Communicable Diseases Information for Physicians

All suspected cases of pertussis should be reported immediately to Halton Region Public Health at 905-825-6000 (or toll-free at 1-866-442-5866) or dial 311 if calling within Halton Region.

Whenever possible, suspect pertussis patients should be placed in a separate room upon arrival.

Isolation

Advise the patient to self-isolate for five days from the start of antibiotic treatment or for 21 days from the onset of cough, if not treated. Also advise the patient to expect a call from Halton Region Public Health.

Testing to confirm pertussis infection

Recommended specimens for acute pertussis infection are:

• Bordetella pertussis Nasopharyngeal swab

Note: these swabs are different from other NPS swabs

Refer to Public Health Ontario Laboratory (PHOL) Test Information Index:

• Complete all fields of the requisition form as indicated on the Bordetella – Respiratory webpage (external link).
• Use a PHOL requisition (external PDF)
• Send specimens directly to the Central Public Health Lab in Toronto (external link).
• STAT testing is not available but if urgent testing is required (i.e. critical samples) Contact the Ontario Public Health Laboratory Customer Service: 1-877-604-4567 to ensure the sample is on the next available run.

All suspected cases of mumps should be reported immediately to Halton Region Public Health at 905-825-6000 (or toll-free at 1-866-442-5866) or dial 311 if calling within Halton Region.

Whenever possible, suspect mumps patients should be placed in a separate room upon arrival. Only health care workers with documented immunity to mumps should assess the patient.

Isolation

Advise the patient to self-isolate at home for five days from the onset of symptoms and to expect a call from Halton Region Public Health.

A mask should be worn if the person requires being in public (e.g. lab or clinic appointments)

Testing to confirm mumps infection

Recommended specimens for acute mumps infection are:

• Buccal swab *preferred* (within nine days from symptom onset) or Throat swab (within nine days from symptom onset)
  AND
• Urine (within 14 days following symptom onset)
• Serology (IgG and IgM)

Refer to Public Health Ontario Laboratory (PHOL) Test Information Index:

• Complete all fields of the requisition form as indicated on the following webpages
  • Mumps – Diagnostic – PCR (external link)
  • Mumps – Serology (external link)
• Use a PHOL requisition (external PDF)
• Contact the Ontario Public Health Laboratory Customer Service at 1-877-604-4567 prior to submitting samples for mumps PCR testing. This will facilitate testing planning and prioritization.
• Follow PHOL’s direction for sending specimens directly to the Central Public Health Lab in Toronto (external link) and marking the specimens as STAT, if applicable.

All suspected cases of measles should be reported immediately to Halton Region Public Health at 905-825-6000 (or toll-free at 1-866-442-5866) or dial 311 if calling within Halton Region.

Important: Whenever possible, suspect measles patients should promptly be isolated in a single room with negative air flow (airborne isolation room). Suspect measles patients should be assessed at the end of day and placed in a separate room upon arrival to minimize contact with other patients. Only health care workers with documented immunity to measles should assess the patient (scroll below for more IPAC Measures).

Signs and symptoms

Symptoms can appear 7 to 21 days after contact with someone who has the measles virus.

Measles symptoms include:

• fever
• cough
• runny nose
• red eyes
• sleepiness
• irritability
• small, white spots on the inside of the mouth (Koplik Spots)
• a red blotchy rash that first starts on the face and spreads down the body, arms, and legs (this rash can last 4 to 7 days)

Isolation

Advise the patient to self-isolate until 4 days after rash onset or until negative test results are available, whichever comes first.

Testing to confirm measles infection

Recommended specimens for acute measles infection are:

• Nasopharyngeal or throat swab PCR using Viral Transport Media (within seven days of rash onset)
  AND
• Urine PCR (within 14 days of rash onset)

Refer to Public Health Ontario Laboratory (PHOL) Test Information Index:

• Measles – Diagnostic – PCR (external link)

Note: serology testing is not recommended for diagnosing acute infection but can be done to determine immune status. Refer to PHOL Measles – Serology for details (external link).

• Use a PHOL requisition (external PDF)
• Complete all fields of the requisition form as indicated on the Measles – Diagnostic – PCR webpage (external link). Must also include travel history and vaccination status on requisition.
• Priority specimens for measles testing must be packaged separately from routine specimens. To assist with laboratory workflow and to identify priority specimens,  specimens must be marked “STAT” on the outside of the package. Call Halton Region Public Health to determine if it is possible to help facilitate transport of samples to PHOL.
• Ensure your office has unexpired testing specimen container/supplies available for testing. Kits can be ordered from PHOL (external PDF).

Infection prevention and control

In addition to routine practices, airborne precautions should be used for patients with a known or suspected case of having measles.

In a clinical office setting, follow the Provincial Infectious Diseases Advisory Committee’s (PIDAC) Infection Prevention and Control for the Clinical Office Practice (external PDF):

• Make an effort to see the patient at the end of the day, if possible.
• Suspect measles patients should be assessed at the end of day and placed in a separate room upon arrival.
• Only health care workers with documented immunity to measles should assess the patient.
• All health care workers, regardless of presumptive immunity to measles must wear a fit-tested, seal-checked N95 respirator when providing care to a patient with suspect or confirmed measles.
• Triage the patient out of the waiting area as quickly as possible. The patient should enter and exit through a separate access point and go directly into and out of the examination room.
• Provide a surgical mask for the patient to wear at all times while in all areas of the office.
• Keep the examination room door closed and open a window in the room if possible.
• After patient assessment, do not use the exam room until at least 2 hours have elapsed.

In an acute care setting, isolate the suspected measles case in a single room with negative air flow and keep the door closed.