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A community outbreak of travel-acquired measles, Ontario 2009
J Armstrong1, A Arajs1, N Bailey1
1Region of Waterloo Public Health, Waterloo, ON.
Background:
Canada has held elimination status for measles since 1998; however, imported cases continue to occur.
Objective:
To describe the public health response to an imported measles case in the Waterloo Region of Ontario in May 2009.
Results:
Contacts and exposures were traced, and cases were quickly investigated to identify the source. Through routine reporting mechanisms it was found that the index case had likely been exposed while on holiday in Disney World to a laboratory-confirmed measles case in a nine year old unimmunized boy from the United Kingdom (UK). Canada's National Microbiology Laboratory confirmed that the index case had the same D4 measles strain as the UK case and the strain that had been circulating in the UK. In total, one probable case and six confirmed cases were reported. The median age of confirmed cases was 14.5 years (mean age 17 years, range 6 to 39 years). Five confirmed cases (83%) were female. One confirmed case (17%) was hospitalized; no deaths were associated with the outbreak.
Conclusion:
This outbreak highlights the importance of collaboration with clinical care, the laboratory and public health at all levels of government to investigate and control a measles outbreak. Global travel and sustained local transmission may continue to pose a challenge with respect to the eradication of measles in developed countries.
Insights
An imported measles case in Ontario led to a small outbreak, emphasizing the need for robust public health responses and international collaboration to maintain measles elimination. Global travel poses ongoing challenges.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Vaccinology
Background:
- Canada has maintained measles elimination status since 1998.
- Imported measles cases continue to be a public health concern.
- Global travel increases the risk of measles importation.
Purpose of the Study:
- To detail the public health response to an imported measles case.
- To analyze the subsequent outbreak in the Waterloo Region, Ontario.
- To understand the challenges in maintaining measles elimination.
Main Methods:
- Contact tracing and exposure investigation were initiated.
- Laboratory confirmation of measles virus strain.
- Surveillance and case reporting through routine mechanisms.
Main Results:
- The index case was exposed to a confirmed measles case from the UK while traveling.
- Genetic analysis confirmed the same D4 measles strain circulating in the UK.
- A total of seven cases (one probable, six confirmed) were reported.
- The outbreak involved individuals aged 6 to 39, with a median age of 14.5 years.
- One hospitalization occurred; no deaths were reported.
Conclusions:
- Effective measles control requires collaboration between clinical care, laboratories, and public health agencies.
- Sustained local transmission and global travel present ongoing challenges to measles eradication.
- Vigilance and rapid response are crucial for preventing widespread measles outbreaks.
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