Erika Vitale, manager of infection prevention and control at Windsor Regional Hospital, stands in the pediatric wing of the hospital’s Met Campus where a child with measles is currently admitted.Dax Melmer /The Globe and Mail
Patients with measles symptoms are directed to the back of Windsor Regional Hospital‘s metropolitan campus, where they enter the building near the shipping and receiving dock and the morgue.
Inside, strict protocols are meant to keep one of the world’s most contagious viruses from spreading: The hospital does not allow visitors under age 16; four pediatric airborne isolation rooms are set up; elevators are shut down for two hours after an infected patient uses them; and admissions are carefully timed to minimize exposures.
Windsor and other hospitals in Southwestern Ontario, located in the epicentre of the measles outbreak, have ramped up preventative measures reminiscent of the response to COVID-19. But the virus makes containment efforts more complicated: Measles is considered twice as contagious and can remain in the air for two hours after an infected person has left an area.
Ontario has logged around 1,800 cases of measles since the outbreak began last fall, according to figures from Public Health Ontario released on Thursday. Alberta has the second-highest case count, with 538 reported, leading hospitals in the province’s south zone to tighten visitor guidelines. They now require proof of vaccination for individuals under 16 in neonatal, pediatric, maternal, child, and labour and delivery units.
In Ontario, public-health officials and hospital staff are particularly concerned about vulnerable populations, including those who are pregnant, newborns and immunocompromised patients.
A sign warning about measles symptoms to be aware of is placed on the door to the lobby to Windsor Regional Hospital.Dax Melmer/The Globe and Mail
“I keep telling people, the more cases we have across Ontario, we’re going to have deaths,” said Erika Vitale, the director of infection prevention and control at Windsor Regional Hospital.
“I hope that the public pays attention to some of the news and information that’s out there. And if you’re not vaccinated, that you strongly consider getting vaccinated or getting your children vaccinated.”
So far, there have not been any deaths attributed to measles in Canada this year. The country recorded a death related to measles last year in an unvaccinated child under the age of 5 from Hamilton, the province’s first in decades. There have been three confirmed deaths from measles in the United States this year.
With measles making a comeback, doctors race to fight a disease many have only seen in textbooks
Childhood vaccination programs have been key to eliminating measles, but a recent study published in the Canadian Journal of Public Health found a decline in vaccine coverage in children in 2023 compared with 2019.
Michelle Barton-Forbes, the division chief of infectious diseases at the Children’s Hospital at London Health Sciences Centre, said hospital leadership and the infection prevention and control team met in January to discuss measles, which led to new protocols.
The hospital currently does not allow children, siblings and non-essential visitors to visit patients. In pediatric in-patient areas, parents or caregivers must pass screening and provide proof of measles immunity – either two doses of the measles-mumps-rubella vaccine or an antibody test result – or wear a N95 mask. The same rules apply to care partners in the obstetrical unit.
Dr. Barton-Forbes worries about a potential outbreak in neonatal intensive-care units (NICUs), where premature babies are highly vulnerable. She said an outbreak in the NICU would be “devastating” because babies have no protection against the virus. The hospital would use immunoglobulin to offer temporary antibody protection to newborns.
Windsor Regional has also considered the possibility of a NICU outbreak because a baby with the virus poses risks to other babies in an open environment. “We have not had that situation happen yet, but we’re just trying to think of worst-case scenario,” Ms. Vitale said.
With infected birthing patients in mind, the hospital has adjusted the direction of how the air flows from operating rooms used for cesarean sections. The rooms are typically positive-pressure environments, meaning air would flow out into surrounding areas.
“What we found out as we were reviewing everything was that our C-section rooms blow air out into our NICU area and could potentially expose all the babies in the NICU,” she said.
Ms. Vitale said measles has not overwhelmed the hospital but some patients have experienced complications, such as pneumonia.
At Woodstock Hospital, about half an hour east of London, fewer than 5 per cent of patients with measles have been admitted and the current situation is manageable.
The hospital has restricted visitors to its maternal unit to two essential caregivers and does not allow children. It also urges people with measles symptoms to call ahead before entering the emergency room.
If a symptomatic individual arrives without prior notice, a response team tracks the cases, reviews exposures and shares information with public health, said Cindy Smart, vice-president of patient care and chief nursing officer.
But if symptoms are mild and manageable, the hospital has a plea to its residents: Please stay home and self-isolate.
“Not calling ahead puts our vulnerable patients at risk,” she said. “That’s why we hope to underscore the important message that anyone with measles symptoms must call ahead before visiting any health care facility.”
With a report from Alanna Smith