Dr. Danielle Smith in her office at South Hill Health Centre in Vancouver, B.C. Dr. Smith and her colleague, Dr. Karina Zeidler, were the team of physicians who diagnosed the first case of measles reported in B.C. in 2024.Isabella Falsetti/The Globe and Mail
Family doctor Danielle Smith has treated dozens of patients with itchy, painful rashes at her B.C. practice, but the blotchy red dots she saw earlier this year puzzled her. The rash was concentrated on the patient’s face and spread out as it moved down the body, almost as if a red bucket of paint had been poured over the person’s head.
Dr. Smith asked her colleague and fellow physician Karina Zeidler for help. The patient was asked a series of questions, including about their travel history. Blood work was ordered. A urine sample was collected. The person’s nose was swabbed.
The tests revealed the culprit was measles, the highly contagious virus that has made a resurgence in Canada in recent months.
“It was a rash that I had never seen before, which I was never expecting to have to see in my career,” said Dr. Smith, who has practised medicine for four years at the South Hill Family Health Centre in Vancouver.
Until last fall, many Canadian physicians had never seen a measles case other than in textbooks. The country had declared the disease eliminated in 1998. But as the virus makes a global and domestic comeback – Ontario’s outbreak has surpassed 1,600 cases and Alberta is at 438 – efforts are under way to bolster understanding of its symptoms and the steps needed to contain its spread, especially among doctors confronting it for the first time.
Measles can be difficult to recognize at first for those who are not familiar with it. There’s the telltale red rash, but it usually appears several days after a high fever, cough and runny nose – symptoms commonly associated with other viral infections.
Public-health officials want measles to be detected early to help prevent its spread. The virus is so contagious that it can linger in the air even two hours after an infected person has left the space. While there is no specific antiviral treatment for it, and most people who are infected recover at home, severe cases can require hospitalization.
Earlier this year, the Canadian Paediatric Society convened online webinars about the clinical presentation of the virus, along with prevention tools. More than 900 people attended.
At Toronto’s Hospital for Sick Children, measles was recently discussed at a continuing education seminar. Upton Allen, the hospital’s head of infectious diseases, said these kinds of sessions are an opportunity for clinicians to get updated on what measles may look like.
So far, cases in Ontario have been concentrated in the southwestern part of the province. Michelle Barton-Forbes, the division chief of infectious diseases at the Children’s Hospital at London Health Sciences Centre, said her colleagues have become “quite proficient at recognizing measles.”
Measles has been reported in several other jurisdictions this year, including in Alberta, Saskatchewan, Manitoba, Quebec and Prince Edward Island. Nine cases, including the one identified by Dr. Smith and Dr. Zeidler, have been reported in B.C.
“I recognize that there are hospitals where the numbers or the exposure is very limited, or not at all,” Dr. Barton-Forbes said. “But with measles present across the country, it behooves all physicians in this season to get a measles recap.”
Rita McCracken, an assistant professor at the University of British Columbia in the Department of Family Practice, saw a case of measles 15 years ago that was not associated with an outbreak.
In medical school, she said, physicians are taught that measles follows a very distinctive pattern, including a rash that almost always begins on the face and moves onto the torso. (Another sign that doctors should watch out for is weepy eyes, she added.)
But symptoms appear differently on individuals of colour – the rash may appear more purple than red – and diagnostic photographs of the disease typically feature white-skinned patients, said Dr. McCracken, who also works with Dr. Zeidler and Dr. Smith at the Vancouver clinic.
Continued medical education efforts must be inclusive for all patients, she said.
But while there may be a learning curve in terms of identifying measles, the pandemic offered helpful lessons about how to contain it and other infectious diseases, Dr. McCracken said. South Hill Health Centre, for example, still requires patients and staff to wear masks.
The clinic also uses air purifiers, and front-desk staff can direct patients to an isolation room to limit exposure. These measures, Dr. McCracken said, helped ensure measles was not spread when the patient presented with the illness.
Measles is considered so infectious, Dr. Allen explained, that a single case can spread like wildfire, particularly among unvaccinated populations.
One person could potentially infect 12 to 18 others, which is why it’s so important for physicians to be on the lookout, he added.
“If somebody’s never seen a case of measles, to me, that’s okay,” he said. “It’s just for them to recognize when they ought to be thinking about measles.”