---
title: "Wastewater Surveillance for Measles Virus: Ontario 2025 Outbreak Insights"
id: "cdc-emerging-infectious-diseases-journal-0-wastewater-surveillance-to-track-resurgent-measles-outbreak-ontario-canada-2025"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-0-wastewater-surveillance-to-track-resurgent-measles-outbreak-ontario-canada-2025"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article"
published_at: "2026-09-22T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Wastewater Surveillance for Measles Virus: Ontario 2025 Outbreak Insights
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-0-wastewater-surveillance-to-track-resurgent-measles-outbreak-ontario-canada-2025
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article)
- **Published At:** 2026-09-22T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- Ontario experienced a major measles resurgence in 2025 with approximately **2,400 confirmed cases** in the province and 5,461 cases nationwide; Canada lost measles elimination status in November 2025 after 12 months of sustained transmission. - Investigators ran concurrent clinical surveillance and **wastewater surveillance (WS)** in southwestern Ontario (Leamington Pollution Control Centre, LPCC) February–November 2025 to track measles virus (**MeV**) circulation. - Composite 24-hour wastewater samples were collected three times weekly from a WWTP serving ≈30,000 people; passive samplers (tampons) were deployed 1–2 times/week to monitor sewer laterals draining Windsor Regional Hospital. - Laboratory workflow included concentration (filtration or affinity capture for influent; centrifugation for hospital effluent), nucleic acid extraction, and qRT-PCR targeting the MeV nucleoprotein (N) gene; sequencing validated N gene amplicon identity. - MeV signal in wastewater correlated positively with clinical case counts when analyzed by epidemiologic week but did not provide an earlier alert of incidence change at that temporal resolution. - Partitioning experiments on a 4-L postgrit LPCC sample showed MeV RNA was broadly distributed across liquid and solid phases but was most concentrated in the **solids** fraction; partitioning calculations used whole-sample, equal-mass, and operational-volume bases. - A multiplex assay adapted to differentiate **vaccine genotype** and wild-type MeV was applied; vaccine-genotype MeV was detected in wastewater following a targeted vaccination campaign for underserved groups. - Investigators estimated MeV shedding into wastewater by sampling sewer laterals from a hospital treating measles patients; exact shedding estimates and some assay details were not fully reported in the provided source excerpt. - This outbreak served as a real-world case study for WS method development for measles, highlighting strengths (population-level coverage, detection of vaccine strains) and challenges (shedding dynamics, partitioning, sensitivity, sewershed proximity).
## Clinical Analysis & Structured Key Points
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[EID Journal](https://wwwnc.cdc.gov/eid/) 2. [Volume 32](https://wwwnc.cdc.gov/eid/early-release) 3. [Early Release](https://wwwnc.cdc.gov/eid/early-release#issue-1346) 4. [Main Article](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article) * [Facebook](https://www.facebook.com/sharer/sharer.php?u=%2Feid%2Farticle%2F32%2F10%2F26-0092_article "Share to Facebook") * [Twitter](http://twitter.com/share?url=%2Feid%2Farticle%2F32%2F10%2F26-0092_article&text= "Share to Twitter") * [LinkedIn](https://www.linkedin.com/shareArticle?url=%2Feid%2Farticle%2F32%2F10%2F26-0092_article&title= "Share to LinkedIn") * [Syndicate](https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent//eid/article/32/10/26-0092_article "Embed this Page") [ Emerging Infectious Disease journal ISSN: 1080-6059 ](https://wwwnc.cdc.gov/eid/) _Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 10—October 2026 ##### _Research_ ### Wastewater Surveillance to Track Resurgent Measles Outbreak, Ontario, Canada, 2025 On This Page [Methods](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article) * * * [Results ](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article) * * * [Discussion ](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article) * * * [Suggested Citation](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article) Figures [Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f1) * * * [Figure 2](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f2) * * * [Figure 3](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f3) * * * [Figure 4](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f4) * * * [Figure 5](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f5) Tables [Table](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-t1) Downloads [Appendix ](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-app1.pdf) * * * [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/10/26-0092.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article) Related Articles [_Acanthamoeba_ and Chronic Lymphocytic Leukemia](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article) * * * [_Mycobacterium abscessus_ in Hospital, Maryland](https://wwwnc.cdc.gov/eid/article/32/9/26-0093_article) * * * [Amebic Meningoencephalitis, Kerala, India, 2025](https://wwwnc.cdc.gov/eid/article/32/9/26-0492_article) * * * [More articles on water](https://wwwnc.cdc.gov/eid/spotlight/water) Ryland Corchis-Scott[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#comment) , Élisabeth Mercier, Edgard M. Mejia, Qiudi Geng, Ethan Harrop, Ana Podadera, Jackie Fong, Natalie Lewoc, Kenneth K.S. Ng, Nataliya Santiago, Natalie Knox, Lawrence Goodridge, Chand S. Mangat, Chrystal Landgraff, Karen B. Riddell, Mehdi Aloosh, Robert Delatolla, and R. Michael McKay Author affiliation: University of Windsor, Windsor, Ontario, Canada (R. Corchis-Scott, Q. Geng, E. Harrop, A. Podadera, J. Fong, K.K.S. Ng, R.M. McKay); University of Ottawa, Ottawa, Ontario, Canada (É. Mercier, R. Delatolla); National Microbiology Laboratory, Winnipeg, Manitoba, Canada (E.M. Mejia, N. Santiago, N. Knox, C.S. Mangat, C. Landgraff); Windsor Essex County Health Unit, Windsor (N. Lewoc, M. Aloosh); University of Guelph, Guelph, Ontario, Canada (L. Goodridge); Windsor Regional Hospital, Windsor (K.B. Riddell); McMaster University, Hamilton, Ontario, Canada (M. Aloosh) [Suggested citation for this article](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#suggestedcitation) ### Abstract The province of Ontario, Canada, experienced a major resurgent outbreak of measles in 2025. We conducted wastewater surveillance concurrently with clinical-based surveillance to track measles incidence in southwestern Ontario, adjacent to the United States. Measles virus (MeV) signal in wastewater was positively associated with clinical cases but did not provide early alert of changes in measles incidence when resolved by epidemiologic week. Assessment of virus partitioning showed MeV RNA was broadly distributed in the liquid phase but is most concentrated in the solids. We adapted an assay for differentiation of vaccine and wild-type MeV and used it to detect vaccine genotype measles after a vaccination campaign targeting underserved groups. We estimated MeV shedding in wastewater through sampling of sewer laterals serving a hospital treating measles infections. This outbreak is a case study in which we highlighted the use of wastewater surveillance for measles while supporting method development in real time. Wastewater surveillance (WS) gained traction during the COVID-19 pandemic as an effective and unbiased means to track community infection complementary to clinical testing. Sampling a wastewater treatment plant (WWTP) or locations within a sewershed revealed infection hotspots and tracked genetic variants ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r1 "1")). Wastewater yielded high-quality whole-genome SARS-CoV-2 sequence data ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r2 "2")); it is a resource for tracking disease spread and a complement to clinical data to identify disease burden and routes of pathogen transmission ([_3_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r3 "3"),[_4_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r4 "4")). WS has extended to additional targets, including respiratory diseases ([_5_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r5 "5")), foodborne illness ([_6_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r6 "6")), and diseases of emerging concern, such as mpox and highly pathogenic avian influenza ([_7_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r7 "7")–[ _9_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r9 "9")). Public health officials warned of the increased potential for outbreaks of vaccine-preventable diseases ([_10_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r10 "10")). COVID-19 pandemic–associated disruptions and vaccine misinformation affected immunization campaigns, including measles vaccination programs ([_11_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r11 "11")). In 2025, Ontario experienced a large outbreak of measles; ≈2,400 confirmed cases were reported. Total cases nationwide reached 5,461 in 2025, positioning Canada as a hotspot for measles in North America ([_12_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r12 "12")). In November 2025, after 12 months of sustained transmission, Canada lost measles elimination status ([_13_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r13 "13")), a designation attained in 1998 ([_14_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r14 "14")). The 2025 outbreak of measles in Canada likely resulted from reduced vaccination coverage ([_15_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r15 "15")) and was the largest outbreak in 3 decades, overwhelming public health services, especially in southwestern Ontario, which experienced the highest caseload ([_16_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r16 "16")). Concurrent outbreaks in the US Southwest ([_17_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r17 "17")) and in Alberta, Canada ([_18_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r18 "18")), have raised interest in WS to complement clinical testing ([_19_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r19 "19")). WS accounts for community members who might be hesitant to seek medical care ([_20_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r20 "20")); that characteristic is relevant to measles, considering most cases in North America have been linked to close-knit undervaccinated communities ([_21_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r21 "21"),[_22_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r22 "22")). Studies since 2025 have highlighted the application of WS to track measles at a community level ([_23_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r23 "23")–[ _26_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r26 "26")) and assays that differentiate between wild-type virus and vaccine genotypes ([_20_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r20 "20"),[_27_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r27 "27")). Despite early successes, many challenges persist to broader and more actionable adoption, including the clinical dynamics of viral shedding, viral partitioning within wastewater, and detection sensitivity ([_21_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r21 "21")), as well as the proximity of cases to monitored sewersheds. Here, we present a case study from a rural border municipality in southwestern Ontario demonstrating the application of WS for MeV during a measles outbreak. The outbreak persisted for >9 months, affording an opportunity for WS method development and enabling investigation to produce insights on MeV partitioning and on rates of viral shedding in wastewater. Our investigation used the outbreak as an opportunity to determine the feasibility of WS for MeV in a semirural setting and to help address challenges to its implementation. ### Methods ##### Sample Collection As part of an ongoing WS program, we collected composite wastewater samples over 24-hour periods, 3 per week, from the Leamington Pollution Control Centre (LPCC) in the Windsor-Essex region of Ontario, Canada, during February–November 2025. The LPCC serves the urban center of Leamington and accepts septage from residential septic tanks and frequently emptied storage tanks serving congregate living facilities in the rural area (≈30,000 total population served). We monitored sewer laterals draining Windsor Regional Hospital (WRH) using passive samplers (tampons) deployed 1–2 times/week. Passive samplers were submerged in the hospital effluent stream for 17–24 hours; at collection, they were transported to the laboratory for immediate processing ([_28_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r28 "28")). ##### Sample Processing for MeV Monitoring We concentrated wastewater influent samples by filtration or affinity capture methods, and hospital effluent samples by centrifugation. After concentration, we extracted total nucleic acids and measured viral concentrations with quantitative reverse transcription PCR (qRT-PCR). We used an assay targeting the MeV nucleoprotein (N) gene for measles quantification ([Appendix](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-app1.pdf) Table 1). We used a separate assay to measure pepper mild mottle virus in samples ([_28_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r28 "28")). We conducted sequencing to validate the identity of the amplicons obtained from the N gene of MeV ([Appendix](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-app1.pdf)). ##### Partitioning of Endogenous MeV in Wastewater Figure 1 ![Schematic overview of wastewater processing in study of the utility of wastewater surveillance to track a resurgent outbreak of measles, Ontario, Canada, 2025. Sample processing and fractionation protocol were used to partition endogenous measles virus into solids, colloids, and supernatant fractions using Amicon Ultra 10K filters \(Sigma Aldrich, https://www.sigmaaldrich.com\) in wastewater collected from Leamington, Ontario, Canada.](https://wwwnc.cdc.gov/eid/images/26-0092-F1-tn.jpg) [Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f1 "Figure 1"). Schematic overview of wastewater processing in study of the utility of wastewater surveillance to track a resurgent outbreak of measles, Ontario, Canada, 2025. Sample processing and fractionation protocol were used... To determine the partitioning of endogenous MeV in wastewater, we processed a 4-L postgrit wastewater sample collected from LPCC to derive fractions of solids, colloids, and supernatant ([Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-f1)). We performed partitioning calculations using 3 different assumptions: whole-sample basis, which considered wastewater composition; equal-mass basis; and operational volume basis, which reflects processing volumes commonly used in laboratory workflows ([Appendix](https://wwwnc.cdc.gov/eid/article/32/10/26-0092-app1.pdf)). ##### Detection of Vaccine Genotype MeV We shipped raw influent samples weekly to the National Microbiology Laboratory (Winnipeg, MN, Canada) for additional analysis. Samples were processed as described previously ([_29_](https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article#r29 "29")), with minor modifications. To measure MeV wild-type and vaccine genotypes in wastewater, we used a multiplex assay developed for clinical detecti
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