“We don’t really know the number of secondary cases yet. Hopefully it’s small.”
By the time the blotchy red rash appears from the ears and the face to the trunk and arms and legs —three to seven days after the fever starts — containing measles is an important afterthought.
There is no treatment for the airborne disease. Just prevention. But now some unimmunized Edmontonians are at risk after a child came through the international arrivals gate at Edmonton International Airport on April 16.
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It’s the second such case in six months.
Also known as rubeola, these days measles is typically imported by an unimmunized traveller who, thinking they just have a cold, unwittingly can spread the virus to other unimmunized people around them.
Who can then spread it further.
It can take up to two weeks to fully engage in an affected individual.
In the early stages, cold-like symptoms make a body miserable: high fever, cough, runny nose, red eyes.
“Measles can easily be missed, unfortunately, because by the time the rash comes out, there might have been at least a few to several days of being potentially infectious before it’s recognizable,” said Dr. Lynora Saxinger, a virologist at the University of Alberta.
Those at highest risk include the very young, pregnant women, and immune-compromised individuals, many of whom can’t be immunized and so are protected only by the herd immunity of those around them.
Alberta Health Services (AHS) said one in 10 measles cases results in middle ear or lung infections.
One in a thousand sufferers contract encephalitis, which can lead to seizures, deafness or brain damage.
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Two to three of every thousand measles patients will die.
In 1963, prior to widespread immunization, there were 60,000 cases of measles in Canada, so there could have been up to 180 deaths.
There is also the extremely rare and fatal subacute sclerosing panencephalitis (SSPE), which can suddenly attack years after measles first strikes.
Ask Dr. Joan Robinson, an Edmonton pediatric infectious diseases physician at the Stollery Children’s Hospital, one of the doctors who has seen the deadly side effect up close.
“It’s a very severe complication that is always lethal. Now it’s incredibly rare but it can happen years after you had the measles,” she said.
Robinson’s reluctant to talk about SSPE because it’s so unusual. “I’ve only seen one case of SSPE in my life,” she said.
In that case, it was an unimmunized boy who travelled from the Philippines and had measles earlier in his life.
Stricken years later by the measles aftermath of SSPE, he eventually stopped talking and doing normal things, and finally died.
There are measles cases in Europe and America, but they’re particularly hard on Third World countries, where vaccination coverage isn’t necessarily consistent.
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“It’s not like a mild infection for everyone,” Robinson said. “If you get severe pneumonia, we can keep you alive in intensive care and you are probably going to survive.”
Coming down with measles in sub-Saharan Africa could result in a very different prognosis.
Another atypical but severe complication is encephalitis, an inflammation of the brain, often leading to severe neurological damage, inability to walk or talk.
Years ago, complications from measles could lead to institutionalization.
The extent of the current outbreak isn’t known yet.
“We don’t really know the number of secondary cases yet. Hopefully it’s small,” said Saxinger.
“And then of course, you’re trying to contact trace to prevent secondary cases because people who have been in contact might be able to get a vaccine, for example, or an immune and antibody treatment to reduce risk if they’re high risk.”
People who were in these places within the specific time windows should review their immunization records:
• April 16, Edmonton International Airport, 3:20-6 pm;
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• April 20, Stollery Children’s Hospital ER, 5 a.m. to 3 p.m.;
• April 22, 66th Medical Clinic, 12:15-3:30 pm;
• April 23, Stollery Children’s Hospital ER, 4:40 a.m. to 9:33 a.m.
“Anyone who attended these locations at these times who was born in or after 1970 and has less than two documented doses of measles-containing vaccine, is at risk for developing measles,” reads the recent Alberta Health Services alert.
Individuals born before 1970 have probably had measles.
Those who are pregnant, under a year old or have a weakened immune system are most at risk, and should contact Health Link at 1-877-720-0707 as they may be eligible for medication to prevent measles.
If symptoms develop, people are advised to call Health Link 811 before visiting a health care provider.
Robinson said theories about links between vaccinations and other ailments such as autism have long since been debunked, but repeated circulation of the ideas prompts some families to hesitate before vaccination.
The initial “connection” was made because of the timing of initial vaccination and diagnosis of autism coinciding, with the rate of diagnosis increasing because of increased awareness within the medical community.
Robinson compares it to other leaps in logic.
“If you get your hair done and then you get in a car accident, did getting your hair done cause the accident?”
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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian Press. All rights reserved.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
The Canadian Press. All rights reserved.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
The Canadian Press. All rights reserved.
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