Measles

• Symptoms occur within 7-21 days after a person has been exposed.
• The first symptoms are a high fever, aches and pains, runny nose, red swollen eyes and cough.
• Koplik’s spots, which are small bluish white spots, may also be seen inside the mouth.
• Four days into the fever, all these symptoms will be worse and a rash appears with bright red, raised, large spots.
• The rash starts on the face then spreads down over the body to the arms and legs. The rash begins to fade after about a week.
• The total illness lasts on average 7-14 days.

• A person with measles is contagious from four days before to four days after the rash appears.
• Measles is spread easily from person to person – over 90% of persons exposed at home to a child with measles will catch it.
• Measles is an airborne disease that is spread simply by breathing in air that contains the measles virus. Measles virus can live in the air for up to two hours where a person has coughed or sneezed.
• It may also be spread by direct contact with nose or throat droplets of infected person.

GEPH advises anyone who believes they may have been exposed to the measles virus to do the following:

1. Check vaccination records to ensure protection from Measles.

Measles is preventable by vaccination. Individuals should check their vaccination records to confirm they and their family members are up to date with their measles vaccinations.

In Ontario, the current immunization schedule includes two doses of measles containing vaccine before the age of 7 – the MMR vaccine (measles, mumps, rubella) is administered at 12 months of age, followed by the MMRV vaccine (which has the addition of varicella) between 4 to 6 years of age. Those who are unsure of their vaccination status are asked to check with their health care provider.

Generally, those born before 1970 are considered immune due to the prevalence of the infection at that time. Anyone born in or after 1970 who has not received two doses of a measles containing vaccine (at least four weeks apart) or has not had measles before is at risk of infection if exposed. Within 72 hours of exposure, administration of the MMR vaccine may reduce the risk of infection in these individuals.

2. Vulnerable individuals with a weakened immune system should contact their health care provider.

Susceptible individuals at higher risk may be eligible to receive immunoglobulin within six days of exposure. This includes:

• infants less than 12 months of age
• pregnant individuals who have not received 2 doses of a measles-containing vaccine
• individuals with compromised immune system

Immunoglobulin may prevent or reduce the severity of infection. These individuals are encouraged to contact their health care provider by phone to discuss treatment options.

3. Monitor for symptoms of measles for 21 days after exposure.

Symptoms can include fever, runny nose, cough, red eyes, a red rash that begins on the face and spreads down the body, and small blue-white spots (Koplik spots) that can appear on the inside of the mouth and throat. Monitor for symptoms even if up to date with measles vaccinations.

Anyone experiencing symptoms should contact their health care provider as soon as possible, or if unavailable, contact GEPH infectious disease team:

• Brantford-Brant: 519-753-4937 ext. 454
• Haldimand-Norfolk: 519-426-6170 or 905-318-6623

Before visiting a clinic or hospital, call ahead to inform them of your symptoms and potential exposure to measles. This allows the facility to prepare and helps prevent the spread of the virus.

Additionally, wear a medical-grade mask when attending the clinic or hospital.

• Measles is diagnosed by laboratory tests, including a urine, blood, or nose/throat test.
• There is no specific treatment for measles; most people recover at home.
• Severe infections may require hospitalization.
• Close contacts of an individual with measles should have their immunization status assessed.

• It is often complicated by diarrhea, ear infection, croup (a condition resulting from blocked airways), pneumonia, or encephalitis (brain swelling).
• Measles can also cause death.
• Measles in pregnancy can lead to premature delivery and miscarriage.

• Anyone with measles must stay away from daycare, school, and work for at least 4 days after the appearance of the rash.
• Measles is a reportable disease and must be reported to the Local Medical Officer of Health under the Health Protection and Promotion Act.
• Isolate immediately by staying home and avoiding contact with others.
• Wear a well-fitting, medical-grade mask (e.g., surgical mask, N95) when getting medical assessment.

To prevent measles, get your child immunized with the measles vaccine (MMR). All children should get the vaccine as soon as possible after their first birthday and a booster at age 4-6 years before the child starts school. All Ontarians should ensure they are fully vaccinated against measles, especially before travelling.

Please see the below quick reference for Measles, Mumps, and Rubella (MMR) vaccine eligibility. If you are eligible and wish to receive an MMR vaccine, please contact your primary healthcare provider. If you are unsure of your vaccine status, please contact your primary healthcare provider.

Infants aged 6 to 11 months

• Eligible to receive one dose of MMR vaccine before travel to an area where the disease is of concern outside of Canada
• Child would still be required to receive two doses after the first birthday, based on the routine immunization schedule (12 months of age and again at 4-6 years of age)

Children aged 12 months to 17 years

• The first dose of measles-containing vaccine is given at 12 months of age (on or after the first birthday). A second dose is routinely given between four to six years of age.
• Children who have not received the measles-containing vaccine are recommended to receive two doses.

Adults aged 18 to 25 years

• Adults aged 18 to 25 years who have not had a measles-containing vaccine should receive two doses of MMR. If only one dose was previously received, individuals in this age group are recommended to receive a second dose.

Adults aged 26 years and older and born in or after 1970

• Adults who have not had a measles-containing vaccine can be immunized by receiving one dose of measles-containing vaccine.
• A second dose of measles-containing vaccine is also recommended for adults who meet the following criteria:
  • Health care workers
  • Post-secondary students
  • Military personnel
  • Anyone travelling outside of Canada
  • Anyone based on their health care provider’s clinical judgement

Those born prior to 1970

• Considered to be immune and do not require a vaccine.
• Eligible for one dose if travelling to an area where disease is of concern outside of Canada.
• Eligible for two doses if a health care worker or military personnel.