Measles

Measles Exposures in Toronto

TPH investigates each case of measles reported in Toronto to identify places where people may have been exposed to the virus. TPH follows up with all known contacts directly to notify them about their exposure, and will also alert the community when there is a possibility of a measles exposure in a public location.

This webpage is updated regularly as new cases are identified and when the monitoring period for symptoms for recent exposures ends. See past public measles exposures in Toronto.

What to Do if You Are Exposed to Measles

If you are a contact of a person with a measles infection, you should monitor for symptoms and see the chart below on next steps to protect yourself.

If you do not have vaccination records, or cannot get them, then you can safely get revaccinated. You can contact your health care provider for a copy of your vaccination records or to get vaccinated. Your local public health unit may have a copy of your vaccination records. Parents can update and look up vaccination records for school-aged children.

Scenario	Action Required	Comments
I work in a health care setting or I work/attend a school or child care centre and have been exposed to someone who has measles.	Call Toronto Public Health at 416 338-7600 to discuss the details of your exposure and vaccination status.	You are at higher risk of spreading the infection to vulnerable populations.
I am pregnant and have been exposed to someone who has measles.	Talk to your health care provider. Based on when you were born and your vaccination records, you may already be protected.	Your health care provider will confirm your vaccination status by reviewing your vaccination records and/or giving you a blood test to check for measles immunity.
I was born before 1970.	Anyone born before 1970 has likely developed immunity to the virus because measles was present then.	If you are unsure, you can safely get the MMR vaccine.
I was born between 1970 and 1995.	Confirm you had two doses of measles vaccines (e.g., MMR). Two doses are needed for full protection.	If you have no documentation of vaccination, you can safely get the MMR vaccine.
I was born after 1995.	Confirm you had two doses of measles vaccines (e.g., MMR or MMRV) by checking your vaccination records.	In Ontario, all children are required to get two shots: the first dose is given on or after the first birthday and a second shot between four to six years of age.

How Measles Spreads

Measles is a highly contagious virus that spreads through the air when an infected person breathes, coughs, sneezes or talks. The measles virus can stay in the air or on surfaces for up to two hours. People can become infected if they breathe the contaminated air or touch the infected surface, then touch their eyes, nose or mouth.

Someone who has measles can spread it to others from four days before the rash appears to four days after the rash appears.

Symptoms & Illness

Symptoms may start around 10 days after being exposed but can start anywhere from seven to 21 days after exposure. Symptoms usually last for one to two weeks.

Symptoms include:

• fever
• runny nose
• cough
• red eyes
• red rash which starts on the face and spreads down the body
• small blue-white spots (Koplik spots) can appear on the inside of the mouth and throat

Children younger than five years old, people 20 years old or older, people who are pregnant or have a weak immune system can get very sick from measles.

Measles can also lead to:

• dehydration
• diarrhea
• ear infections
• lung infections (pneumonia)
• swelling of the brain (encephalitis)
• hearing loss
• blindness
• seizures
• permanent brain damage (subacute sclerosing panencephalitis)
• death

Measles in pregnancy can lead to premature delivery and miscarriage.

Measles Vaccine

Measles is a vaccine preventable disease.

The measles vaccine is safe and effective to help stop the spread of measles.

You are considered protected from measles if you got two doses of the measles vaccine after your first birthday.

One dose given at 12 or 15 months of age provides protection in about 85% of people, and two doses provide over 95% protection.

There are two measles-containing vaccines in Canada: MMR (measles-mumps-rubella) and MMRV (measles-mumps-rubella-varicella). MMRV also provides protection from chickenpox (varicella). Both vaccines are made up of weakened, live viruses.

See the MMR and MMRV vaccine fact sheet for more information.

Individual/group:	Recommendation:
Infants (6 to 11 months)	Are at greatest risk since Ontario’s routine vaccination schedule for measles does not begin until one year of age. Infants 6 to 11 months of age who are travelling to an area with increased measles activity, including southwestern Ontario, should get the vaccine. Note: infants who get their first dose of MMR vaccine before one year of age will need two additional doses after their first birthday.
Children (12 months and older)	Should get their first dose of MMR at one year of age, and their second dose of MMRV between 4 to 6 years of age (before school entry) as part of Ontario’s routine vaccination schedule. Children who are travelling to an area with increased measles activity, including southwestern Ontario, should get a second dose before travel, between 1 to 4 years of age. Note: if your child attends school in Toronto, report their vaccines to Toronto Public Health. If there is a measles exposure in a school/child care centre, students who do not have two doses of a measles vaccine will be excluded from school/child care to keep them and others safe.
Born in 1970 or later	Need two doses of measles vaccine for protection if you did not have measles. Children routinely get vaccinated after their first birthday and between ages 4 to 6. Adults born in 1970 to 1995 may have only had one dose of measles vaccine as a child and should get a second dose.
Born before 1970	May have had measles infection, since measles was present a lot during this time. You can get a dose of vaccine if unsure.
Travellers to areas with increased measles activity, either in Canada or internationally	If born in 1970 or later, should get tw doses of vaccine before travel if you are not up-to-date, never had a measles infection, or you are not sure. If born before 1970, can get one dose of measles vaccine is you are not sure if you had measles before.
Health care workers & military personnel	Need to be immune to work. This includes either having proof of vaccinations (two doses) or immunity (blood test) or record of confirmed measles infection.
Post-secondary students	Should ensure vaccination or proof of immunity.
Unsure about vaccination status	It is safe and recommended to get vaccinated with the MMR vaccine for the best protection. A blood test can also be done to find out if someone is immune if they think they had a measles infection in the past.
Breastfeeding individuals	Getting the MMR vaccine while breastfeeding not only protects you but prevents passing the virus to your baby or other family members. In addition, antibodies have been shown to pass in breastmilk following immunization, which may protect babies against measles. Note: Measles vaccines are not given during pregnancy. It is safe to get vaccinated after pregnancy.
School/child care centre staff and volunteers	If born in 1970 or later, need proof of vaccination with two doses of a measles vaccine or have proof of immunity if there is a case of measles at your school/child care centre. If born before 1970, you are considered protected since measles was present a lot during this time, and you may have had a measles infection.

Where to get vaccinated

The measles vaccine is free and available for adults and children at doctors’ offices or at a TPH community vaccine clinic  for school-aged children.

Seeking Medical Care & When to Isolate

If you think you have measles, it is important to:

• Isolate immediately by staying home and avoiding contact with others.
• Call before visiting a clinic or hospital so they can prepare for your arrival and stop virus spread.
• Wear a well-fitting, medical grade mask (e.g., surgical mask, N95) when getting medical assessment.

Your doctor will assess you for measles and will test you if they think you have measles.

Diagnosis & Treatment

Measles is diagnosed with laboratory tests including a blood, urine and nose or throat test. The laboratory will process these tests to determine if a person has the measles virus. It can take a few days for the laboratory to confirm test results.

When a case of measles is confirmed, Toronto Public Health will continue with the case investigation and management.

There is no specific treatment for measles. Most people can recover at home. Severe complications may be avoided through supportive care including good nutrition and fluid intake. Hospitalization may be needed for severe infections.

If There is a Measles Exposure at School/Child Care

Measles is a reportable disease in Ontario, which means health care providers, laboratories, hospitals, schools and institutions must report suspected or confirmed cases of measles to their local public health unit.

Once a report is received, TPH will begin an investigation that includes risk assessment and contact tracing as outlined by the Ontario Ministry of Health. TPH will request a list of children, staff and volunteers at the school/child care centre and any available vaccination information to help with contact management. TPH takes every step to notify contacts directly about their exposure. If TPH is unable to identify or notify contacts of a potential exposure, a public service announcement may be issued.

If there is a case of measles in a school or child care centre, any children, staff or volunteers who do not have two doses of a measles vaccine or do not have proof of immunity may be excluded from attending school/child care.

• Anyone born in or after 1970 who has not received any doses of the measles vaccine including children, will be excluded for 21 days or longer if the individual remains unvaccinated and cases continue at the school/centre. If children or staff get a dose of measles vaccine within 72 hours of exposure, they can return to school/child care.
• Anyone born in or after 1970 with only one dose of the measles vaccine including children between 1 to 4 years of age who haven’t yet received their second dose, will be excluded from school/child care until they get a second dose. Once children or staff get their second dose, they can return to school/child care.
• Adults born before 1970 are generally considered immune since measles was present a lot during this time, and they may have had a measles infection. They will not be excluded from school/child care.

Vaccination is important for the health of each student and the school community. Under Ontario’s Immunization of School Pupils Act (ISPA), TPH routinely reviews immunization records of children attending school in Toronto to ensure they are vaccinated against measles or have a valid exemption on file.

Parents/guardians or students 16 years of age and older are responsible for reporting student’s immunizations to TPH.

TPH will coordinate access to post-exposure prophylaxis (PEP) for susceptible individuals as needed.

Resources

• Public Health Agency of Canada (PHAC) Travel Health Notices
• Measles in Ontario Surveillance report (PHO)
• Measles Exposures in Ontario (PHO)