Measles is a highly communicable infectious disease, with 90% of susceptible contacts (those who have not had measles or are unimmunized) becoming infected after exposure to a person with measles. Serious complications include blindness, encephalitis, and pneumonia. Treatment is limited; however, measles is largely preventable through immunization, with efficacy approaching 100% after two doses of measles-containing vaccine. Although vaccination programs have eliminated endemic measles (i.e., measles circulating within the country) in Canada, outbreaks occur due to foreign travel and pools of unimmunized Canadians. Public health interventions to reduce the secondary spread of measles are vaccination of susceptible contacts; human immunoglobulin (Ig) for susceptible contacts; quarantine of susceptible contacts; isolation of active measles cases; and special vaccination clinics or activities during outbreaks to increase population immunization coverage. The objective of this study is to inform the development of a Canadian public health intervention strategy by systematically reviewing the clinical evidence on the effectiveness of these five public health interventions in reducing the secondary spread of measles during an outbreak in a population similar to Canada that has achieved elimination of endemic measles.

Contents

• ACRONYMS AND ABBREVIATIONS
• EXECUTIVE SUMMARY
• 1. CONTEXT AND POLICY ISSUES
• 2. RESEARCH QUESTIONS
• 3. KEY FINDINGS
• 4. METHODS
  • 4.1 Literature Search Strategy
  • 4.2 Selection Criteria and Methods
  • 4.3 Exclusion Criteria
  • 4.4 Data Extraction Strategy
  • 4.5 Critical Appraisal of Individual Studies
  • 4.6 Subgroup Analyses
• 5. RESULTS
  • 5.1 Quantity of Research Available
  • 5.2 Study Characteristics
  • 5.3 Critical Appraisal of Individual Studies
  • 5.4 Data Analyses and Synthesis
• 6. DISCUSSION
  • 6.1 Summary of Evidence
  • 6.2 Limitations
• 7. CONCLUSIONS AND IMPLICATIONS FOR DECISION- OR POLICY-MAKING
• REFERENCES
• APPENDIX 1 DEFINITIONS
• APPENDIX 2 LITERATURE SEARCH STRATEGY
• APPENDIX 3 SELECTION OF INCLUDED STUDIES
• APPENDIX 4 INCLUDED STUDIES FOR CLINICAL EVIDENCE
• APPENDIX 5 EXCLUDED STUDIES FOR CLINICAL EVIDENCE (AND REASONS)
• APPENDIX 6 CLINICAL EVIDENCE — STUDY CHARACTERISTICS
• APPENDIX 7 CLINICAL EVIDENCE — CRITICAL APPRAISAL OF STUDIES
• APPENDIX 8 CLINICAL EVIDENCE — STUDY RESULTS

About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs, medical devices, diagnostics, and procedures in our health care system.

Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. Views: The views expressed herein are those of CADTH and do not necessarily reflect the views of our funders.

Suggested citation:

Foerster V, Perras C, Spry C, Weeks L. Public health interventions to reduce the secondary spread of measles [Internet]. Ottawa: CADTH; 2015 May. (CADTH rapid response report: systematic review). [cited YYYY - MM - DD]. Available from: https://www.cadth.ca/public-health-interventions-reduce-secondary-spread-measles

Disclaimer: This report is a review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) that are available to CADTH. The accuracy of the contents of the source documentation on which this report is based is not warranted, assured, or represented in any way by CADTH, and CADTH does not assume responsibility for the quality, propriety, inaccuracies, or reasonableness of any statements, information, or conclusions contained in the source documentation.

CADTH takes sole responsibility for the final form and content of this report. The statements and conclusions in this report are those of CADTH and not of reviewers.

This document is prepared by the Rapid Response Service, an information service of the Canadian Agency for Drugs and Technologies in Health. The service is provided to those involved in planning and providing health care in Canada. This Rapid response is based on a comprehensive and systematic search of the literature available to CADTH at the time of preparation. The intent is to provide a systematic review of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. This response has been peer-reviewed by content experts. The information in this document is intended to help Canadian health care decision-makers make well-informed decisions and thereby improve the quality of health care services. Rapid responses should be considered along with other types of information and health care considerations. This report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process, or as a substitute for professional medical advice. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness, particularly in the case of new and emerging health technologies for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation or the document to ensure that its contents are accurate, complete, and up to date as of the date of the date of publication, CADTH does not make any guarantee to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.