This communication is intended to answer the questions you may have received from patients with respect to the measles outbreak currently occurring in Metro Vancouver.

Dear Healthcare Providers:

This communication is intended to answer the questions you may have received from patients with respect to the measles outbreak currently occurring in Metro Vancouver.  Apart from one case whose source of exposure is being investigated, it is important to note that the outbreak is largely contained and that measles cases are not widespread across our communities. 
Call volumes to Public Health and demand for vaccinations has increased markedly and we have increased our call-centre staff and number of immunization appointments in response. Contacts of confirmed cases of measles have been prioritized for immunizations so as to prevent further cases. Despite increasing the number of clinics, there still continues to be very high demand and we are relying on our partners, GPs, NPs, and pharmacists, to assist as possible.
We recognize the impact the outbreak has had on call volumes and requests for vaccine to your offices. Public Health has developed responses to frequently asked questions you may be receiving and to improve the efficiency of your contact with us. 
Q. Is there enough MMR vaccine to meet demand or should I prioritize who I immunize?
A. Yes, there is sufficient vaccine for all those who are not up to date with their immunization.  The priority should be given to anyone who does not have any, or only one, documented dose(s) of the vaccine and have been exposed to a confirmed measles case. Also, please ensure you are only immunizing those born after 1970 (or healthcare workers born after 1957) who have had no doses or only one dose of measles-containing vaccine. Continue to provide immunizations as per the provincial immunization schedule.
Q. How can I order more vaccine in an expedient way?
A. Please continue to use your current process for faxing in your vaccine orders. Please note that we are currently experiencing higher than usual requests for vaccine from community vaccine providers.   Orders are filled based on the available supply, and with the aim to provide equitable access to all those requesting it. 
Q. Who do I report a suspect measles case to? 
A. Immediately contact the communicable disease team at 604-507-5471 to speak with a Communicable Disease Nurse, or, after hours the On-Call Medical Health Officer (604-527-4806), in order to facilitate investigation and contact follow-up. For more information on what to do when you suspect measles, please refer to last week’s (February 20, 2019) Medical Health Officer update.

Q. Who can I speak with if I have additional questions regarding measles vaccination? 
A. Call 811 with any general questions regarding measles vaccination. 
To book an appointment for measles vaccination at a public health unit, call 604-587-3936.  Please note that currently, appointments are being booked 3-5 weeks in advance.
To speak with a public health nurse at your local health unit with questions about measles vaccination, call 604-587-3936 and press 0 to speak with an operator.  Tell the operator that you would like to speak with the duty nurse at your local health unit.
 Q. My patients are requesting an early second dose of MMR vaccine. What do you recommend?
A. We do not recommend providing either an early first dose of MMR prior to the 1st birthday (i.e. children aged six to 12 months) or an early second dose to children between the ages of one and four years old. Children between one and four years of age are considered up to date with one dose of MMR. A measles booster dose (MMRV) is due starting at age four.
 Q. My patient under the age of 12 months is traveling to a measles endemic country.  Can I provide an early dose of vaccine?
A. There has been a worldwide increase in measles cases.  Please consider early immunization of infants on a case by case basis (this applies to infants aged between 6-12 months) for those traveling to measles endemic countries. Please note that if a child receives MMR prior to 12 months of age, it will need to be repeated after 12 months of age as the early dose is not considered a valid dose. A second dose for children with one dose of measles-containing vaccine traveling to a measles endemic area can also be considered.  Information on which countries/regions have elevated numbers of measles cases can be found here:
World Health Organization (WHO)
Center for Disease Control (CDC)
Public Health Agency Canada (PHAC)
Q: What if I am exposed to a measles case in my office?
A: Depending on your employment situation, Public Health or Workplace Health will follow up and conduct a risk assessment of the exposure and your susceptibility. For those health care workers who are not immune (i.e. born after 1957 without documented evidence of two doses of measles-containing vaccine), exclusion from work is recommended. Exclusions may occur for the period from 5 days after the first exposure to 21 days after the last exposure. If you are immune/protected from measles, no further follow-up will be required.
Q. How can I access my patient’s records from Public Health to see if they’re immunized?
A. Patients can request their own records for vaccines delivered by Fraser Health Public Health by completing the attached Request for Information form.

The form can be mailed or dropped off by patients to their local public health unit. 

For childhood records (up to age 18): Patients should contact their local public health unit
For adult records (19 years and over):

  • If vaccines were provided by public health, patients should contact their local public health unit
  • If vaccines were provided by another provider, contact the provider directly

For vaccines provided out of province/country, patients should contact the appropriate jurisdiction for records.
Please note:  Please inform your patients that they do not need to send same request multiple times. Public Health follows the provincial Privacy (FOIPPA) guidelines and timelines to respond to request for records. Depending on the request and the volumes, it can take up to 30 days to respond (although we typically aim to respond much sooner than that).  We are unable to process same-day requests. 

Q. I don’t do immunizations.  How can I refer my patient to Public Health for their immunizations?
A. Please ask your patients to call 604-587-3936.  Please note that owing to increased call volumes, individuals may need to wait longer than usual to book an appointment.  Patients who have been exposed to a known measles case and do not have any, or only one, dose(s) of the vaccines will be prioritized. All other requests for vaccine may experience a wait of anywhere from three to five weeks for an appointment.
If your patient is older than 5 years of age, they can go to some pharmacists to receive their immunizations. Please instruct patients to call the pharmacy ahead of time to ensure they provide the desired vaccine(s). 
Q. I would now like to take up immunizations in my practice.  Who can I contact to get this started?
A. Please contact your local Public Health unit Supervisor via phone or fax at the number located on this letter footer. The BCCDC website has resources available to you to set up immunization in your practice.    (please look for the “PEARLS” course).
Once again, we thank you for your support during this time.  To re-iterate, the outbreak is largely contained and measles cases are not widespread across our communities.  We thank you for your patience and understanding as well as your support in immunizing our population.
If you have any further questions, please contact the Medical Health Officer line at 604-587-3828.


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