The Re-emergence of Measles: A Wake-Up Call for Ontario

As per the guidance provided by Public Health Ontario in their Enhanced Epidemiological Summary, delivered weekly on Thursdays, IPAC Consulting feels compelled to issue this white paper. Our goal is to outline critical information on measles, its prevention, and transmission, enabling our clients to keep themselves, their staff, and their residents safe. Reflecting on these recommendations, we aim to provide support to healthcare settings in managing individuals with suspected or confirmed measles.

The Return of Measles

Once considered nearly eradicated, measles has alarmingly re-emerged in recent months. Despite active vaccination programs and advances in healthcare, outbreaks and deaths continue to occur. Measles primarily affects unvaccinated individuals, posing significant concern among health officials and communities alike.

Understanding Measles

Measles is a dangerous and highly contagious respiratory infection. The virus spreads through respiratory droplets when an infected person coughs or sneezes and can also be transmitted by touching contaminated surfaces and then touching the mouth or face. Symptoms include fever, cough, runny nose, lethargy, red eyes, and small white spots inside the mouth and throat. A red blotchy rash typically appears on the face and then spreads down the body 3 to 7 days after the initial symptoms. Complications can include pneumonia, encephalitis, ear infections, diarrhea, seizures, and death.

Factors Contributing to the Recent Measles Outbreak in Ontario

Decline in Immunization Rates

One of the primary causes of the resurgence of measles is declining immunization rates. Distrust and misinformation have led to lower vaccination rates in certain areas, increasing the susceptibility of populations to outbreaks.

International Travel

Travelers from regions where measles is common can bring the virus into Ontario. The recent spike in measles cases after March break is a clear indication of this trend. The movement of people within the province can further facilitate the spread of the virus.

Local Transmission Hotspots

Measles can quickly spread in crowded environments such as schools, daycares, and healthcare facilities, where close contact promotes transmission through respiratory droplets.

Vitamin A Deficiency

Individuals with a lack of vitamin A in their diet are more susceptible to severe symptoms and complications from measles.

Public Awareness and Education

A lack of public awareness and education regarding the importance of vaccinations and the dangers of measles can contribute to the spread. Misinformation about vaccine safety needs to be actively countered with accurate, science-based information.

Implications for Long-Term Care and Retirement Homes

Vulnerability of Residents

Residents in long-term care and retirement homes are particularly vulnerable to infectious diseases like measles due to their age and potential underlying health conditions. An outbreak in such facilities can have severe consequences, including higher morbidity and mortality rates.

Immunization of Staff and Residents

It is crucial to ensure that all staff and residents are fully vaccinated against measles. Regular immunization checks and updates should be part of the health protocols in these facilities. Vaccination not only protects individuals but also helps create a herd immunity effect, reducing the overall risk of an outbreak.

Infection Control Measures

Implementing strict infection control measures is essential in preventing the spread of measles within long-term care and retirement homes. This includes:

• Regular screening for symptoms among staff and residents.
• Immediate isolation of suspected cases.
• Use of appropriate PPE by healthcare workers.
• Regular hand hygiene and sanitization of high-touch surfaces.

Addressing Challenges in Healthcare Settings

Mandatory Immunization

All healthcare workers should have received two doses of a measles-containing vaccine. Only those with presumptive immunity should care for patients or residents with suspected or confirmed measles.

Appropriate Personal Protective Equipment (PPE)

Healthcare workers, regardless of their immunity status, should always wear a fit-tested N95 respirator when caring for individuals with confirmed or suspected measles. Additional PPE, such as gloves, gowns, and eye protection, may be necessary based on a point-of-care risk assessment (PCRA).

Placement in an Airborne Infection Isolation Room (AIIR)

Individuals with suspected or confirmed measles should be placed in an acute care facility with access to an AIIR to prevent airborne transmission. Please check your nearest local acute care facility with an AIIR, as these may not be available in all jurisdictions.

Restrictive Movement

Movement of suspected or confirmed measles cases should be limited within healthcare settings. Direct contact should be minimized, and patients should wear medical masks when possible. Healthcare workers involved in transportation should wear a fit-tested and seal-checked N95 respirator.

Recommendations for Long-Term Care and Retirement Homes

Enhanced Surveillance

Long-term care and retirement homes should enhance their surveillance systems to quickly identify and respond to potential measles cases. This includes regular health assessments and prompt reporting of symptoms.

Staff Training

Regular training sessions for staff on the recognition of measles symptoms, proper use of PPE, and infection control protocols can help prevent outbreaks. Staff should be well-informed about the importance of vaccinations and the procedures to follow in case of a suspected measles case.

Visitor Policies

Implementing strict visitor policies can help minimize the risk of introducing measles into the facility. This might include screening visitors for symptoms and verifying their vaccination status.

Emergency Preparedness

Having an emergency preparedness plan in place for dealing with infectious disease outbreaks is crucial. This plan should include isolation protocols, communication strategies, and procedures for managing an outbreak within the facility.

The spike in measles cases in Ontario underscores the need for preventive measures to safeguard public health. Prioritizing vaccination, enhancing surveillance systems, ensuring appropriate use of PPE, and fostering collaboration can help mitigate the impact of measles outbreaks and protect the health of Ontario’s population. IPAC Consulting is committed to supporting healthcare settings, including long-term care and retirement homes, in implementing these measures effectively.

By following these guidelines, Ontario can work towards reducing the resurgence of measles and ensuring the health and safety of its residents, particularly those in long-term care and retirement homes.

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