Abstract
In early 2015, an outbreak of 10 confirmed measles cases occurred in Toronto, Ontario. As part of the outbreak response, the Toronto Public Health staff conducted both traditional and supplementary case investigation activities. Despite this extensive effort, and unlike many previous measles outbreaks in Canada, neither the source case nor any confirmed epidemiologic links between cases were identified. The outbreak investigation brought to light potential gaps in the current measles surveillance and suggested approaches to future investigations: routine use of social media and other time-stamped resources to enhance case investigation; early and repeated targeted communication with primary care partners to improve case detection; and continued efforts to increase and maintain sufficient immunization coverage to interrupt transmission.
Highlights
On January 28, 2015, Toronto Public Health was notified of a laboratory-confirmed measles case
10 confirmed and genotypically similar measles cases were reported to Toronto Public Health between January 28, 2015, and February 17, 2015
Despite routine and enhanced investigations of an outbreak of measles limited to 10 laboratory-confirmed cases in Toronto, Ontario, neither the source nor any confirmed epidemiologic links were identified
Summary
On January 28, 2015, Toronto Public Health was notified of a laboratory-confirmed measles case. Reports of nine additional confirmed cases soon followed. Molecular evidence supported the hypothesis that all the cases resulted from a single importation, but this could not be confirmed through epidemiologic evidence. A detailed description of the epidemiology and public health response to this outbreak will be provided elsewhere 10 confirmed and genotypically similar measles cases were reported to Toronto Public Health between January 28, 2015, and February 17, 2015. All cases and contacts were investigated and managed as per Ontario’s Infectious Diseases Protocol (1). This included follow-up of 1,548 contacts and hosting of 10 post-exposure prophylaxis clinics. Routine case investigation information did not reveal the source of the measles outbreak
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