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After an explosion of measles cases in Europe, medical experts say it’s just a “question of time” before outbreaks happen in Canada, thanks to high rates of global travel and low rates of vaccinations.
There were 42,200 measles cases across more than 40 European countries last year, the World Health Organization (WHO) announced this week — a more than 40-fold increase from 2022, which saw fewer than 1,000 cases. In December, the organization said there had been more than 20,000 hospitalizations and at least five deaths in the European region.
Globally, the situation is even grimmer, with a spike in infections in 2022 that included nine million known cases and 136,000 reported deaths, mostly among children.
The WHO said the rise in cases in Europe has accelerated in recent months, and the upward trend is expected to continue if urgent measures — like vaccination efforts — aren’t taken to prevent further spread of this potentially deadly infection.
“It’s not something that is mild,” said Dr. Kate O’Brien, a Canadian pediatric infectious diseases specialist and director of the WHO’s department of vaccines and immunization. “And it’s not something to be taken lightly.”
The risk in Canada
Canada eliminated measles back in 1998 through widespread vaccination programs.
Here, the vaccine is given to children as two doses of a combined shot that also protects against a combination of infections — either measles, mumps and rubella, or measles, mumps, rubella and varicella.
The annual case count remains small — only a dozen confirmed infections were reported country-wide in 2023 — and most cases are now acquired through travel outside the country.
But clinicians say outbreaks are still a risk. Canada, like many other countries, hasn’t hit the 95 per cent vaccination coverage required to prevent its spread.
“Measles is probably the most infectious human virus that is known, and as a result, in order to prevent measles infections, vaccination rates have to be really high in a community,” said O’Brien.
“What’s happened is, over the course of the pandemic, we’ve had a historic backsliding in the immunization rates around the world.”
A mother and her daughter wait at a community health centre in Caracas to complete their vaccination schedule. About 95 per cent vaccination coverage is required to prevent its spread. (Yuri Cortez/AFP/Getty )
Vaccination catch-up crucial
In Europe, the level of coverage with two doses of the measles vaccine dropped from 92 per cent in 2019 to 91 per cent by 2022, WHO data shows. Nearly two million infants also missed their measles vaccination in the first two years of the pandemic.
That means children are particularly at risk, clinicians say. Measles spreads easily through the air, leads to high hospitalization rates, and can cause a hacking cough, high fever and a prominent rash. In more serious cases, it leads to pneumonia, brain damage, and death in up to three out of every 1,000 children infected.
Infections can have wide-ranging and sometimes lifelong consequences, including blindness, deafness, or immune system impacts that leave people vulnerable to other infections.
In the U.K., where there have been hundreds of cases in recent months, including 127 reported infections in January alone, health officials also point the finger at “falling” vaccination coverage. One in 10 children start school in England without protection.
That’s similar to Canada. Federal data from 2021 shows that 79 per cent of children had two doses of measles, mumps, and rubella vaccine by their seventh birthday, down from 83 per cent in 2019 and 87 per cent in 2017.
That suggests close to two in 10 children hadn’t yet had their full set of shots — far from Canada’s target of 95 per cent coverage for that age group.
“Right now we’re underneath the level of immunization that we need to prevent onward transmission in Canada,” said pediatric infectious diseases specialist Dr. Charles Hui, who works with CHEO and the University of Ottawa.
Another study on population immunity in Ontario, published in 2019, found nearly eight per cent of blood samples had antibody levels below the threshold needed to ward off a measles infection. This suggested that immunity in some age groups may be waning “despite high vaccine coverage.”
Dr. Charles Hui, a pediatric infectious diseases specialist who works with CHEO and the University of Ottawa, says Canada’s vaccination level for measles is too low. (Mathieu Theriault/CBC)
And clinicians warn the situation is getting worse.
During the pandemic, when doctors’ offices were shut and public health units were tied up with COVID-19 screening and testing, routine immunization rates to protect infants and children from serious infections like measles plummeted across Canada.
“I think the answer is trying to do everything we can to optimize vaccination delivery and catch up all those people who missed vaccinations during that pandemic, ’cause there are a lot of them,” said Dr. David Pernica, division head of infectious diseases at McMaster Children’s Hospital.
“Most of these are people who would get their kids vaccinated if they had the time and means to do so.”
Normally, Pernica said, if someone doesn’t cough in our face or shake hands with snotty fingers then respiratory viruses don’t spread.
Measles, on the other hand, is so contagious that if an infected person walks into a store and another person who isn’t vaccinated comes in two hours later, they can still catch it.
Research suggests that one person with measles can spread it to an average of 12 to 18 others.
“It will be really critical for governments to provide the resources for public health and to primary care, to really do all they can to catch up all of those who have missed vaccinations, and to encourage vaccinations among those who have not yet decided to receive them,” he said.
The WHO’s O’Brien also stressed the safety and effectiveness of measles vaccines, which are roughly 97 per cent effective. “Over the past 20 years, we estimate that over 56 million deaths have been averted as a result of measles vaccination around the world,” she said.
WATCH | Families encouraged to catch up on vaccinations:
Ontario issues warning: update kids’ vax records or face school suspension
4 days ago
Duration 2:13
Tens of thousands of Ontario students are facing suspension if they don’t update their vaccination records, as the province pushes hard to get kids caught up on shots for everything from COVID-19 to chickenpox.
Travellers bringing it home
Global travel remains a key concern for clinicians. In recent weeks, multiple Canadian public health alerts have been issued about possible travel-related exposures.
“The 12 cases last year from Canada were all imported cases and that is concerning in and of itself,” Hui said. “But the concern would be if we import cases, and they come into contact with people who don’t have immunity, then we have transmission within Canada.”
He added it’s likely “just a question of time” before cases linked to travel abroad end up sparking an outbreak.
Dr. Shelly Bolotin, director of the Centre for Vaccine Preventable Diseases, urged families heading out of the country for spring break to plan ahead, even if they’re heading to places without outbreaks of measles or other vaccine-preventable infections.
A volunteer nurse examines six-month-old child who is infected with measles in Larintsena, Madagascar. Canadian public health officials says people who are travelling globally should ensure they are vaccinated. (Laetitia Bezain/The Associated Press)
“We can also get exposed at an airport,” said Bolotin, an associate professor at the University of Toronto’s Dalla Lana School of Public Health.
Normally, infants receive their first dose of measles vaccine at 12 months. But if a child is six months or older and going to a place where measles is circulating extensively, parents should discuss early immunization, she said.
Canada’s federal government has an ongoing global measles notice for travellers, noting outbreaks are “occurring in every region of the world,” leaving anyone unprotected at risk of being infected when travelling.
“That’s why it’s so important that every individual is protected against measles,” said O’Brien. “Because you don’t know where that exposure is going to come from.”
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.
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.
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.
