Ask the Pharmacist

Q: I am hearing about more measles cases appearing in Ontario. Should I be worried?

A: You are correct that measles appears to be on the rise. We have not had to be too concerned about measles over the past few decades since it was officially eradicated in 1988 within Canada, with only sporadic cases reported that were linked to travel. We can thank the high vaccination rates against measles in the 1970s and ‘80s for accomplishing this eradication.

The Measles, Mumps, Rubella (MMR) vaccine is a publicly-funded vaccine and is routinely given to children, through their primary health-care provider, around 12 months of age, and again between the ages of four and six. It has been found that receiving two doses of the MMR vaccine reaches near 100-per-cent efficacy.

With such a high efficacy rate with the MMR vaccine, you might be wondering why we are seeing more cases of measles arising. Granted, there have always been a few people who are either against or hesitant toward vaccines. But since the COVID-19 pandemic, the rates of unvaccinated children have increased substantially.

During the pandemic, there was a delay or a complete oversight in the usual routine vaccinations of our children. Some parents might have decided to forego the routine vaccinations as they were feeling the effects of pandemic fatigue, and many families never got back on track with their immunizations. 

Measles is so contagious that nine out of 10 unvaccinated individuals exposed to it, will get infected. It is easily spread through airborne droplets (via talking, coughing, sneezing) and these droplets can hang in the air for an hour afterwards. This means that anyone (most particularly, an unvaccinated individual) who walks in that vicinity within that time frame may acquire the infection.

The droplets that find their way to land on a surface may be “active” for several hours. This is relevant for schools and daycares that may have unvaccinated children who often learn by touch, feel and putting objects in, or to, their mouth. This doesn’t mean that adults won’t get measles in this fashion but we, ideally, are not putting these objects in our mouths.

The signs and symptoms to look for are:
 

• Cough
• Coryza (runny nose)
• Conjunctivitis (eye infection)
• Rash that often starts on the face and works its way down 
• Fever
• Koplik spots (tiny white spots inside mouth)

As is the case with most communicable diseases, many people who acquire measles will fare okay and complain about the above symptoms. However, the very old, very young and those with compromised immune systems, are at risk of serious complications. In fact, it is reported that one in four or five people who are infected with measles, are hospitalized with pneumonia or encephalitis, or can die. Other complications that can arise, are life-long deafness, blindness or a fatal brain disorder.  

If you do get sick with measles, there is no treatment for it other than supportive treatment of the symptoms, themselves. For example, you might take acetaminophen or ibuprofen to manage your fever, or a cough suppressant to stop your cough. The best medicine, however, is prevention. The only way to prevent measles is through vaccination, unless you plan on living in a bubble for the remainder of your days.

If you were born before 1970, you more than likely have life-long immunity from your exposure to measles. For those born after 1970, look into your vaccination records to see if you have received two doses of MMR vaccine. If you have not been vaccinated, or you have no way of finding out your vaccination status, we strongly consider getting vaccinated.

From Public Health Ontario, People are considered protected if they have at least one of the following:
 

• Proof of vaccination with two valid doses of measles-containing vaccine (e.g. MMR vaccine)
• Blood work showing antibodies to measles
• Documentation of prior laboratory-confirmed measles infection
• Are born before 1970 (with the exception of health-care workers)
  • All health-care workers require evidence of vaccination with two valid doses of measles-containing vaccine or blood work suggestive of immunity (measles IgG reactive) regardless of year of birth

If you do not have any of the above, you are not protected against measles.

If you discover you have been exposed, be on the look-out, for the next 21 days, for the above symptoms. If you fit into one of the above categories to be considered protected, it is highly unlikely that you will experience the illness.  

If you do not fall into the above categories to be considered protected, follow the guidelines posted below from Public Health Ontario:
 

• If you attend or work at a school, child care, or health-care setting, you MUST stay home and contact your local public health unit for further direction.  
• If you have had no doses of MMR vaccine, stay at home and contact your local public health unit for further direction.
• If you have had one dose of MMR vaccine, call your health-care provider or local public health unit to receive an additional dose of MMR vaccine. Notify your health-care provider of your exposure so that they can take appropriate precautions to limit the spread of measles. Unless you work in a health-care setting, you can immediately return to work, school, or daycare after you get a second dose of measles-containing vaccine.
• If you (or a family member) are at high risk of complications as listed below, contact your health-care provider or local public health unit to discuss options to reduce the risk of measles infection through vaccination or a product called immunoglobulin. For these to be effective, they must be given very soon after exposure:
• Babies under one year age who have not received measles vaccine
• People with a severely weakened immune system
• Pregnant individuals who are not protected against measles
• If you are uncertain about your vaccination status, call your health-care provider or your local public health unit to determine if you have received an MMR vaccine in the past.
• Watch for the onset of measles symptoms until 21 days after the date of exposure (see Places and dates of possible exposure to a case of measles)
• If you develop symptoms and need medical care, call ahead before you visit the doctor, clinic, or hospital to inform staff of your exposure to measles so staff can prepare for your arrival and take appropriate precautions.
• If you develop symptoms and do not need medical care, call your local public health unit.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/.