Toronto Public Health says two people confirmed to have measles in the city were not fully vaccinated but not "necessarily anti-vaccine."

Dr. Vinita Dubey, associate medical officer of health, says two new cases announced on Monday bring the total number of confirmed cases in Toronto this year to five. That total matches the annual average of measles cases in the city over the last five years.

Dubey said she expects the city to surpass its annual average by the end of the year, which means it will have more than five cases in all, and she is urging people to check their immunization records to find out if their vaccinations are up-to-date.

"Toronto is a microcosm of what is going on around the world. And measles is spreading like wildfire in other places. A lot of people in Toronto travel. We can expect to see more cases this year," Dubey told CBC Radio's Metro Morning on Tuesday.

What public health officials want to do, she said, is "prevent the outbreak, to prevent continuous spread within the city from occurring."

Dr. Vinita Dubey, associate medical officer of health, says: 'There are many adults who were born between 1970 and 1992, many newcomer adults as well, who are not necessarily up-to-date on their vaccinations just because they haven't necessarily gone to their doctor and checked. Two doses provides the best protection.' (CBC)

Dubey said the largest risk of contracting the disease comes from international travel. If you are going anywhere, make sure you are up-to-date, she added.

"This is an extremely contagious illness," she said. "There are many adults who were born between 1970 and 1992, many newcomer adults as well, who are not necessarily up-to-date on their vaccinations just because they haven't necessarily gone to their doctor and checked. Two doses provides the best protection."

Toronto Public Health says people who are unsure if their vaccinations are up-to-date should check with their doctors. Two doses are recommended for people born after 1969. But in general, those born before 1970 are considered protected against measles, TPH said Monday in a news release.

TPH compiles 'detailed history' once disease confirmed

Dubey said once the two most recent cases were confirmed through laboratory testing, Toronto Public Health did what it calls "case and contact followup."

That means it interviewed the two people with the disease to find out where they went in the four days before they developed the rash and in the four days after. Officials want to determine who may have been exposed to the disease.

Then the agency compiled a list of places they went, she said.

"We get a very detailed history on everywhere they went to make sure that, every location they went to, we notify people to let them know they may have been exposed to the measles," she said.

Toronto Public Health officials say members of the public may have been exposed to measles in several places early in May after two new cases were confirmed on Monday.

After that, officials determined where the two people themselves contracted the disease. One picked it up in North America where the virus is circulating, while the other contracted it in Southeast Asia.

Both people, who were born after 1969, went to their doctors who tested them for the disease. Toronto Public Health was notified about the cases on Friday and on the weekend. Then it issued a public notification on Monday.

Members of households of infected people can be contacted

As part of its investigation, Toronto Public Health can contact members of the household of the infected person and ask them if they are up-to-date with their vaccinations and to tell them to watch for symptoms. If they work in a school or health-care setting, they can be prevented from going to work until the agency can confirm they are immune.

If the agency can reach people within 72 hours of them possibly being exposed, they can be given a vaccination.

The agency said anyone who has not had two doses of a measles vaccine, known as MMR or MMRV, or who has not had measles in the past, is at risk of infection. Infants under one year of age, pregnant women and people with weakened immune systems can get very ill with measles, it said.

Symptoms include a high fever, cold-like symptoms, such as cough and a runny nose, sore eyes or sensitivity to light and a red rash lasting from four to seven days.

Public warned of possible exposure at several locations

In its warning, Toronto Public Health said that members of the public may have been exposed to the measles virus in several locations on May 5 and May 8.

Those locations include Toronto's Pearson International Airport,Terminal 1, between 6 p.m. and 10:30 p.m. on May 5, and between 5 p.m. and 7:30 p.m. on May 8.

Passengers on two Air Canada flights might also have been exposed to the virus — AC848 that left Toronto at 8:40 p.m. on May 5 and arrived at London's Heathrow airport at 8:35 a.m. on May 6, as well as AC849 from London Heathrow arriving in Toronto at 5 p.m. on May 8.

Other locations include Remely's Restaurant in north Toronto between 10 a.m. and 7 p.m. on May 5, and the Toronto Zoo between 1:30 p.m. and 5 p.m. on May 8.