Measles Updates

For all paediatric inpatient areas, including on B6, the Paediatric Critical Care Unit (PCCU), High Dependency Transition Unit (HDTU) and Child & Adolescent Mental Health (CAMH):

• Two (2) adult parents/care partners at a time will be permitted to stay with a patient while they are in their care space.
• Before entering, all parents/care partners will need to pass screening and provide proof of measles immunity (preferable) or wear an N95 mask at all times.
  • Proof of immunity includes: a certificate showing two doses of the MMR vaccine, those born before 1970 or bloodwork results that show antibodies to the virus.
  • Those who are unaware of their vaccination status can contact their local public health unit or primary care provider.
• No children, including siblings, or other family and friends will be allowed to enter at this time. 
• Parents/care partners are encouraged to stay in the patient’s immediate care area/room at all times. 
• Exceptions can be made by each patient's care team on a case-by-case basis. Patients seeking exception are asked to contact their care team.

For the Neonatal Intensive Care Unit (NICU):

• Option 1: Two (2) parents/adult care partners at a time will be permitted to stay with a patient while they are receiving care IF they pass screening AND provide proof of measles immunity.
  • Proof of immunity includes: a certificate showing two doses of the MMR vaccine, those born before 1970 or bloodwork results that show antibodies to the virus.
  • Those who are unaware of their vaccination status can contact their local public health unit or primary care provider.
• Option 2: Only one (1) parent/adult care partner at a time will be permitted to stay with a patient while they are receiving care IF they cannot provide proof of measles immunity. The one parent/adult care partner must still pass screening and wear an N95 mask at all times.
• No children, including siblings, or other family and friends will be allowed to enter at this time. 
• Parents/care partners are encouraged to stay in the patient’s immediate care area/room at all times. 
• Exceptions can be made by each patient's care team on a case-by-case basis. Patients seeking exception are asked to contact their care team.

For all paediatric outpatient areas, including the Paediatric Medical Day Unit (PMDU), Children’s Emergency Department and Child & Adolescent Mental Health (CAMH):

• Two (2) adult parents/care partners at a time will be permitted to stay with a patient while they are receiving care.
• Before entering, all parents/care partners will need to pass screening and provide proof of measles immunity (preferable) or wear an N95 mask at all times.
  • Proof of immunity includes: a certificate showing two doses of the MMR vaccine, those born before 1970 or bloodwork results that show antibodies to the virus.
  • Those who are unaware of their vaccination status can contact their local public health unit or primary care provider.
• No children, including siblings, or other family and friends will be allowed to enter at this time. 
• Parents/care partners are encouraged to stay in the patient’s immediate care area/room at all times.
• Exceptions can be made by each patient's care team on a case-by-case basis. Patients seeking exception are asked to contact their care team. 

For all inpatient areas, including Antenatal, the Obstetrical Care Unit (OBCU) and Postpartum Care Unit (PPCU):

• Two (2) adult care partners at a time will be permitted to stay with a patient while they are in their care space.
• Before entering, all care partners will need to pass screening and provide proof of measles immunity (preferable) or wear an N95 mask at all times.
  • Proof of immunity includes: a certificate showing two doses of the MMR vaccine, those born before 1970 or bloodwork results that show antibodies to the virus.
  • Those who are unaware of their vaccination status can contact their local public health unit or primary care provider.
• No children, including siblings, or other family and friends will be allowed to enter at this time. 
• Care partners are encouraged to stay in the patient’s immediate care area/room at all times. 
• Exceptions can be made by each patient's care team on a case-by-case basis. Patients seeking exception are asked to contact their care team.

For all outpatient areas, including the Obstetrical/Gynecology Ambulatory Clinic:

• One (1) adult care partner at a time will be permitted to stay with a patient while they are receiving care.
• Before entering, all care partners will need to pass screening and provide proof of measles immunity (preferable) or wear an N95 mask at all times.
  • Proof of immunity includes: a certificate showing two doses of the MMR vaccine, those born before 1970 or bloodwork results that show antibodies to the virus. 
  • Those who are unaware of their vaccination status can contact their local public health unit or primary care provider.
• No children, including siblings, or other family and friends will be allowed to enter at this time. 
• Care partners are encouraged to stay in the patient’s immediate care area/room at all times. 
• Exceptions can be made by each patient's care team on a case-by-case basis. Patients seeking exception are asked to contact their care team. 

The care partner and visitor policy changes keep our most vulnerable patients safe by limiting their exposure to people who may be carrying the measles virus. We know the virus lingers in the air for up to two hours and that the more people in the room, the more viral particles may be present. By asking basic screening questions and requiring proof of immunity or masks to be worn, we can help ensure care partners and visitors being let into patient care spaces do not unknowingly pass the virus to others.

The care partner and visitor policy is being reviewed weekly to ensure it remains the most effective way of keeping patients safe amid ongoing changes in measles activity in our region. Our teams in Infectious Diseases, Infection Prevention and Control, Risk, Privacy, Patient Experience, Ethics and more are present during these discussions, helping to ensure we strike the right balance between keeping patients safe while still allowing their valued care partners to be present throughout their care.

A care partner is anyone who is present to emotionally, physically or otherwise support a patient and help them make decisions about their care. This may be a parent/guardian, sibling, other family member or friend. It may also be a paid support person that is not considered LHSC staff (for purposes of this policy).

The care partner and visitor policy currently only applies to Children’s Hospital and the Women’s Care program. This is because children and pregnant persons are among the highest risk for complications from measles. That said, LHSC currently has seasonal respiratory illness precautions in place to protect other patients in all care areas.

The care partner and visitor policy is different depending on the type of patient population being cared for, their risk of complications from measles, how the care area is set up, the purpose of their visit/stay and how many care partners they may need present at one time.

Upon arrival, you will be asked if you have any symptoms of or have recently been exposed to measles. Symptoms include, but are not limited to, fever, runny nose, cough, red watery eyes, small white spots in the mouth or a rash.

While vaccination rates for London-Middlesex area residents remain high, LHSC is a tertiary acute care centre that cares for the highest acuity patients from a catchment area reaching as far north as Thunder Bay. This means we have a large number of high-risk patients being cared for within our walls that may not have been vaccinated or remain at high-risk for complications despite vaccination because of one or more health concerns.

Adults and children are encouraged to receive their measles vaccination from a primary care provider or their local health unit. However, Children’s Hospital at LHSC is home to a special Paediatric Vaccination Clinic, which is offering the measles vaccine to children and youth who need extra support not typically available in traditional health-care or community vaccination settings.

Measles is a highly contagious viral infection. It spreads through the air when an infected person breathes, or through droplets when they cough or sneeze.

The virus can linger in the air for up to two hours, making it incredibly easy to catch if you’re not vaccinated. In fact, nine out of 10 unvaccinated people who are exposed will catch it. It’s the most contagious virus known to humans.

Symptoms typically begin about seven to 21 days after a person is exposed. You are considered contagious at this point.

Initially, you might feel like you have a common cold. You're likely to experience a fever, sore throat, cough and runny nose. You may even have red, watery eyes like when a person has conjunctivitis (pink eye).

About three to seven days after your initial symptoms begin, a patchy rash will appear on your face and spread down the rest of your body. The rash appears red on light skin but can appear white or purple on dark skin. This can be challenging because people associate measles with a red rash, not necessarily a white or purple one.

That said, it’s important to note that not everyone will get the same symptoms – or any symptoms at all. To be clear, measles is NOT a cold with a rash.

Measles is dangerous because it can affect multiple areas of the body, from the lungs to the intestines and the brain. It can lead to severe complications, including death, during the infection or after.

The most common complication requiring hospitalization is pneumonia or respiratory failure, which may result in someone needing oxygen or a ventilator. Measles also commonly causes gastroenteritis (vomiting and diarrhea), leading to dehydration. Additionally, you can get meningitis (swelling of membranes surrounding your brain and spinal cord) and encephalitis (swelling of the brain itself), as well as damage to your immune system and permanent blindness.

For individuals who are pregnant, measles can affect the growth of baby and lead to a miscarriage, stillbirth or premature labour. The baby can also become infected.

In rare cases, unvaccinated children who contract measles will experience a special type of brain swelling that is associated with degenerative decline, sometimes resulting in a coma, 10 to 12 years after their initial infection has passed.

Thankfully, measles is entirely vaccine preventable.

While the risk of complications from measles is low for healthy individuals, it can be particularly catastrophic for babies and young children, pregnant persons and those who are immunocompromised.

About one in 20 healthy people will experience complications from measles and one in five children will require hospitalization.

The mortality rate for measles is one to three people per 1,000 healthy individuals, 40 to 70 per cent for high-risk groups (such as those with cancer or those who have received a transplant) and three to 20 per cent for pregnant individuals.

The Measles, Mumps and Rubella (MMR) vaccine is our best protection against the virus. It’s given in two doses; the first around one year old and the second at four to six years old. If someone didn’t receive the vaccine as a child, they can still get it as an adult.

The vaccine works by introducing a weakened version of the virus to your immune system so it can create antibodies. These antibodies are what helps your body recognize and fight off the actual virus when you’re exposed to it in the real world.

The measles vaccine is safe and highly effective (about 97 per cent). Like with other vaccines, you may have minor side effects such as a sore arm or redness after receiving it, but these are not serious and resolve quickly. Contrary to what you might have read online, the vaccine does not cause autism.

Anyone who has questions about their immunity status or would like to receive the vaccine is encouraged to contact their primary care provider or local health unit. After receiving both doses of the vaccine, it will take about two weeks before you are considered immune.

While measles was eradicated in Canada in the 90s, it continued to circulate in other parts of the world that didn’t have such high vaccination rates.

Unfortunately, in recent years, we’ve seen a drop in vaccine rates across Canada. This is partially due to the health-care system playing catch up after the COVID-19 pandemic, but also because of rising vaccine hesitancy being fueled by misinformation online. Some communities are also less willing to vaccinate because of cultural or religious reasons.

So, measles is once again circulating across Canada – and perhaps the fastest across southwestern Ontario. It’s like a fire that will burn until it runs out of trees. Practically speaking, this means until 95 per cent of the population is vaccinated and we’ve once again achieved herd immunity.

While new cases are being announced every day, they are likely significantly underestimated, as not everyone who gets the virus seeks care. We would likely have to multiply current cases by four to 10 to have an accurate picture of the number of people in Canada who are currently infected with measles.

There is no specific treatment or antiviral for measles. This means that once an infection occurs, care providers focus on relieving a patient’s symptoms and preventing complications while their body fights the infection.

Anyone who would like more information about measles is encouraged to reach out to their primary care provider or local health unit. The Middlesex-London Health Unit and Southwestern Public Health Unit, for example, have some excellent resources online, as does the Canadian Paediatric Society’s Caring for Kids initiative.