Measles

March 4, 2024

Measles is a highly contagious virus spread through coughing and sneezing that can live for up to two hours in the air. Symptoms of measles include fever, a red blotchy rash, red watery eyes and Koplik (white) spots in the mouth. Measles is prevented by vaccination. Children in Ontario receive two doses of measles-containing vaccine before the age of 7. Endemic measles has been eliminated in Canada; however, imported cases continue to occur.

To obtain or inquire about an immunization record, or for general immunization information, please contact your local public health unit.

Measles cases in Canada were related to unvaccinated travelers.
However, there are now indications of domestic transmission. Currently, there have been no
confirmed cases of measles in Wellington-Dufferin-Guelph.

Clinical Information on Measles
Measles illness follows a traditional clinical pathway with 3 distinct phases:2
• Prodromal phase – Usually between 2-4 days, with a range of 7-21 days. In this phase,
measles cases present with a high fever (39°C-40°C), along with the 3 Cs - cough,
coryza, and conjunctivitis. During this time, Koplik’s spots may be found on the buccal
mucosa.
• Eruptive phase – A maculopapular rash appears beginning at the hairline and upper
neck and, over the next 3 days, proceeds down and outwards covering the palms of
the hands and soles of the feet. The rash lasts between 5-6 days.
• Convalescent phase –After 3-4 days, the rash begins to disappear which may leave
brown spots and peeling skin.

Confirm the Diagnosis
Patients may be quite ill and develop complications that require a clinical assessment. A
laboratory sample or a direct epidemiological link to a confirmed case is required to make the
diagnosis. Do NOT send the patient to a lab for serology to make the diagnosis as it is not the
best test. This greatly increases the potential for transmission and spread in the community
whereas a NP or Urine PCR test confirms the diagnosis.
Collect a: NP or throat swab within 7 days after rash onset.
Urine-50 mL within 14 days of rash onset.

Who is at risk?
• Individuals born prior to 1970 are considered immune.
• Individuals born between 1970 and 1978 may have had only 1 dose of measles vaccine.
• Individuals born after 1978 are likely to have received 2 doses of measles vaccine if they
attended school in Ontario.
• In 1996 a two-dose measles vaccine schedule was started as well as a measles booster
campaign to provide a second dose to all children in school from SK to grade 13 in most
provinces.
• One dose of measles vaccine is 93% effective, 2 doses 97% effective.
• Any unvaccinated individual remains at risk.
All suspect patients should self-isolate until results are known.
Reporting
Measles is a reportable disease. If you suspect a case of measles, please report it to
Wellington-Dufferin-Guelph Public Health immediately, 519-822-2715 ext. 4752. After
hours, weekends and holidays please call 1-877-884-8653.

Preventing the Spread of Measles
Measles is one of the most infectious diseases (R0=18) and is spread by airborne droplet nuclei
and close or direct contact with respiratory secretions of a case. The measles virus can remain
active and contagious in the air or on infected surfaces for as long as 2 hours. See these
patients at the end of the day if possible. If the patient is so ill they need to be seen in the
emergency department, ensure the hospital is aware to protect infants and newborns on their
site. When routinely assessing pregnant women, draw serology for measles immunity.
Who is at risk?
• Individuals born prior to 1970 are considered immune.
• Individuals born between 1970 and 1978 may have had only 1 dose of measles vaccine.
• Individuals born after 1978 are likely to have received 2 doses of measles vaccine if they
attended school in Ontario.
• In 1996 a two-dose measles vaccine schedule was started as well as a measles booster
campaign to provide a second dose to all children in school from SK to grade 13 in most
provinces.
• One dose of measles vaccine is 93% effective, 2 doses 97% effective.
• Any unvaccinated individual remains at risk.
All suspect patients should self-isolate until results are known.

Reporting
Measles is a reportable disease. If you suspect a case of measles, please report it to
Wellington-Dufferin-Guelph Public Health immediately, 519-822-2715 ext. 4752. After
hours, weekends and holidays please call 1-877-884-8653.

*Information provided by Public Health

WHAT TO DO IF YOUR CHILD HAS A FEVER OR VIRAL ILLNESS?

November 21, 2022

Viruses and other illnesses are running rampant this fall. Things are even harder because there seems to be a shortage of almost all the things you might use to treat your child at home. Here are some tips for getting through the winter and fall

Prevention is worth a pound of cure

The best way to avoid needing medications is to do your best to avoid getting sick in the first place. All the things we've been doing for years to prevent covid, prevents all the other things too.

Wear masks (and have your child wear a mask) when in high risk situations.
Wash hands often and well or use sanitizer
Cough into your elbow instead of your hands
Stay home or keep your child home when they are sick - especially in the first couple of days when things are most infectious.
Everyone should get a flu shot and keep their covid shots up-to-date

Taking a temperature and managing a fever

The Canadian Pediatric Society has good outline on taking a temperature and what to do including all the different types of thermometers

This great video from the NHS goes over managing fever in a child

Medications to treat a fever & viral illnesses

Most viruses should be managed at home with simple supportive things. Very few of them need any prescription medications.

Fever - do simple things like not overwrapping your child but avoid cold cloths and baths (they don't help but often make the child feel worse). Treat the crummy feeling that comes with the fever rather than the number. I know a high fever seems scary but the height of the temperature isn't a good marker of how sick your child is - looking at them will tell you more than the thermometer does. Fevers may help the immune system work better so if your child feels fine, there is no need to treat it. Acetaminophen (Tylenol) and Ibuprofen (Advil, Motrin) are your best choices to treat a fever if you need medications

Red eyes and discharge - this is almost always viral, esp if your child also has cold symptoms. Despite what the daycare and the internet tells you "pink eye" does not generally need treatment - 90% of the time it will go away on its own. Over the counter antibiotic drops like Polysporin are not needed. Use warm compresses and artificial tears to reduce the discomfort.

Stuffy and runny nose - Sadly most decongestant medications don't work well in kids but can have risks. That's why they are never available for children under 6. Try things like saline rinsing sprays, a humidifier or the "snot sucker". For older children, you can consider trying OTC medications but don't be surprised if they don't help much.

Earache - most ear infections are also viral so antibiotics don't help them. The good news is they will go away on their own in 2-3 days. About 30% of ear infection are caused by bacteria and will need antibiotics. Have your child assessed if their earache lasts more than 48-72 hours, if there is discharge from the ear or if your child has had more than 2-3 ear infections in the last year.

Covid - lots of the viral infections we are seeing are caused by covid. Managing covid in your child is very much the same as if the same symptoms are caused by a cold or other virus. Confused about covid is a great source of information for all things covid including what to do for your child.

How much can I give?

These handy charts outline how much acetaminophen and how much ibuprofen to give a child.

The recommended dose of ibuprofen is 10 mg/kg. That means a 10 kg (22lb) child would need 100 mg. An adult regular strength ibuprofen is 200 mg which means a 22lb child could have 1/2 an adult regular strength tablet.

The recommended dose of acetaminophen is 10-15 mg/kg. That means a 15 kg (33lb) child would need 130-225 mg. An adult regular strength acetaminophen is 325 mg. Half of that tablet is 162.5mg which is right in that range. So a 33 lb child could have 1/2 of an adult regular

Does all that calculating confuse you? Not sure if it is safe to cut the adult pills you have? Talk to your nurse practitioner, doctor or pharmacist for advice. Pharmacists are great at this! Just make sure you have a fairly recent and fairly accurate weight for your child.

When should my child see a doctor?

Most of the time you can manage this at home and your doctor or nurse practitioner won't be able to do anything more to help. You should have your child assessed if:

Any child with a fever under 6 weeks of age
If your child has a fever lasting 72 hours or more
If your child has an earache lasting more than 48-72 hours
If your child is struggling to breath or is really out of breath
If your child is not eating or drinking. It's very normal to eat and drink less. Liquids are more important than food

If you're not sure what to do, check out health Connect Ontario which has a symptom checker, live chat with a nurse or you can call 811 to be connected with a nurse 24 hours a day.

Gordon Street Family Medical does our best to keep same day appointments for your children when they need to be seen. When we are closed, our patients can use the After Hours Clinic at 21 Surrey St. But all these viruses are keeping us very busy everywhere. By managing your child at home until they need to see the doctor it helps us have enough time and space to look after the children that do need to be seen.

Covid Vaccines

We encourage all eligible people to get vaccinated for COVID, including their latest booster shot. Although less shots still protects you against serious illness, one, two or three booster shots significantly reduces illness and transmission to others. You can book your COVID vaccine through the WDG website.

We are currently NOT giving COVID vaccines in our office.

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