patient in a single room with negative air flow (airborne infection isolation room [AIIR]) with the door closed. If an AIIR is not available, the patient should be placed in a single room with the door closed.
Only health care workers (HCWs) with at least two doses of measles-containing vaccine or laboratory evidence of immunity, regardless of year of birth, should provide care to patients with suspect/confirmed measles.
All HCWs regardless of immunity to measles are to wear a fit-tested, seal-checked N95 respiratory when providing care to a patient with suspect or confirmed measles.
Additional personal protective equipment such as gloves, gown and eye protection may be required based on a point of care risk assessment (PCRA).
After patient leaves, the door to the room where the patient was examined must remain closed with signage to indicate that the room is not to be used. Do not use the room for two hours to allow for sufficient time for the air to be free of respiratory particles.
Once sufficient time has elapsed, conduct routine cleaning of the room and equipment.

Public Health Ontario: Measles: Information for Health Care Providers; page 6-7
Public Health Ontario: Measles IPAC Checklist for Clinics and Specimen Collection Centres

Laboratory Testing

Diagnostic laboratory testing is essential for all suspected measles cases and should include both measles virus detection by polymerase chain reaction (PCR) in nasopharyngeal/throat swab AND urine as well as diagnostic serology.

Ensure your office has specimen containers and supplies available for testing. Confirm the expiry dates on the specimen containers (e.g., swabs). Kits can be ordered from the Public Health Ontario Laboratory (PHOL).

Post Exposure Prophylaxis

Post Exposure Prophylaxis (PEP) involves the timely administration of measles, mumps, and rubella (MMR) vaccine or immunoglobulin (Ig) to susceptible individuals following measles exposure. Immunoglobulin is generally administered in hospital settings. The goals of PEP are to lower the risk of infection and reduce the severity of illness if measles infection occurs.