With measles cases increasing worldwide, including nine cases in Vancouver, Canadians are being urged to ensure they are fully vaccinated.
Quebec has seen only a handful of measles cases in recent years and the vaccination rate in the province is relatively high, but local public health officials are nonetheless warning against complacency.
“Measles is a disease that doesn’t need a lot of susceptible individuals to start a serious epidemic,” said Dr. Gaston De Serres, an epidemiologist and expert on vaccination with the Institut national de santé publique du Québec (INSPQ).
Canada’s Public Health Agency issued a statement this week reminding Canadians to ensure they are fully vaccinated against measles, especially if they are travelling outside the country. The alert was in response to an outbreak of nine cases in Vancouver, which was tracked to an unvaccinated Canadian child who reportedly contracted the disease on a family trip to Vietnam.
Measles causes high fever, coughing, sneezing and a widespread painful rash. The infection can lead to serious complications, such as pneumonia and encephalitis, and can be fatal. The chances of contracting measles are greatly reduced by being fully vaccinated. According to Quebec’s immunization program, children should receive two doses of the Measles-Mumps-Rubella vaccine — the first soon after their first birthday, and the second at 18 months. Adults born after 1970 should also be fully vaccinated.
Quebec’s vaccination rates for measles have been improving over the past decade. An INSPQ study shows that in 2016, 94 per cent of Quebec two-year-olds had received both doses of the measles vaccine, up from 88 per cent in 2006.
Quebec had only four recorded cases of measles last year, and most years see fewer than that. But outbreaks are not unknown here. In 2015, an outbreak in the Lanaudière region affected 163 people. And the largest measles outbreak in North America in a decade occurred in Quebec in 2011.
A total of 725 people contracted measles in Quebec that year, with 678 cases stemming from one adult who may have contracted the disease while on holiday in the Caribbean or at the Montreal airport. The person had received only one of the two recommended doses of measles vaccine as a child and worked at a high school in Drummondville. The person was in contact with several groups of students before being diagnosed. A total of 110 students and four other staff members subsequently contracted the disease. The school outbreak spread to a nearby rural town. A subsequent investigation of the school where the outbreak began revealed that 4.7 per cent of students had received no dose of the measles vaccine.
Measles are on an upswing globally, with serious outbreaks occurring in Africa, Asia, South America and Eastern Europe, as well as smaller outbreaks in the U.S.
“We seem to be in a period where it is rising. So it’s sure that the risk of importation in those years is higher,” said De Serres. “We’ve seen some outbreaks in the U.S. of 30 or 40 cases. Those are relatively confined outbreaks. But this illness is one of the most contagious, so we have to maintain very good vaccination rates.”
People who cannot be vaccinated, including infants, people with certain underlying health conditions and those undergoing chemotherapy, rely on high levels of immunity within communities to protect them from the disease.
De Serres calls Quebec’s high vaccination rates and relatively low illness rates “reassuring.”
“But if people start to decide not to vaccinate, this illness can come back very fast. With this illness, as soon as you get fewer people vaccinated, it finds these people and it takes off.”
Caroline Quach, a pediatric infectious disease specialist at Ste-Justine Hospital, said Quebec could do even more to make sure adults and children have every opportunity to be vaccinated.
One reason some parents may not be getting the full roster of recommended shots for their kids, she said, is that many pediatricians stopped vaccinating in 2017, when Quebec abolished their right to charge patients incidental fees for that service.
“From my standpoint, every opportunity to vaccinate should be used to vaccinate. So (if) you are in hospital and you’re leaving and you are not up to date, you should be vaccinated upon discharge. If you are seen in the ER for something and somebody has the time to vaccinate you, you should be vaccinated.”
As for measles, she said now is the time for everyone to ensure they and their children are fully protected.
“People should get vaccinated. This is a vaccine-preventable disease which can cause mortality. It is not a benign disease.”