Canada’s provinces are taking differing approaches to rolling out fourth doses of COVID-19 vaccines. Some are offering the second boosters to all adults in response to the highly contagious BA.4 and BA.5 subvariants of Omicron, while others are keeping access limited for now with an eye to the fall.
Here are the eligibility guidelines for every province and territory:
In Ontario, adults aged 18 to 59 can book a fourth dose as of July 14, but the province’s top doctor says healthy residents in that age group can wait until the fall for a new shot that’s expected to better target Omicron variants. Those who are 60 and older, immunocompromised or Indigenous adults have been eligible since April.
Adults in Quebec have been able to get a second booster shot since May, three months after their first booster. Those who are 12 years of age and older and on dialysis or have a compromised immune system are also eligible.
New Brunswick expanded eligibility for fourth doses of a COVID-19 vaccine to include all adults as of July 12. Residents 18 and older can obtain a second booster of COVID-19 vaccine if at least five months have passed since their third shot.
Nova Scotia expanded vaccine eligibility to adults 50 and older as of July 8, but is recommending residents wait until the fall to get it. Second booster doses are also available to residents of long-term and residential care facilities.
NEWFOUNDLAND AND LABRADOR
Newfoundland and Labrador is lowering the minimum age for second boosters to 50 from 70 as of July 20. Those currently eligible include people aged 70 and older, those living in congregate settings for seniors, as well as Indigenous people or individuals living in a remote or isolated Indigenous community aged 18 and up. The interval between the two booster shots is 20 weeks.
PRINCE EDWARD ISLAND
Prince Edward Island expanded eligibility for a fourth shot to every resident aged 12 and up on July 6. Second boosters were previously only available to those over the age of 60 and immunocompromised people.
Since May, Manitoba has been offering second boosters to those aged 50 and up, First Nations, Inuit and Métis people aged 30 and up and residents of any age who live in personal care homes or congregate living sites. People who are moderately to severely immunocompromised between the ages of 18 and 49 are also eligible.
Albertans have been able to receive a fourth dose since April if they are 70 years of age or older, First Nations, Métis or Inuit and 65 and older, or living in congregate care settings. Those 12 and older who require additional doses to meet international travel rules are also eligible.
Saskatchewan residents 50 years of age and older have been able to receive a fourth dose, four months after receiving their third, since April. Those with designated health conditions and residents of long-term care and personal care homes are also eligible.
British Columbia has announced that a fourth dose will be available to all residents aged 12 and up starting in the fall. Residents over the age of 65, Indigenous people 55 and older, and immunocompromised or vulnerable individuals are receiving invitations to book appointments. Those living in long-term care and assisted living have already been offered shots.
All Yukon residents aged 18 and older can book a fourth shot as of July 7 as long as six months have passed since their third shot.
Nunavut has been offering a fourth dose to all residents aged 18 and older since May if they got their last dose four and a half months ago.
Northwest Territories has been doling out fourth doses to all individuals aged 50 and older since May as well as immunocompromised people 12 and up.
This report by The Canadian Press was first published July 13, 2022.
Symptoms of measles to be vigilant about include high fever, typically exceeding 101°F, accompanied by a persistent cough, runny nose, and red, watery eyes. Symptoms of measles usually begin 10–14 days after exposure to the virus. The hallmark sign is a distinctive rash that starts on the face and spreads downwards, consisting of flat red spots that may merge as the illness progresses. Additionally, individuals may experience sensitivity to light, sore throat, and tiny white spots inside the mouth. Severe complications like pneumonia, encephalitis, or even death can arise, particularly in vulnerable populations.
Erica Finkelstein-Parker planned her daughter’s 8th birthday party with love.
Because Emmalee adored airplanes, Finkelstein-Parker chose the theme “Flying High with Emmalee.” Finkelstein-Parker filled nearly two dozen brightly colored goody bags for Emmalee’s friends — one for every child in her class, so no one would feel left out.
Months later, the treat bags remained unopened in Finkelstein-Parker’s bedroom, reminders of a birthday party that was never held.
Emmalee, who developed a rare complication of measles that can strike years after infection, spent her 8th birthday in hospice care at her family’s home. Her parents adopted Emmalee from an orphanage in India when she was 2 ½ years old. The orphanage staff didn’t tell them she had been infected with measles.
“There are some things that a parent should never have to do,” said Finkelstein-Parker, of Littlestown, Pennsylvania. “I had to call the birthday venue and explain that we were canceling the party because our daughter was dying.”
Emmalee died on Jan. 2, 2011.
“People think these diseases are ancient history, but they’re still around,” said Finkelstein-Parker. “Measles is a stealth virus. It may look like it has cleared your body, but it can hide in your nervous system.”
“All it takes is one infected traveler to spark an outbreak,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “It’s coming from people who are getting off airplanes.”
Measles is so contagious that even one case is considered an outbreak. Each measles patient infects an average of 12 to 18 people who lack immunity from vaccines or natural infection. In comparison, each Covid-19 patient infects about two other people, said Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
“Measles is much, much more contagious than Covid or the flu,” Offit said.
Although two doses of the measles vaccine protect 97% of children, the airborne virus spreads so quickly that 95% of children in a community need to be vaccinated in order to stop outbreaks. About 93% of children were up to date on the measles vaccine in 2022-23, according to the CDC.
All states mandate vaccinations for children in public schools, but a growing number of families are taking advantage of exemptions for religious, philosophical or medical reasons. About 3% of students are now exempt from vaccine mandates. In 10 states, more than 5% of schoolchildren are exempt, a rate that makes it harder to contain outbreaks.
People who decline to vaccinate their children against measles are taking large and unnecessary risks, Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital, said. Measles vaccines have repeatedly been shown to be safe.
Long-term effects of measles
For every 10,000 children infected with measles, 2,000 will be hospitalized; 1,000 will develop ear infections with the potential for permanent hearing loss; 500 will develop pneumonia; and 10 to 30 will die, said Hotez, who is also dean of the National School of Tropical Medicine at Baylor College of Medicine.
Ariel Loop was shocked when her 4-month-old son, who had received all recommended vaccines, became sick with measles after visiting Disneyland in 2015. Babies are vulnerable to measles because they aren’t routinely vaccinated against the virus until age 12 to 15 months.
Loop took her son to the emergency room after he developed red spots, itchy eyes and a fever of 102 degrees that acetaminophen didn’t help. Loop, a nurse, was especially worried about her son because he was born prematurely and suffered a stroke while in utero.
“He was my first baby, and I didn’t know how dangerous measles was,” said Loop, who lives in Pasadena, California.
Measles often leaves patients vulnerable to secondary bacterial infections, such as pneumonia, one of the most common causes of death in measles patients, said Patricia Stinchfield, president of the National Foundation for Infectious Diseases.
Measles also causes “immune amnesia,” in which the immune system loses its ability to fight infections that a patient was previously immune to, Cherry said. The virus wipes out 11% to 73% of a person’s antibodies — both those acquired through infection and vaccination — which can leave patients at increased risk from viruses such as the flu and bacteria that cause pneumonia and skin infections.
Early symptoms of measles
In addition to the well-known red spots on the skin, measles usually causes white spots in the mouth, which can make it painful for children to eat or drink, Stinchfield said. Many kids with measles become dehydrated and malnourished during their illness.
About 20% of measles patients are hospitalized, often because they need intravenous fluids, she said.
“These kids come in, slung over their parents’ shoulders, barely able to hold the head up,” Stinchfield said. “They’re like little rag dolls. They won’t even take a popsicle.”
In the days before children develop a red measles rash, symptoms include:
Many become so sensitive to light that ordinary room lights hurt their eyes.
“It might look like the common cold except for the degree of misery they have,” Offit said.
People with measles can spread the virus for nine days — from four days before they develop spots until four days after, Stinchfield said.
Because the virus spreads through aerosols, it can infect people up to two hours after a sick person has left the room.
A fatal long-term complication
Although Emmalee was always tiny for her size — topping out at a weight of 39 pounds — she was otherwise healthy, Finkelstein-Parker said.
The first signs of serious illness occurred when Emmalee was 7 and began tripping over her feet, Finkelstein-Parker said. At first, her mother said she wondered if Emmalee’s new shoes were too big. The next day, Emmalee’s chin dropped onto her chest, as if she couldn’t hold up her head. While sitting in a chair, Emmalee listed to one side, without enough muscle control to remain upright.
A pediatrician at Children’s Hospital of Philadelphia who was trained in India quickly recognized the early signs of a devastating long-term complication of measles called subacute sclerosing panencephalitis, which is more common in countries where the virus remains endemic. The fatal condition can cause memory loss, irritability, disturbances in movement, seizures and blindness, and can develop six to eight years after a child has apparently recovered from measles. Although anti-seizure drugs can sometimes ease symptoms, they don’t cure the disease.
Emmalee began having uncontrollable seizures. After four months, Emmalee slipped into a coma while at home, Finkelstein-Parker said.
“My father couldn’t understand why she wouldn’t wake up,” Finkelstein-Parker said. “He tried everything, including playing music from her favorite music box.”
Emmalee spent five weeks in home hospice, passing away five months after symptoms began, Finkelstein-Parker said.
After Emmalee died, Finkelstein-Parker took the goody bags to school as presents for her daughter’s classmates. The children, who were also grieving, shared their favorite stories about Emmalee, and made a hanging mobile decorated with drawings and notes.
“Their teacher said they needed closure,” Finkelstein-Parker said. “They handled that day a whole lot better than I did.”
Caused by abnormal proteins, or prions, that collect in the brain, spine and lymph nodes, the disease in its late stages leaves animals extremely skinny and exhibiting strange behaviour like stumbling, drooling and increased drinking and urination.
The province has tracked the disease’s advance from the west and south of the U.S. border with increasing alarm — particularly after it was found in animal populations within 50 kilometres of the B.C. border with Alberta and Montana in recent years.
The disease has far-reaching social, economic, and conservation impacts — especially for Indigenous populations that rely on hunting for traditional foods, the province’s 2023 CWD response plan states.
Moose in the region are also increasingly under pressure from similar threats, like logging, road building, climate change, wildfires and recreational hunters who have drawn moose tags, noted Louie.
“We haven’t hunted a moose in six years because of the low numbers,” said Louie, also a councillor for the Yaqan Nuʔkiy (Lower Kootenay Band).
In his youth, he harvested three or four moose a year, Louie said. So, any potential threat to the deer and elk populations the band depends on is a concern, he stressed.
“We’re always worried that the elk and the deer are going to follow suit one day.”
Access to traditional food is essentially food security, Louie said, adding the Yaqan Nuʔkiy rely heavily on wild game.
“Usually the community eats about 30 elks and 60 deer a year and we’re a small community with a little over 100 people living on reserve,” he said.
“That’s a substantial amount of food.”
Harvesting game is also foundational to his nation and family’s culture, tradition and identity, said Louie, who takes his children, other youth and non-Indigenous people hunting. He also shares the preparation, rituals and spiritual relationship the Yaqan Nuʔkiy have with animals and their land.
“My job now is as a knowledge keeper, passing on what I got from elders and my older family members,” Louie said.
“Our cultural knowledge has everything to do with the animals.”
Youth learn how to skin and process the meat and hides, sinew, bones and antlers for other uses and tools.
Meat is also medicine in the community, he said.
People who are sick will request specific parts of the animal, like fresh hearts, kidneys and livers, depending on their illness.
In honour of a successful hunt, youth are offered a portion of the fresh game as part of a traditional ceremony.
“When we kill our animals, we still hold up the kidney and heart to our kids, say our words and they choose to be a hunter or warrior or both,” Louie said.
“If our traditional practices cannot be passed on, our culture starts disappearing, and it’s already been impacted severely over the years.”
The heavy reliance of Indigenous people on wild game may also mean they face higher potential health risks from eating infected deer, elk, moose and caribou meat.
There is no evidence to date that CWD has made the jump from animals to humans with fatal consequences like mad cow (Creutzfeldt-Jakob) disease did — another type of prion degenerative brain disease — after surfacing in British cattle in the mid-1980s.
Since some animals may not show symptoms, hunters in areas where CWD occurs should get meat tested before anything is used or consumed, federal authorities state.
B.C.’s preliminary defence to CWD is centred on the area where the first confirmed cases were found, working to confirm details and minimize transmission.
On Tuesday, the province ordered that any roadkill of moose, deer, elk and caribou in that immediate radius get mandatory testing. There are also restrictions on the transport or disposal of carcasses.
The disease’s hot zone includes south of Highway 3, south of Cranbook to the U.S. border, west to the Moyie Range and east to the Mcdonald Range.
Louie said the next step is to have information sessions and discussions with Ktunaxa members about the arrival of CWD in their territory.
“We’ll look at submitting heads more often,” he said.
But waiting for test results will be a burden.
The community hunts when they require food and can’t necessarily store meat or wait for test results before eating it, he added.
“We really hope the government focuses on developing some sort of rapid test because nobody harvests more elk or deer than us.”
However, Louie is confident in Yaqan Nuʔkiy’s ability to track animal populations for outbreaks, gather vital information on transmission and partner with conservation authorities to tackle the problem.
Regular licensed hunters typically only have eyes on animals during the hunting season, but their community is on the land interacting and harvesting animals year-round, he said.
The strong relationship with deer and elk populations means the nation has a solid understanding of their behaviour and range patterns, Louie said.
“We monitor the animals so much that we know where they come from, what their schedule looks like, and the paths they travel,” he said.
“If they are in areas they shouldn’t be or start acting irrational, we’ll have a good heads up.”
Rochelle Baker / Local Journalism Initiative / Canada’s National Observer