Two health units in southwest Ontario are dealing with almost 50 confirmed cases of measles and they are urging parents to consider vaccinating their babies early.
Southwestern Public Health serves Oxford County, Elgin County and the city of St. Thomas. At least 12 measles cases have been reported within its jurisdiction since Jan. 1.
Grand Erie Public Health, meantime, represents Brant County, Brantford, Haldimand County and Norfolk County. They have reported at least 37 confirmed cases. As of Tuesday, five of those cases were in adults while the remaining involved children. The latest update come after the health unit reported an additional 15 cases on Monday.
As both areas continue to see case numbers climb, they are encouraging parents to take action to help protect their children from the highly contagious disease.
“Because we’re in an outbreak situation, we’re also asking parents to look at protecting their infants earlier,” Dr. Ninh Tran, Southwestern Public Health’s medical officer of health, said during a media event on Tuesday. “We’re encouraging our local parents to talk to their health care provider about getting a first dose of the measles vaccine between the ages of 6 and 11 months. Your child will still need an additional dose of the measles vaccine after the age of one, but this earlier dose can help infants be greater protected against the health impacts of a measles infection.”
“The younger they are, the more susceptible they are to more serious complications to the disease,” added Dr. Malcolm Lock, Grand Erie Public Health’s medical officer. “I’m already hearing from primary care providers that people are turning up at their clinics not presenting with measles necessarily, but coming in with the complications – ear infections, throat problems and chest problems, related to the complications that can arise. Even though they’re turning up at clinics and they’re diagnosed, when they get there with measles, primarily they are coming not for the measles, they’re coming for other reasons, other complications.”
Precedent for early vaccination
Vaccinating children against measles between 6 and 11 months is not a new concept.
“What has changed is the context,” Tran explained. “It’s been there for years in the sense that if you travel, you go to areas, historically overseas, that have higher rates of measles, that’s always been an option for travellers and for those individuals from those areas and who have a different immunization schedule. The reason Canada and Ontario has traditionally had your first dose at one year and a second dose after that is because that having two doses starting at the age of one year provides much better lifelong protection. Getting that early 5 to 11 months protection has always been safe, has provided protection, but because the immune system is still developing, it’s not the optimal time to provide lifelong protection, so you’d still need those two doses.”
Another reason for the vaccination delay was the illness stopped being a serious concern, due to a drop in infections.
“When Canada had eliminated measles, predominately, that wasn’t really needed. What’s changed now is our implementation of that recommendation because we’ve been having cases in Ontario,” Tran said.
Both medical officers of health said vaccination is key to combating the spread of measles.
“Most of our cases are situated in the Haldimand-Norfolk area, an area that is known to be underserviced when it comes to vaccination coverage,” Lock said.
Both health units said the majority of the cases are in people who are either unvaccinated or under vaccinated.
Serious complications
Symptoms of measles include a fever, a red blotchy rash, red watery eyes and a cough, but it can also cause more serious complications including pneumonia and brain infections, leading to hospitalizations.
“To my understanding, of our 12 cases, 3 of them have been hospitalized this year,” Tran explained. “We know that measles does have complications and some people who do get measles do have complications and do end up in hospital. As case counts grow, we will see a higher number of hospitalizations.”
Lock said he is unaware of any recent hospitalizations within Grand Erie Public Health’s coverage area.
Other symptoms can include ear infection, diarrhea, respiratory failure and encephalitis. Long-term complications can include blindness, deafness and brain injuries.
Unreported cases
Because measles can spread so quickly, both health units are concerned they are only seeing a fraction of the infections.
“I think there are many cases out there that we are unaware of and are unreported,” Lock said. “Some of the cases that get reported to us are anecdotal from other community members that say, ‘I know of a couple of cases in the community,’ that haven’t been reported to us. One area of concern that we have is, generally, when we know of a case, we go into a provincial database to see whether or not any vaccinations have been recorded for that individual. But, of course, if it’s not reported, we can’t do that, so our contact tracing is limited to only those that we know of.”
Exposures at schools
At least two schools have been listed as possible exposure sites: Houghton Public School in Langton and Walsingham Christian School. Both schools fall under the responsibility of Grand Erie Public Health.
Although there are no plans to close the schools at this time, public health is taking steps to try to educate families about what can be done to lower their risk. They are also hosting immunization clinics at the schools and sending information home with students in hopes of reaching parents who may not use the internet, watch television or listen to the radio.
Some students who may have come into contact with a measles case may be out of school for almost a month if they refuse to be vaccinated.
“We’re doing a full survey of students in the school to see where they are in regard to their immunizations,” Lock said. “For those that require boosters, we are trying to encourage them to come to the clinic, or if they are unvaccinated and unwilling for whatever reason, to get another MMR [shot] at the clinic. Then we are excluding them from attending school for the 21-day incubation period.”
Protecting the public
Anyone who is experiencing measles symptoms should stay home and avoid high-risk settings such as doctor’s offices, childcare facilities and hospital emergency rooms.
If someone needs to seek medical attention during a measles infection, they should contact their health care provider before going into their office. That gives staff time to set up proper infection protocols, ensuring the patient can access the help they need without putting other people at the doctor’s office at risk.
Symptoms of measles can appear 7 to 21 days after a person has been infected by the virus and, according to the Government of Canada, they are infectious anywhere from 4 days before to 4 days after a rash appears.
Lessons learned from the pandemic
CTV News asked both health units what they learned from the Covid-19 pandemic that they have applied to the current measles outbreak.
“We learned from Covid that, basically, closing schools is probably not a good idea,” Lock said.
Each virus has a different incubation period and risks, so they had to adapt their recommendations.
“If children are exposed, they’re sent home for 21 days until the incubation period is passed,” Lock explained. “But if we send them home for 21 days, and then we get another case and another exposure, then there’s another 21 days added to that. So, in fact, if we applied that to the school, the schools could be closed for months.”
Tran said professional relationships forged during the pandemic, between the health care community, schools, cultural organizations and local media, have paid off.
“I think that’s been helpful,” he said during the media event on Tuesday.
Lock praised NACI (the National Advisory Committee on Immunization) for acting quickly, alongside the federal and provincial government, to recommend parents consider the lower the age of eligibility for the first measles vaccine in response to the outbreak.
“That’s a thing that we don’t see very quickly, normally,” he said.
Lock also addressed whether mask mandates should be put in place.
“As this is an airborne [virus], it isn’t necessarily, I don’t think, going to provide the level of protection that people would need specifically in health care settings,” he explained. “[Our] numbers for contact tracing are very high.”
Lock also pointed out the outbreak is mostly centered around one specific community.
“These [cultural groups] tend to stick together as a community,” he said. “As far as we’re aware, there’s not a lot of interaction with the general public.”
