Vaccine-preventable disease specialists say the severity of the situation in Canada will depend, to a degree, on chance.ANDREW TESTA/The New York Times News Service
A worldwide surge in measles cases combined with lower vaccination rates and one of the year’s busiest travel seasons has many health professionals on high alert for outbreaks and preparing an urgent response to stop further spread of the highly contagious virus.
A measles expert with the World Health Organization said the next few months will be a test of Canada’s vaccination systems and could expose potential weaknesses.
“This is where we find out whether or not the immunization systems are as good as we think,” said Natasha Crowcroft, senior technical adviser for measles and rubella with the WHO. “You can go along thinking everything is fine until measles takes off everywhere.”
There have been nearly two dozen confirmed cases of measles reported in Canada so far this year, compared with just 12 in all of 2023. Of this year’s cases, 12 are in Quebec, with the Montreal area experiencing community transmission of the virus in areas with low vaccination rates. This past week, B.C. confirmed its first case of measles since 2019.
Health officials have urged March break travellers to be cautious, given the increased measles spread worldwide.
Vaccine-preventable disease specialists say the severity of the situation in Canada will depend, to a degree, on chance. If an individual acquires measles on an international trip, but lives in a highly vaccinated community, the risks are lower. But if a measles case is introduced into an unvaccinated area or even a hospital with many immune-compromised patients, the situation could be much more difficult to manage.
“It’s always sort of the luck of the draw, where will that imported case come to,” said Monika Naus, medical director of Immunization Programs and Vaccine Preventable Diseases Service at the BC Centre for Disease Control. “That risk is higher if those imported cases come into an under-vaccinated population.”
There was a 79-per-cent increase in measles cases around the world last year, reaching more than 300,000, according to the WHO. Experts say a combination of factors, including disruptions to immunization programs during the pandemic, lack of access in lower- and middle-income countries and vaccine hesitancy or anti-vaccine beliefs, are all part of the problem.
How effective is the measles vaccine?
The measles, mumps and rubella vaccine is around 95 per cent effective, meaning five per cent of those who get it remain susceptible. Imagine a group of 100 individuals, in which 95 are vaccinated and five are not. The unvaccinated people are at risk of catching measles, as are five people in the vaccinated group. If all 100 are exposed to the virus, the five unvaccinated and five of the vaccinated individuals will likely become infected. In the end, 5.3 per cent in the vaccinated group will get sick, compared with all the unvaccinated individuals.
Immune-vaccinated
Susceptible-
vaccinated
Susceptible-
unvaccinated
carly weeks and john sopinski/the globe and mail,
Source: Bc Centre for disease control
How effective is the measles vaccine?
The measles, mumps and rubella vaccine is around 95 per cent effective, meaning five per cent of those who get it remain susceptible. Imagine a group of 100 individuals, in which 95 are vaccinated and five are not. The unvaccinated people are at risk of catching measles, as are five people in the vaccinated group. If all 100 are exposed to the virus, the five unvaccinated and five of the vaccinated individuals will likely become infected. In the end, 5.3 per cent in the vaccinated group will get sick, compared with all the unvaccinated individuals.
Immune-vaccinated
Susceptible-
vaccinated
Susceptible-
unvaccinated
carly weeks and john sopinski/the globe and mail,
Source: Bc Centre for disease control
How effective is the measles vaccine?
The measles, mumps and rubella vaccine is around 95 per cent effective, meaning five per cent of those who get it remain susceptible. Imagine a group of 100 individuals, in which 95 are vaccinated and five are not. The unvaccinated people are at risk of catching measles, as are five people in the vaccinated group. If all 100 are exposed to the virus, the five unvaccinated and five of the vaccinated individuals will likely become infected. In the end, 5.3 per cent in the vaccinated group will get sick, compared with all the unvaccinated individuals.
Immune-vaccinated
Susceptible-
vaccinated
Susceptible-
unvaccinated
carly weeks and john sopinski/the globe and mail, Source: Bc Centre for disease control
Canada eliminated measles in 1998, meaning the virus no longer spreads on its own here; cases are typically introduced through international travel. But if transmission of the virus here continues for more than a year, Canada will lose its measles-free status. That almost happened in 2011, after a major outbreak in Quebec that led to nearly 800 cases.
A 2012 study of that outbreak, published in the Journal of Infectious Diseases, noted that many of the cases spread in school students who had one or two doses of the measles vaccine. But overall vaccination rates were below 95 per cent, which is the threshold needed to keep the virus at bay, according to the WHO.
The study concluded that, considering a small number of vaccinated individuals will remain susceptible to the virus, having even 3-5 per cent of people unvaccinated could be enough to “push the population toward a critical tipping point for epidemic risk.”
Another large outbreak occurred in B.C. in 2014. The outbreak was mainly confined to a religious community that opposes vaccination. But Dr. Naus noted the outbreak didn’t spread beyond the community because of efforts undertaken by its members and public health.
She said that during outbreaks in that community and others that oppose vaccines, health workers will often set up quasi-undercover immunization centres where community members can get vaccinated without anyone else knowing.
“People, members of the community, didn’t want to be shunned by family or friends if they did come forward,” Dr. Naus said, adding that it’s essential for public health to establish trust and maintain communication with communities that reject vaccines.
Health officials say that Canadians who plan on travelling internationally should ensure they’re up to date on their vaccinations. People born before 1970 are presumed to have immunity from the era when measles was highly prevalent in Canada and should receive one dose to ensure they are immune. People born after 1970 need two doses to be immune. Officials advise individuals to check with their health care provider, but given that Canada doesn’t have a national vaccine registry, figuring out who has been vaccinated can be a challenge.
Babies are eligible for their first dose of measles vaccine at one year. Babies aged six to 12 months can get a vaccine if they are travelling internationally (but still require another dose at 12 months).
Measles is one of the most contagious viruses in existence. Almost everyone who comes into contact with the virus will get infected if they aren’t vaccinated or immune from a prior illness. The virus can remain suspended in the air for two hours, meaning a person doesn’t even have to be in the room at the same time as an infected individual to catch it.
One in five people infected require hospital admission. One in 10 will develop a complicating infection, such as pneumonia, while one in 1,000 will develop brain inflammation, which can cause severe problems, including deafness and intellectual disability. Up to three in 1,000 people infected with measles will die.
That’s why health officials are quick to raise the alarm after even a single case is reported, a situation playing out in the York Region of the Greater Toronto Area. On Feb. 29, York Region Public Health said it had confirmed measles in an adult male in his 30s who had not recently travelled or been in contact with a measles case. He was fully vaccinated and his illness was mild.
As soon as the case was confirmed, health officials alerted about 1,800 close contacts and identified those at highest risk for severe complications. So far, no reports of transmission have occurred.
An alert was sent out to advise the public of places the man had visited before he went into isolation. York Region’s associate medical officer of health, Sarah Erdman, said the health unit set up a vaccine clinic and a post-exposure prophylaxis clinic to target higher-risk groups. A person who is exposed to measles has a 72-hour window to receive a vaccine or, in the case of infants under six months, pregnant women or those with compromised immune systems, a blood product containing measles antibodies, to help ward off complications.
Back at the World Health Organization, Dr. Crowcroft said that vaccination rates have been falling around the world, creating a “perfect storm” of risk.
“We’re in a really urgent emergency situation for the rest of the world,” she said. “I don’t get the sense this is being taken seriously. We need urgent action now.”
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
