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Health Professionals Update – Vol. 18, No. 11

May 9, 2025

From: 
Monica Hau, MD, MSc, CCFP, FRCPC 
Associate Medical Officer of Health

In this issue:

  • Update: Measles immunization recommendations
  • Reminder: Meningococcal vaccine requirements for entry to Saudi Arabia for Hajj and Umrah
  • Considerations for returning travelers with possible travel-related illness, including invasive meningococcal disease and reporting requirements

Key messages:

  • The Chief Medical Officer of Health (CMOH) has updated measles immunization recommendations for individuals at higher risk of exposure in regions of Ontario experiencing outbreaks.
  • The World Health Organization (WHO) is reporting cases of invasive meningococcal disease (IMD) associated with travel to the Kingdom of Saudi Arabia.
  • Proof of quadrivalent meningococcal vaccination is required for entry to Saudi Arabia for Hajj and Umrah.
  • Men-C-ACYW is not publicly funded in Ontario for travel purposes.
  • When assessing a patient with a possible travel-related illness, including invasive meningococcal disease, consider both their symptoms and travel-related risk factors.
  • Diseases of public health significance must be reported to Peel Public Health.

Update: Measles immunization recommendations

The Chief Medical Officer of Health (CMOH) of Ontario has updated its immunization recommendations for individuals at higher risk of measles exposure in regions currently experiencing outbreaks.

These recommendations apply to individuals who live, work, travel (e.g., family visit), worship, or spend time in the following health units: Chatham-Kent, Grey Bruce, Lambton, Middlesex-London, Waterloo, Wellington-Dufferin-Guelph, Windsor-Essex, Southwestern, Grand Erie and Huron Perth.

  • Infants (six to 11 months): should receive one dose of the measles, mumps, rubella (MMR) vaccine. Two additional doses continue to be recommended after the age of one year.
  • Children (one to four years): who have received their first dose of measles-containing vaccine are encouraged to receive a second dose as soon as possible (at a minimum of four weeks from the first dose).
  • Adults (18+ years) born on or after 1970: a second dose of MMR vaccine is recommended.

Peel Public Health recommends that health care providers continue to follow all measles prevention and preparedness recommendations outlined in the February 19, 2025: Vol. 18, No. 6 Health Professionals Update and the CMOH's updated immunization recommendations.

Reminder: Meningococcal vaccine requirements for entry to Saudi Arabia for Hajj and Umrah

The Public Health Agency of Canada (PHAC) is currently monitoring reports from the World Health Organization (WHO) of cases of invasive meningococcal disease (IMD) associated with travel to the Kingdom of Saudi Arabia.

The annual Hajj pilgrimage to Mecca, Saudi Arabia, is among the largest mass gatherings in the world. This year, Hajj will take place between June 4 to 9, 2025. Umrah, a separate pilgrimage, may be performed at any time throughout the year.

Quadrivalent meningococcal vaccination (Men-C-ACYW or Men-P-ACYW) is required for pilgrims to the Hajj and Umrah in Mecca. Hajj and Umrah visas cannot be issued without a valid proof of vaccination. Only Men-C-ACYW (Nimenrix®, Menactra® and Menveo) are currently distributed in Canada. Men-C-ACYW must have been administered within the last 5 years and at least 10 days prior to arrival.

Men-C-ACYW eligibility

The following individuals are eligible for publicly funded Men-C-ACYW:

Primary care providers can order vaccine for eligible adults on the Health Professionals Portal.

NOTE: Men-C-ACYW is not publicly funded in Ontario for the purpose of travel.

Actions for health care providers

  • Assess all travellers 6 weeks of age and older going to Saudi Arabia if they or their family will be participating in the Hajj or Umrah for appropriate quadrivalent conjugate meningococcal vaccination or other routine vaccinations.
  • Ensure that eligible patients are current with their routine immunizations (measles, mumps, rubella, tetanus, diphtheria, pertussis, polio and varicella) prior to travel as per the Publicly Funded Immunization Schedules for Ontario.

Considerations for returning travelers with possible travel-related illness, including invasive meningococcal disease and reporting requirements

Mass gatherings may increase the risk of transmission of various communicable diseases, such as invasive meningococcal disease, measles, COVID-19 and influenza. When assessing a patient with a possible travel-related illness, approach the differential diagnosis by incorporating both the patient presentation and risk factors related to travel (e.g., destination, travel duration, and exposures). Details about the timing of illness, vaccinations, travel history, exposures, and any existing health conditions can help make a more accurate diagnosis.

Invasive meningococcal disease can develop 2 to 10 days after being infected with the bacteria (usually after 3 to 4 days). The two most common presentations are meningococcal meningitis and meningococcal sepsis or meningococcemia. Droplet precautions should be used in addition to routine infection prevention and control practices when assessing a patient with suspect invasive meningococcal disease. More details including clinical presentation and testing can be found on the Public Health Agency of Canada (PHAC) website.

Additional information related to returning travelers can be found in the CDC Yellow Book.

Reporting requirements

Diseases of public health significance, including suspect or confirmed cases of invasive meningococcal disease, must be reported to Peel Public Health by phone at 905-799-7700, 1-888-919-7800 (toll-free) or send lab results by fax to 289-801-0257.

Contact us

The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic. 

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