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As routine vaccination rates dip, polio survivor hopes her story reverses that trend

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When Miki Boleen sees new parents in her doctor’s office, she often asks if they’ve immunized their child against polio — a disease that immobilized her.

Her desire is not to frighten, but with vaccination rates declining in babies and toddlers due to missed routine immunizations at the start of the pandemic, she hopes her story will help others stay healthy. Boleen, 83, suggests people talk to their doctor — and with others who’ve had infectious diseases that can be prevented with vaccines.

Her message is simple: Why not consider immunization and prevent an avoidable serious illness?

“Please, please get your children immunized,” the Abbotsford, B.C., resident said in a conversation with Dr. Brian Goldman, host of CBC Radio’s White Coat, Black Art. “You don’t want them ending up like me.”

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These conversations are happening public health experts warn that polio could resurface, following outbreaks in the U.S. and the U.K. In New York state this summer, a young man suffered paralysis after a polio infection, the first case in the U.S. in nearly a decade. Health officials are investigating how the illness connects to virus detections in England and Israel.

By the 1990s, mass immunization campaigns that began in Canada in 1955 largely eradicated polio here. Before then, thousands of children were infected.

Boleen, right, and her friend Lillian in 1955. They were hospitalized for polio during Winnipeg’s outbreak. (Submitted by Miki Boleen)

Boleen first had polio when she was eight years old in Gladstone, Man., about 160 kilometers west of Winnipeg. Initially, the only ill effect was no longer being able to run quickly.

Then Boleen was infected again by another strain during the 1953 epidemic. Winnipeg was the epicentre, with more than 2,300 cases of the country’s nearly 9,000 — including 500 deaths that year.

A headache turned into an ambulance ride for the then-14-year-old when she became unable to walk, coupled with a fear she might die.

On the hospital children’s ward, others with polio lay in beds alongside her. All the beds were pushed together so closely that if the children had any mobility at that point, they could’ve rolled onto another bed, she said.

“Sometimes during the night, I’d hear noises and I’d wake up,” Boleen recalled. “Well, I couldn’t move and my voice was just a whisper at that time, but I knew what was going on. Either I would hear a respirator quit during the night or I’d see the staff come in and move somebody away from the bed next to me. And you knew they’d passed away.”

In the morning, the children were told that the patient was moved. As the oldest on the ward, Boleen knew what had really happened.

She says she’s still traumatized by the deaths she witnessed.

Polio can strike again

Boleen was in hospital for nine months, which was followed by surgeries and a full leg brace to help her to walk again.

She threw out the braces and crutches, before she started training at age 16 to be a psychiatric nurse. Though she loved her career, symptoms of post-polio syndrome appeared in 1986 and she retired early.

 

White Coat Black Art26:30Polio comeback threatens Canadians

Polio is making a comeback around the world and falling vaccine rates in Canada make us vulnerable to a disease that was once close to eradication. Miki Boleen, an 83-year-old polio survivor, has made it her mission to urge parents to get their infants vaccinated as routine immunization rates slip.

Learning of this summer’s case of paralyzing polio in an adult in New York state upset Boleen, she said, but she was expecting it due to declining immunization rates. About 40 per cent of two-year-olds weren’t up-to-date with their vaccines in her area of B.C.

Canada’s vaccination goal for polio is 90 per cent, but several provinces and territories fall below that target, including 88 per cent in B.C. and 86 per cent in Manitoba.

Drop in immunization must be reversed: public health

Dr. Jia Hu serves as CEO of 19 To Zero, a not-for-profit coalition of medical and other experts who facilitate vaccination. Their efforts include campaigns geared toward parents of babies and preschoolers who missed polio and other immunizations when family practices closed down during the COVID-19 pandemic.

Hu’s team conducted a series of surveys suggesting vaccination coverage dropped from 70 per cent to less than one per cent in school-aged children getting the HPV vaccine, which protects against cancers that still kill about 400 Canadians each year.

Polio wards were lined not only with beds but with iron lungs, large metal ventilators that helped patients to breathe during the worst of the infection. Some survivors never regained lung function and spent the rest of their lives in the devices. (U.S. Food and Drug Administration)

When it came to vaccinations for babies and preschoolers that protect against polio and measles, the decline was about 25 per cent, said Hu, who is also a public health specialist and a family physician. Before the pandemic, a five per cent decline would be considered massive and concerning, he noted.

“The main reason for all of these drops was actually due to reduced access,” Hu said, particularly to family physicians and nurse practitioners during the pandemic.

“There is totally a crisis in primary care,” Hu said. “What we need is primary care to be supported in providing immunizations.”

The all-hands-on-deck approach to getting Canadians caught up on their immunizations should include pharmacists, just as they helped roll out COVID-19 vaccines to adults, he said, as well as online registries to flag to parents when their kids need a top up.

Understanding and outreach

Hu was the medical officer of health during a COVID-19 outbreak at a Cargill meat processing plant in High River, Alta., where his team helped run town halls, translate materials and set up vaccination clinics where community leaders encouraged residents to turn out.

“We launched a fairly large vaccine uptake campaign in northern rural Alberta,” Hu recalled.

A woman wears a nursing cap and uniform holding roses in this black and white photograph.
Miki Boleen graduated from nursing training in 1959 and worked as a psychiatric nurse until post-polio syndrome forced her to retire early. (Submitted by Miki Boleen)

To succeed, Hu said they used surveys and focus groups to understand why COVID-19 vaccination rates among rural residents lagged behind city dwellers, followed by TV ads, billboards and social media campaigns. Similar outreach could boost routine other types of immunization rates as well, he said.

Dr. Zulfiqar Bhutta, chair in global child policy at the Centre for Global Child Health at Sick Kids in Toronto, also says understanding what drives a community’s concerns about vaccination is key to encouraging uptake. He works in two countries where wild poliovirus still circulates: Pakistan and Afghanistan.

Bhutta said polio won’t be eradicated until it is under control everywhere in the world. To promote vaccination in Pakistan, Bhutta talks to parents about their family’s unmet needs, like hunger and reproductive care. The team works to provide those services alongside vaccines.

A headshot of a man wearing a blue shirt and half zipped sweater.
Outreach could boost routine immunization rates that fell during the COVID-19 pandemic, says Dr. Jia Hu. (Submitted by Jia Hu)

Public health doctors and nurses often say vaccines are a victim of their own success since we don’t see the illness and deaths they’ve averted. But they only work when enough of the population gains the protection.

“I often tell people what we see in lower-middle income countries, we see in pockets of deprivation in high income countries,” said Bhutta, who is also with the Institute for Global Health and Development at Aga Khan University in Karachi, Pakistan.

Bhutta said vaccine hesitancy anywhere can be tempered by reaching the most vulnerable people and maximizing participation.

In Canada, Boleen channels disappointment over falling immunization rates into her speeches in support of March of Dimes’ work with post-polio survivors, as well as conversations so younger adults discover just how damaging polio can be.

“Trust me, if I could have had immunization, I wouldn’t have had polio twice and I’d still be dancing,” Boleen said. “That’s the thing I miss the most.”

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Canadians should ensure kids get routine vaccines following COVID disruptions: doctors – National | Globalnews.ca – Global News

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Preventable diseases like measles could follow trends seen elsewhere in the world and spread quickly in Canada due to a drop in routine vaccinations during the COVID-19 pandemic, say pediatricians who are urging parents to ensure their kids are fully immunized.

Provinces and territories log data on vaccinations provided in the community against infectious diseases like measles, diphtheria, polio and whooping cough, as well as vaccines against other illnesses administered in school immunization clinics.

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Although much current data doesn’t cover years beyond 2019, provinces with more recent figures are already seeing a dramatic decline in routine vaccinations.

Read more:

Measles vaccination rates in Canada have decreased, PHAC says amid global concern

Pediatricians are concerned about possible outbreaks of preventable diseases if too many children were underimmunized or not vaccinated at all while public health clinics focused on COVID-19 vaccines. Widespread school closures and vaccine disinformation that swayed some parents against immunization efforts complicated matters still further.

Recent data from Public Health Ontarioshows that for 12-year-olds, vaccination against the liver infection hepatitis B plummeted to about 17 per cent in the 2020 to 2021 school year, compared with 67 per cent in the school year ending in 2019.

For human papillomavirus, or HPV, which can cause cancer, the vaccination numbers were even lower, plunging to 0.8 per cent last year, compared with 58 per cent in 2019. For the meningococcal vaccine, which helps protect against four types of the bacteria that cause a rare disease, vaccinations fell to about 17 per cent from 80 per cent over the same time. Risks of the potentially deadly illness include meningitis, an infection of the lining of the brain and spinal cord.


Click to play video: 'Flu cases on the rise in Alberta'

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Flu cases on the rise in Alberta


“The large decline in coverage in 2019-20 and 2020-21 illustrates the impact of the COVID-19 pandemic, as there was limited capacity to deliver school-based immunization programs,” Public Health Ontario said in a statement.

It said data for uptake of vaccines aimed at protecting younger kids against measles, for example, is not available beyond 2019, and a report on later numbers is expected to be released next spring.

Dr. Monika Naus,medical director of Immunization Programs and Vaccine Preventable Diseases Service at the BC Centre for Disease Control, said in-school vaccines, starting in Grade 6, were delayed, but work is underway to return to pre-pandemic levels.

Younger children missed appointments at doctors’ offices while physicians were seeing patients virtually and public health clinics, which mostly administer routine vaccines for kids outside of the Lower Mainland region of the province, were busy with COVID-19 shots, Naus said.


Click to play video: 'Routine childhood vaccinations drop during pandemic'

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Routine childhood vaccinations drop during pandemic


Dr. Sam Wong, director of medical affairs for the Canadian Paediatric Society, said disinformation and vaccine hesitancy during the pandemic, “combined with the failure of the public health system” to provide routine vaccines, mean certain populations could be left vulnerable to highly contagious diseases like measles, which spreads through coughing and sneezing.

“You could walk into a room an hour after someone’s been in there and potentially get infected,” he said.

“We’re worried, as a group of health-care providers, that if you have lower rates of vaccinations that you’re more likely to have localized outbreaks of vaccine-preventable illnesses such as measles or mumps and chickenpox,” Wong said.

Read more:

Some childhood routine vaccines declined in Alberta over last 2 years due to COVID delays

Wong said it’s important for doctors and parents to discuss the importance of routine vaccinations that have been proven effective for decades, adding some people believe young kids’ immune systems are not ready so they’d rather wait until they’re older.

“But that’s why you want to give the vaccine, because their immune system is not able to fight off infections,” he said.

“Some parents don’t want to even have discussions with me about it. But if there is an opening, I’m happy to talk about it,” said Wong, who works in Yellowknife, Edmonton and Victoria.

The Public Health Agency of Canada said Canadian studies have found immunization coverage declined during the pandemic for the measles, mumps and rubella vaccine.


Click to play video: 'Toronto Public Health to resume in-school vaccination clinics in September'

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Toronto Public Health to resume in-school vaccination clinics in September


Quebec saw a 39 per cent drop in April 2020 compared with 2019, the agency said, with the greatest impact seen in children aged 18 months.

In Alberta, the agency said vaccination for those diseases declined by 10 per cent in April 2020 compared with the same month a year earlier. Coverage for Ontario children under two decreased by 1.7 per cent, it added.

“The Public Health Agency of Canada continues to work with provinces and territories on an ongoing basis to understand the impact of the pandemic on routine immunization coverage across Canada, and to improve the availability of high-quality data to inform immunization programs,” it said in a statement.

It is currently in discussions with all jurisdictions on ways to monitor coverage of vaccines, similar to a surveillance system used for COVID-19 vaccines, the agency said.

Nova Scotia Health said its last report on childhood vaccines was completed three years ago, and numbers have fallen during the pandemic.

“Anecdotally, we know there was a drop in childhood vaccination, but we do not have the specific numbers available at this time,” it said in a statement.

However, the school immunization program is aiming to help students catch up on vaccines that were missed early in the pandemic, mostly through doctors’ offices, it said, adding that getting an appointment was a challenge for some families.

“We know that a substantial number of Nova Scotians do not have a family doctor. Public Health often works with local primary care clinics to provide vaccines to those who do not have a family doctor and some public health offices will offer clinics to this population.”

Last week, the World Health Organization and the United States Centers for Disease Control and Prevention released a statement saying a record high of nearly 40 million children missed first and second doses of the measles vaccine in 2021 due to disruptions in immunization programs since the start of the pandemic.

The two groups said there were an estimated nine million measles cases and 128,000 related deaths worldwide in 2021, and 22 countries experienced large outbreaks.

Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University in Halifax, said a national registry that could quickly tell doctors which children have not been vaccinated is essential in Canada.

“I feel like I’m banging my head against a brick wall,” she said of her efforts to call for that change.

“How can we do proper health-care planning when we don’t have the data?”

Canada is an “outlier” that lags behind most European countries on the measles vaccine, she said, adding a coverage rate of 95 per cent is needed to create so-called herd immunity against the highly infectious disease.

Canada recently had 84 per cent uptake of the second dose of the measles vaccine. MacDonald said Australia, in comparison, had 94 per cent based on the most recent data from the WHO. She used the two countries as an example because they had a similar number of births _ 368,000 in Canada, and 300,000 in Australia in 2021.

“We are just not in the same league, and we should be embarrassed.”

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Flu shots are now free for everyone in Quebec due to overwhelmed hospital ERs

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While the campaign for flu shots has already been underway in Quebec for several weeks, the provincial government announced on Friday that immunization will now be free of charge for any Quebecer over the age of six months.

Previously, only people who met certain criteria (babies, seniors, the chronically ill, etc) were able to get the influenza immunization free of charge, and the vaccination sites set up for COVID-19 were only handling free flu shots. Meanwhile, the general population in Quebec was previously only able to get vaccinated at pharmacies, for a fee.

The decision was made due to the critical state of hospital ERs in the province, particularly at children’s hospitals in Montreal, where kids are being brought in by parents in larger numbers than usual due to rising rates of flu, COVID-19 and RSV infections.

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“With the trio of viruses currently circulating, the influenza vaccine is now available free of charge to all Quebecers who wish to take advantage of it. It’s one more tool to limit the pressure on our network.”

—Quebec Health Minister Christian Dubé

To schedule an appointment for a flu shot and/or a COVID-19 shot, please visit the Clic Santé website.

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Deadly Bird Flu Outbreak Is The Worst In U.S. History

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An ongoing outbreak of a deadly strain of bird flu has now killed more birds than any past flare-up in U.S. history.

The virus, known as highly pathogenic avian influenza, has led to the deaths of 50.54 million domestic birds in the country this year, according to Agriculture Department data reported by Reuters on Thursday. That figure represents birds like chickens, ducks and turkeys from commercial poultry farms, backyard flocks and facilities such as petting zoos.

The count surpasses the previous record of 50.5 million dead birds from a 2015 outbreak, according to Reuters.

Separately, USDA data shows at least 3,700 confirmed cases among wild birds.

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Turkeys in a barn on a poultry farm.
Turkeys in a barn on a poultry farm.

Turkeys in a barn on a poultry farm.

On farms, some birds die from the flu directly, while in other cases, farmers kill their entire flocks to prevent the virus from spreading after one bird tests positive. Such farmers have occasionally drawn condemnation from animal welfare advocates for using a culling method known as “ventilation shutdown plus,” which involves sealing off the airways to a barn and pumping in heat to kill the animals.

The virus has raged through Europe and North America since 2021. A variety of wild birds have been affected worldwide, including bald eagles, vultures and seabirds. This month, Peru reported its first apparent outbreak of highly pathogenic avian influenza after 200 dead pelicans were found on a beach.

Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.
Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.

Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.

The migration of infected wild birds has been a major cause of the spread. Health and wildlife officials urge anyone who keeps domestic birds to prevent contact with their wild counterparts.

While health experts do not generally consider highly pathogenic avian influenza to be a major risk to mammals, a black bear cub in Alaska was euthanized earlier this month after contracting the virus. Wildlife veterinarian Dr. Kimberlee Beckmen told the Juneau Empire newspaper that the young cub had a weak immune system.

Over the summer, avian flu also spread among seals in Maine, which the National Oceanic and Atmospheric Administration believed contributed to an unusually high number of seal deaths.

The Centers for Disease Control and Prevention states that the risk “to the general public” from the bird flu outbreak is low. However, the agency recommends precautions like wearing personal protective equipment and thoroughly washing hands for people who have prolonged contact with birds that may be infected.

In April, a Colorado prisoner working at a commercial farm became the first person in the U.S. to test positive for the new strain, though he was largely asymptomatic.

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