Updated March 2015

Measles

Measles, also called red measles or rubeola, is a very contagious viral infection. Measles spreads when a person infected with measles virus breathes, coughs, or sneezes. The virus can still be on surfaces and in the air up to 2 hours after that person is gone from a room. Measles still spreads in some parts of the world. Measles is rare in Canada due to high vaccination rates, but outbreaks do occur from time to time.

Symptoms of Measles

Measles symptoms begin with a fever, runny nose, cough and red eyes. After a few days, a red blotchy rash will appear on the face and spreads down the body. Most people recover fully from measles in 2 weeks. Symptoms are more severe in infants and adults.

Measles can also lead to ear infections, lung infections (pneumonia), swelling of the brain (encephalitis), hearing loss, seizures, permanent brain damage (subacute sclerosing panencephalitis) or death. Measles in pregnancy can lead to premature delivery, low birth weight and miscarriage.

Timeline for Infection

Symptoms usually appear 10 days (range 7 to 21 days) after contact with a person who is contagious with measles. The rash usually appears 10-14 days after exposure.  An infected person can spread measles to others from four days before to four days after the rash appears. Once a person has had measles they are protected for life. If you think you have measles, it is important to speak to a doctor before visiting the doctor’s office so that the infection is not passed to others.

Persons at Risk

  • Infants are at greatest risk since routine vaccination for measles does not begin until one-year of age.
  • Health care workers, travellers to areas where measles is circulating, post-secondary students and military personnel, are at greatest risk of measles exposure from unvaccinated/under-vaccinated individuals and should ensure they are protected.
  • Regardless of age, health care workers and military personnel are required to have two-doses of measles vaccine, or laboratory evidence of immunity, or a history of laboratory-confirmed measles disease.
  • Those born before 1970 are likely immune to measles because measles was widely circulating in Canada then. Those who are unsure or at higher risk should get vaccinated with at least one dose of MMR vaccine. A blood test can also be done to find out if someone is immune.
  • Those born on or after 1970 and have never had measles infection require vaccination for protection. Two doses of measles vaccine provide over 95% protection.

Diagnosis and treatment

Measles is diagnosed by the symptoms and laboratory tests including a blood, urine and throat test.  There is no specific treatment for measles. Most people can recover at home. Supportive care in hospital may be needed for severe infections. Vaccination is the best protection.

Measles Vaccine

Measles vaccine is available as measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) vaccine. Both vaccines are made up of weakened, live viruses. One dose provides protection in about 85% of people, and two doses provide over 95%.

Recommendations for Vaccination

  • MMR vaccine is part of routine childhood immunization at age one and a second dose of MMRV vaccine (with chickenpox) is given at four to six years of age.
  • MMR vaccine is safe for women who are breastfeeding.
  • All persons born in 1970 or later should receive 2 doses of measles-containing vaccine.
  • Susceptible health care workers, travellers, post-secondary students and military personnel should ensure they are protected.  See “Persons at risk” for more details.
  • If travelling to areas where measles is circulating widely, infants 6 to 12 months of age can receive one dose of MMR vaccine. Two additional doses of measles-containing vaccine are required on or after the first birthday.
  • Persons who are not immune and have been exposed to someone who is contagious with measles can receive the vaccine within 72 hours of exposure to prevent infection.
  • Human immune globulin (Ig) may be used for measles post-exposure immunization in non-immune persons who are at high risk if given within 6 days of exposure.

Vaccine Side Effects and Risks

Reactions to MMR and MMRV vaccine are generally mild and temporary and include pain and redness at the injection site, fever and rash. Risk of allergic reactions following immunization such as trouble breathing, rash, swelling in the throat and face may occur but are very rare and can be treated. For more information, see MMR vaccine fact sheet.

People Who Should Not Get the Vaccine

  • Individuals who have had a severe allergy to a previous dose of MMR, or any component of the vaccine, including gelatin or an antibiotic called neomycin sulphate
  • Pregnant women
  • Individuals with a severe weakened immune system (e.g., due to  HIV, cancer or taking medications that weaken the immune system)

Delay MMR Vaccine

  • If there is high fever or an infection more severe than a cold
  • If you are pregnant, think you may be pregnant, or are trying to become pregnant
  • Women should not get pregnant for one month after receiving the MMR vaccine
  • Have recently received a blood product (e.g. serum immune globulin)
  • Have recently received a live vaccine (e.g. MMR, chickenpox) in the past 28 days, or MMRV vaccine in the past 6 weeks.

Source

Canadian Immunization Guide, Evergreen Edition. Part 4 Active Vaccines: Measles. Ottawa: Public Health Agency of Canada.

How Do I Know If I am Protected Against Measles?

If you have come into contact with someone who is contagious with measles, this chart will help you determine the best way to protect yourself. As a precaution, everyone who has come into contact with a contagious measles case, regardless of what category you are in as described below, should monitor for symptoms. Symptoms include a fever (over 103ºF), cough, runny nose, red and watery eyes and a rash on the face and body. If you develop symptoms, stay home, and call ahead to your physician’s office before visiting.

Scenario Action Required Comments
I work in a healthcare setting, school, or day care and have been exposed to someone who has measles. Call Toronto Public Health at 416 338-7600 to discuss the specifics of your exposure and immunization 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. Consult with your physician. Based on when you were born and your immunization records, you may already be protected.

 Your doctor will confirm your status by reviewing your immunization records and/or giving you a blood test to checked for measles immunity.

 

I was born prior to 1970. Anyone born after January 1, 1970 who is not vaccinated and who has never had measles infection is at risk. People born before December 31, 1969 have likely developed immunity to the virus and are considered protected. It is important to watch for signs and symptoms of measles (see above and fact sheet) and if you develop any symptoms, talk to your doctor.
I was born between 1970-1995. Confirm you had measles vaccine, usually given as MMR (measles, mumps, rubella). If you had one or no shots of measles vaccine, get a first (or second) shot.

Two doses of measles vaccine provides almost 100% protection. One shot provides 85% to 90% protection.

 

I was born after 1995. Confirm you had 2 doses of MMR vaccine by checking your immunization records or contacting your physician. In Ontario, all children are required to get 2 shots: the first dose is given on or just after the first birthday and a second shot between 18 months to 6 years of age.

More Information

Call Toronto Public Health at 416-338-7600 (TTY at 416-392-0658) or speak to your health care provider.