Measles & Rubella Weekly Monitoring Report – Week 34: August 18 to August 24, 2019

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Epidemiological Summary:

During epidemiological week 34, 2019 nineteen new confirmed cases of measles and no new cases of rubella were reported in CanadaFootnote 2. All cases were reported by the province of Quebec. One case was a close contact of a previously reported case and had rash onset in week 34. The remaining 18 cases were identified retrospectively as a result of public health investigation within the community where previous cases had occurred. The dates of rash onset have not been reported at this time for these cases, and therefore not included in Figures 1 and 2. Given the current information available for these cases, it is estimated that they developed illness between epidemiological weeks 27 to 31 (or June 30 to August 3) and are all related to an ongoing outbreak.

To date in 2019, 107 cases of measles and no cases of rubella have been reported. The last case of rubella was reported in 2016 and the last case of congenital rubella syndrome/infection was reported in September 2018.

Figure 1: Number of cases of measles (n=107), rubella (n=0), and congenital rubella syndrome Footnote 3 by week of rash onset, as reported to the Canadian Measles/Rubella Surveillance System (CMRSS) and Measles and Rubella Surveillance System (MARS), for the period ending August 24, 2019. Footnote † Figure 1 - Text Equivalent Figure 1: Number of cases of measles (n=107), rubella (n=0), and congenital rubella syndrome Footnote 3 by week of rash onset, as reported to the Canadian Measles/Rubella Surveillance System (CMRSS) and Measles and Rubella Surveillance System (MARS), for the period ending August 24, 2019. Epidemiological Week of Rash Onset, 2019 Number of confirmed measles cases reported Number of confirmed rubella cases reported Number of confirmed congenital rubella syndrome/infection cases reported 1 0 0 0 2 1 0 0 3 0 0 0 4 1 0 0 5 5 0 0 6 2 0 0 7 3 0 0 8 6 0 0 9 4 0 0 10 5 0 0 11 2 0 0 12 2 0 0 13 6 0 0 14 4 0 0 15 3 0 0 16 0 0 0 17 2 0 0 18 2 0 0 19 4 0 0 20 3 0 0 21 7 0 0 22 6 0 0 23 0 0 0 24 3 0 0 25 2 0 0 26 3 0 0 27 1 0 0 28 5 0 0 29 1 0 0 30 1 0 0 31 0 0 0 32 4 0 0 33 0 0 0 34 1 0 0 Cases (year-to-date) 107 0 0 Footnote 1 Note: 18 cases not shown due to missing date of rash onset. These cases likely occurred between epidemiological weeks 27 to 31. Return to footnote † referrer

Geographic Distribution

There are currently four active Footnote * cases of measles reported in Canada.

Figure 2: Distribution of active Footnote *, confirmed measles cases by health region. Figure 2 - Text Equivalent Figure 2: Distribution of active Footnote *, confirmed measles cases by health region. Health Region Measles Active Cases Eastern Regional Integrated Health Authority 0 Central Regional Integrated Health Authority 0 Western Regional Integrated Health Authority 0 Labrador-Grenfell Regional Integrated Health Authority 0 Prince Edward Island 0 South Shore District Health Authority 0 South West Nova District Health Authority 0 Annapolis Valley District Health Authority 0 Colchester East Hants Health Authority 0 Cumberland Health Authority 0 Pictou County Health Authority 0 Guysborough Antigonish Strait Health Authority 0 Cape Breton District Health Authority 0 Capital District Health Authority 0 Zone 1 (NB) 0 Zone 2 (NB) 0 Zone 3 (NB) 0 Zone 4 (NB) 0 Zone 5 (NB) 0 Zone 6 (NB) 0 Zone 7 (NB) 0 Québec et Chaudières-Appalaches 0 Centre-du-Québec 0 Montréal et Laval 1 Ouest-du-Québec 3 Montérégie 0 Nord-Est 0 Ontario Central East 0 Ontario Central West 0 Ontario Eastern 0 Ontario North East 0 Ontario North West 0 Ontario South West 0 City of Toronto Health Unit 0 Winnipeg Regional Health Authority 0 Prairie Mountain Health 0 Interlake-Eastern Regional Health Authority 0 Northern Regional Health Authority 0 Southern Health 0 Saskatchewan South 0 Saskatchewan Central 0 Saskatchewan North 0 South Zone 0 Calgary Zone 0 Central Zone 0 Edmonton Zone 0 North Zone 0 British Columbia 0 Yukon 0 Northwest Territories 0 Nunavut 0

Footnote 6 Active cases or outbreaks are those in which the onset date of the most recent case/outbreak-associated case falls within 32 days of the issue date of this report Footnote 4. Return to footnote * referrer

Laboratory Summary

Measles

In 2019, seventy (70) cases of measles have been genotyped and the genotypes were B3 (n=18) and D8 (n=52), both of which are circulating globally.

Figure 3: Distribution of measles genotypes detected in 2019 (n=70) by week Footnote † of rash onset. Figure 3 - Text Equivalent Figure 3: Distribution of measles genotypes detected in 2019 (n=70) by week Footnote † of rash onset. Epi week B3 B3 - Harare D4 D8 D8 - Taunton D9 H1 Total 1 0 0 0 0 0 0 0 0 2 1 0 0 0 0 0 0 1 3 0 0 0 0 0 0 0 0 4 0 0 0 1 0 0 0 1 5 1 0 0 2 0 0 0 3 6 0 0 0 2 0 0 0 2 7 1 0 0 2 0 0 0 3 8 3 0 0 3 0 0 0 6 9 2 0 0 2 0 0 0 4 10 0 0 0 2 0 0 0 2 11 0 0 0 1 0 0 0 1 12 1 0 0 1 0 0 0 2 13 2 0 0 4 0 0 0 6 14 0 0 0 3 0 0 0 3 15 1 0 0 2 0 0 0 3 16 0 0 0 0 0 0 0 0 17 0 0 0 2 0 0 0 2 18 2 0 0 0 0 0 0 2 19 1 0 0 2 0 0 0 3 20 0 0 0 2 0 0 0 2 21 0 0 0 5 0 0 0 5 22 0 0 0 5 0 0 0 5 23 0 0 0 0 0 0 0 0 24 0 0 0 3 0 0 0 3 25 1 0 0 1 0 0 0 2 26 0 0 0 3 0 0 0 3 27 1 0 0 0 0 0 0 1 28 0 0 0 0 0 0 0 0 29 0 0 0 0 0 0 0 0 30 1 0 0 0 0 0 0 1 31 0 0 0 0 0 0 0 0 32 0 0 0 4 0 0 0 4 33 0 0 0 0 0 0 0 0 34 0 0 0 0 0 0 0 0 Total 18 0 0 52 0 0 0 70 Footnote 5 Epidemiological weeks for laboratory specimens submitted to the National Microbiology Laboratory are assigned and reported in accordance with WHO guidelines (WHO.WER.2012;9(87):73) with week 1 beginning on the first Monday of the year, which for 2019 is January 7. However, for the purposes of this report, the genotype data is presented in accordance with PAHO reporting weeks with week 1 of 2019 beginning on December 30, 2018). Return to footnote † referrer

The current global distribution of measles genotypes can be found on the WHO Measles Surveillance website.

For information regarding the interpretation and use of measles genotyping (including a discussion of genotypes and named strains), refer to Hiebert J and Severini A. Canada Communicable Disease Report. 2014; 40-12: 257- 260.