Step up measles vaccinations, say doctors as outbreaks accelerate in Ontario, Alberta
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Doctors are urging public health officials in Ontario and Alberta to step up vaccination and messaging efforts as measles outbreaks in those provinces continue to grow.
Ontario reported 223 new confirmed and probable infections of measles over the past week. As of May 2, a total of 210 confirmed measles cases were reported to Alberta Health.
"That's the largest single week increase since the outbreak began in October of 2024," said Dr. Sarah Wilson, a public health physician with Public Health Ontario.
"A lot of important developments in the last week, unfortunately."
The bulk of Ontario's cases are in the Southwestern Public Health region that includes the city of St. Thomas and surrounding counties.
In a sign of how serious measles can be, Public Health Ontario reported 84 people have been hospitalized — including 63 children — during the outbreak. Eight patients were hospitalized in the last week, including seven who needed intensive care, Wilson said.
The vaccine-preventable disease commonly causes fever, cough, red watery eyes and, later, a blotchy rash.
Because the measles virus is so infectious, it can spread rapidly among those who have not been vaccinated, even if most people in a community are immunized. Public health authorities aim for 95 per cent of people in a community to be protected from measles to prevent outbreaks.
But vaccination rates are nowhere near that in many places, for a variety of reasons — from disruptions caused by the COVID-19 pandemic, to vaccine misinformation proliferating online.
While current top provincial doctors have said little, or nothing at all, since the outbreak began, one doctor didn't mince words during a recent lecture at the University of Alberta.
"I think there has been a complete failure of leadership at all levels, and there's public complacency," said Dr. Mark Joffe, Alberta's former chief medical officer of health, whose contract ended about two weeks ago.
The Canadian Immunization Guide recommends kids get their first routine dose of measles-containing vaccine at 12 to 15 months of age and the second dose at 18 months but no later than when the child starts school.
Children who aren't yet vaccinated are most at risk, doctors say. The Public Health Agency of Canada says people who are at higher risk of developing severe complications from measles include those who are pregnant, people with weakened immune systems and children who are less than 5 years of age.
In Ontario, vaccination coverage to protect seven-year-olds from measles ranged as low as 24.6 per cent in the 2022-23 school year in Halton Region, which includes the city of Oakville, according to the most recent publicly available data.
In terms of having 95 per cent of people immunized to prevent outbreaks, only the public health unit for Kingston and surrounding areas met that goal for seven-year-olds in Ontario.
In Alberta, no public health unit reached that threshold, according to the latest provincial data from 2023.
In Oakville, Ont., Dr. Joanna Oda, an associate medical officer of health for Halton Region, thinks vaccination rates in that region may be higher than what public records show due to underreporting.
"Our experience is actually most people are immunized, most people want to be protected," Oda said. "They just don't know how to report. They didn't know they needed to report."
In Ontario and New Brunswick, parents and caregivers are required to report student vaccine records to public health to enforce legislation like the Immunization of School Pupils Act. The act requires proof of immunization for students to attend school, with exceptions just for medical or ideological reasons.
During the height of COVID, Oda said limits on in-person appointments and the diversion of health care resources away from preventative care like immunization created barriers to routine childhood vaccinations. Now, lack of access to primary care providers continues to limit access to vaccines even for willing families, she said.
Countering misinformationBut access to vaccinations isn't the only problem. Countering anti-vaccine misinformation is another challenge.
Michael Gardam, an infectious diseases physician based at Women's College Hospital in Toronto, called it unfortunate, but also not surprising, that measles vaccination rates in Ontario fell so low. He'd like to see provincial public health messaging promoting uptake of the measles vaccine.
Gardam said what's new is how prevalent misinformation about vaccines is on social media. It can come from anywhere in the world and spread in Canada, while news stories are blocked on Facebook and Instagram in this country.
"While you're trying to message positively and meet people halfway and understand their concerns, there is an entire group of people whose sole purpose in life is to undermine everything that you're saying," Gardam said.
Joffe, Alberta's former top doctor, said before he left his post, he was speaking with colleagues about low immunization rates, and the need to get information about measles to people who don't interact with the government closely.
"We need to meet them, and explain in their language, and in a way they can understand. And we need to work with faith leaders and community leaders, cultural leaders who have a big influence."
CBC News has repeatedly requested an interview with Dr. Kieran Moore, the chief medical officer of Ontario, within the Ontario's Ministry of Health, and Dr. Sunil Sookram, Alberta's interim top doctor. Neither have been made available.
Ontario Health Minister Sylvia Jones defended Moore on Thursday, saying he is working behind the scenes on controlling the measles outbreak. Moore directed local public health units 18 months ago to refocus their effort to ensure childhood vaccinations were up to date, Jones said at an unrelated news conference.
"He's been working incredibly hard and I just want to acknowledge and thank him for his work with the public health units," Jones said.
More recently, Jones said the province restarted a public education campaign, on Moore's recommendation, to help parents and caregivers understand the importance of getting vaccinated to protect against measles.
No deaths have been reported in Canada during the current outbreak, which began in October 2024. According to the Public Health Agency of Canada's website, death occurs in one to 10 of every 10,000 cases of measles in higher income countries.
Countering complacencyDr. Allison Gonsalves, a medical officer with Alberta Health Services in the province's South Zone, pointed to several reasons why children may not be fully vaccinated against measles, including vaccine hesitancy and misinformation.
"There's the issue of complacency," Gonsalves said. "A lot of people think that measles is benign and it's absolutely not."
Gonsalves's team lead has been discussing vaccine concerns with families in communities with particularly low immunization uptake, she said.
"Our teams have been noticing an increase in calls to public health for immunization for MMR [measels, mumps and rubella] in particular," Gonsalves said. "We've seen an increase of about 78 per cent uptake in measles-containing vaccine in April alone compared to March," for the South Zone.
Shelley Duggan, president of the Alberta Medical Association, said average measles immunity in Edmonton and Calgary is a little above 70 per cent, but it falls as low as 10 per cent elsewhere in the province.
"I think that public health really needs to step up at this point," Duggan said. "This is a grave, grave concern."
Duggan called for weekly public updates from the chief medical officer of health and additional vaccination clinics, including pharmacies, to make it easier to receive measles immunizations.
"Public health needs to be front and centre trying to educate Albertans on what measles is, that the vaccine is safe."
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