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Is Canada prepared for a measles outbreak? Many health officials are on high alert

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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.

The return of measles is cause for concern, not disdain

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.”

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 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.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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