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Alert Date: 
Wednesday, March 27, 2019 - 9:30am
Location: 
Windsor-Essex/Michigan

As of March 25, 2019, the Michigan Department of Health and Human Services have 18 confirmed measles cases. Chatham-Kent Public Health Unit is also investigating a probable case of measles in their area. There are no confirmed cases of measles in Windsor and Essex County. We may continue to see cases in surrounding areas.

Measles is a highly contagious infectious disease and is spread by airborne droplet nuclei, close personal contact or direct contact with the respiratory secretions of a case. Measles virus can remain active and contagious in the air or on infected surfaces for at least two hours. Individuals may spread the disease one day before the start of prodromal period (usually 4 days before rash onset) to 4 days after the onset of rash. In Ontario, measles cases occur because of travel to endemic areas or through exposure to cases in measles affected areas.

LOCAL EPIDEMIOLOGY

Measles was eliminated in the Americas. Based on the available data, there have been no confirmed cases of measles since 2006 in Windsor and Essex County. In 2017, only 8 cases of measles were reported in Ontario.

WHO IS SUSCEPTIBLE

  • Lack of documented evidence of immunization with measles containing vaccine; OR
  • Lack of laboratory evidence of prior measles infection or documentation of prior confirmed measles diseases; OR
  • Lack of laboratory evidence of immunity (i.e., “reactive” or “positive” anti-measles IgG antibody or a previous measles antibody level of >200 mIU per ml).

DIAGNOSIS OF MEASLES CASES

Clinical Evidence: Clinically compatible signs and symptoms characterized by all of the following:

  • Fever > 38.3 degrees Celsius (oral);
  • Cough, coryza or conjunctivitis;
  • Generalized maculopapular rash for at least three days

Further assessment for suspected cases should include:

  • Immunization history (2 doses of measles containing vaccine is considered to provide immunity)
  • Travel history to measles endemic areas
  • Contact with a confirmed case of measles

Diagnostic testing to confirm diagnosis includes (all three are required to rule out measles):

MANAGEMENT OF SUSPECTED MEASLES CASES

  1. Please rule out all other potential diagnoses before suspecting measles.
  2. Notify the Windsor-Essex County Health Unit (WECHU) immediately if you suspect a case of measles.
  3. Isolate the patient immediately and initiate contact and airborne precaution (if available). If the patient is already in the clinic, please ask them to wear a mask for their entire visit. Move the patient to a room immediately instead of keeping them in the waiting area. Disinfect the room after client leaves and do not use the room for 2 hours until after the patient has left.
  4. Collect appropriate specimens and choose the right laboratory testing based on the history and clinical presentation. Refer to the Measles Investigation and Reporting Form for guidance included in this alert. This is also available online at www.wechu.org in the Health Care Provider section.
  5. There is no specific treatment for persons with measles infection; however, severe complications can be avoided through supportive care that ensures good nutrition and adequate fluid intake.
  6. Individuals diagnosed with measles should be advised to stay home (self-isolate from: child care settings, schools, post-secondary education 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 or until measles is ruled out clinically or by laboratory testing. This should apply to all cases, regardless of their immunization history.

PREVENTION/VACCINATION

The best way to protect against measles is for all individuals to receive two doses of MMR or MMRV vaccine. Ontario’s immunization schedule recommends the first dose of MMR be given between 12-15 months of age to avoid interference from maternal antibodies. The second dose is generally given between 4-6 years of age. Note that in the case of a confirmed outbreak, a second dose of MMR(V) may be given as soon as 4 weeks (28 days) after the first dose. Please contact the WECHU for any questions about the immunization schedule. The measles vaccine is free for all residents/students living in Ontario.

MORE INFORMATION

Visit www.wechu.org for more information. For additional support or consultation, please call the Health Unit @ 519-258-2146 ext. 1420.