Dealing with measles

I was pleased to see your recent public health article on measles.¹ Because measles has become a rare disease in Canada, it is harder for clinicians to differentiate the clinical syndrome of measles from other rash-type illnesses (such as parvovirus B19). At the same time, it is important to diagnose it accurately through laboratory confirmation. Accurate case diagnosis is crucial to both the preventive management of contacts of a patient and the evaluation of our immunization programs. Case confirmation must occur rapidly to allow for timely public health interventions. Also, clinical specimens such as nasopharyngeal or throat swabs and urine can be subtyped by public health laboratories to describe the importation or endemic spread of measles or both.

Recently a case of measles involving a 13-month-old unimmunized child was linked to transmission in a clinic waiting room. As such, I would like to add a little more advice regarding “measles in your office.”

Because measles is the most infectious of the communicable diseases, office visits involving patients suspected of having measles should be scheduled as the first or last of the day, and the office should be allowed to “breathe” for at least an hour after the patient departs. All surfaces contacted by the patient should be disinfected. Finally, the patient should not have contact with office staff members who are not known to be immune. This is a reminder that the immunization status of all staff should be checked and updated upon hiring.

Signature

Lori Kiefer
Medical Specialist and Associate Medical Officer of Health Communicable Disease Control Toronto Public Health Toronto, Ont.