Notice: Updated infection prevention and control recommendations for Measles in healthcare settings
On this page
- Background
- Updated recommendations for measles infection prevention and control in healthcare settings
- References
Background
Measles is a highly contagious disease that is spread through the air and by contact with respiratory secretions from the nose and mouth. It is both a provincially and federally notifiable disease. Canada achieved elimination of endemic measles transmission through vaccination in 1998Footnote 1. However, since 2023, there has been a significant increase in measles cases worldwide. In Canada, recent measles outbreaks associated with international travel introductions have raised concerns about the increased potential risk of transmission of measles in healthcare settingsFootnote 1.
As of January 2024, there has been an increase in cases and outbreaks reported in Canada and globally as indicated by the Canadian Measles and Rubella Surveillance System (CMRSS).
Since 2013, peer-reviewed literature has documented measles transmission in health care settings to fully vaccinated health care workers (HCW)Footnote 2Footnote 3Footnote 4Footnote 5Footnote 6Footnote 7Footnote 8Footnote 9Footnote 10Footnote 11Footnote 12Footnote 13Footnote 14Footnote 15Footnote 16. Thus, infection prevention and control (IPC) practices should focus on preventing transmission of measles to both vaccinated and unvaccinated HCWs.
The previous Public Health Agency of Canada recommendations, in the Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings guideline (RPAP) and the Prevention and Control of Occupational Infections in Health Care guideline, did not recommend HCWs who had been vaccinated or had documented immunity to measles to wear respiratory protection as an additional precaution when caring for patients with suspected or confirmed measles. Given the risk of breakthrough infection among vaccinated HCWs, respiratory protection recommendations for HCWs caring for patients with suspected or confirmed measles have been updated.
These new recommendations are based on the best available evidence, and represent an update to the measles recommendations situated within the following guidelines:
- Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (2013)
- Prevention and Control of Occupational Infections in Health Care (2002)
For the purposes of this guidance, the term "patient" will be used to include those receiving healthcare who are traditionally and routinely referred to as patients, clients, or residents.
Healthcare setting refers to any location where health care is provided, including emergency care, prehospital care, hospital, long-term care, home care, ambulatory care and facilities and locations in the community where health care is provided.
Updated recommendations for measles infection prevention and control in healthcare settings:
- Only HCWs with presumptive immunity, should enter the room of a patient with suspected or confirmed measles. Definition of presumptive immunity can be found in the Canadian Immunization Guide.
- A fit-tested N95 (or an equivalent or higher protection) respirator is recommended when caring for patients with suspected or confirmed measles, regardless of the immunity/vaccination status of the HCW. All other guidance as per RPAP remain unchanged.
- Caregivers and visitors should be restricted to essential persons and should also wear respirators (or an equivalent or higher protection).
- As measles infections have been increasing in Canada, it is important to:
- collaborate with public health authorities, provincial, territorial, and local health laboratories,
- prevent the spread of measles outbreaks through vaccination; details pertaining to national immunization recommendations are available here: Measles vaccines: Canadian Immunization Guide,
- ensure the maintenance of up to date records for measles immunity of HCWs.
For more information on general infection prevention and control measures:
- Routine Practices and Additional Precautions for Preventing Transmission of Infection in Healthcare Settings
- Hand Hygiene Practices in Healthcare Settings
- Prevention and Control of Occupational Infections in Health Care
References
Footnotes
- Footnote 1
-
Public Health Agency of Canada. Rapid risk assessment: Measles in Canada, public health implications in 2024. Canada.ca: Government of Canada 2024.
- Footnote 2
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Augusto GF, Cruz, D., Silva, A., Pereira, N., Aguiar, B., Leca, A., Serrada, E., Valente, P., Fernandes, T., Guerra, F., Palminha, P., Vinagre, E., Lopo, S., Cordeiro, R., Saez-Lopez, E., Neto, M., Nogueira, P. J., Freitas, G.. Challenging measles case definition: Three measles outbreaks in three Health Regions of Portugal, February to April 2018 Eurosurveillance. 2018;23(28).
- Footnote 3
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Augusto GF, Silva, A., Pereira, N., Fernandes, T., Leca, A., Valente, P., Cale, E., Aguiar, B. A., Martins, A., Palminha, P., Vinagre, E., Cordeiro, R., Lopo, S., Nogueira, P. J. Report of simultaneous measles outbreaks in two different health regions in Portugal, february to may 2017: Lessons learnt and upcoming challenges Eurosurveillance. 2019;24(3).
- Footnote 4
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Cornelissen L, Grammens, T., Leenen, S., Schirvel, C., Hutse, V., Demeester, R., Swennen, B., Asikainen, T., Wyndham-Thomas, C.. High number of hospitalisations and non-classical presentations: Lessons learned from a measles outbreak in 2017, Belgium. Epidemiology and Infection 2020.
- Footnote 5
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Fiebelkorn AP, Redd, S. B., Kuhar, D. T.. Measles in Healthcare Facilities in the United States during the Postelimination Era, 2001-2014 Clinical Infectious Diseases. 2015;61(4):615-8.
- Footnote 6
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Gohil SK, Okubo, S., Klish, S., Dickey, L., Huang, S. S., Zahn, M.. Healthcare Workers and Post-Elimination Era Measles: Lessons on Acquisition and Exposure Prevention Clinical Infectious Diseases. 2016;62(2):166-72.
- Footnote 7
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Hahné SJM, Lochlainn, L. M. N., Van Burgel, N. D., Kerkhof, J., Sane, J., Yap, K. B., Van Binnendijk, R. S. Measles outbreak among previously immunized healthcare workers, the Netherlands, 2014 Journal of Infectious Diseases. 2016;214:1980-6.
- Footnote 8
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Kohnen M, Hoffmann, P., Frisch, C., Charpentier, E., Sausy, A., Hubschen, J. M.. Diagnostic challenges and pockets of susceptibility identified during a measles outbreak, Luxembourg, 2019 Eurosurveillance. 2021;26(22).
- Footnote 9
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Lopez-Perea N, Fernandez-Garcia, A., Echevarria, J. E., Ory, F., Perez-Olmeda, M., Masa-Calles, J. Measles in vaccinated people: Epidemiology and challenges in surveillance and diagnosis in the post-elimination phase. spain, 2014-2020 Viruses. 2021;13(10).
- Footnote 10
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Marron L, McDermott, R., Conway, R., Ennis, O., Bruton, O., Ward, M., Murray, H. Paediatric nosocomial and health care worker transmission during measles outbreak, Dublin 2018 Archives of Disease in Childhood. 2019;104.
- Footnote 11
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Pampaka D, Lopez-Perea, N., Fernandez-Garcia, A., Huertas-Zarco, I., Castellanos-Martinez, M., Villatoro-Bongiorno, K., Roig-Sena, J., Torner, N., Mosquera, M. M., Echevarria, J. E., Prats, J. F., Masa-Calles, J. An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018 Eurosurveillance. 2023;28(17).
- Footnote 12
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Sa Machado R, Perez Duque, M., Almeida, S., Cruz, I., Sottomayor, A., Almeida, I., J, R. Oliveira, Antunes, D. Measles outbreak in a tertiary level hospital, Porto, Portugal, 2018: Challenges in the post-elimination era Eurosurveillance. 2018;23.
- Footnote 13
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Torner N, Solano, R., Rius, C., Dominguez, A. Implication of health care personnel in measles transmission: The need for updated immunization status in the move towards eradication of measles in catalonia Human Vaccines and Immunotherapeutics. 2015;11(1):288-92.
- Footnote 14
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Torner N, Ferras, J., Curto, L., Rebull, J., Sol, J., Costa, J., Mosquera, M. M., Izquierdo, C., Martinez, A., Jane, M. Measles outbreak related to healthcare transmission Vacunas. 2021;22(1):20-7.
- Footnote 15
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Van Binnendijk R, Van Burgel, N., Lochlainn, L. N., Kerkhof, J., Hahne, S.. Outbreak of measles B3 virus in a hospital among healthcare workers with prior evidence of immunity, The Hague, 2014; Implications for measles control Journal of Clinical Virology. 2015;1.
- Footnote 16
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Woudenberg T, Van Binnendijk, R. S., Sanders, E. A. M., Wallinga, J., De Melker, H. E., Ruijs, W. L. M., Hahne, S. J. M. Large measles epidemic in the Netherlands, May 2013 to March 2014: Changing epidemiology Eurosurveillance. 2017;22(3).
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