Vaccination gap has local officials scrambling as measles cases surge around the world

Just 59 per cent of seven-year-olds in the city have been immunized against measles, according to the latest estimates from Ottawa Public Health.

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Published Feb 08, 2024 • Last updated 17 minutes ago • 6 minute read

Getty images Measles is entirely vaccine-preventable and was previously eliminated in Canada because of high vaccination rates, but it is making an explosive comeback globally. Photo by Getty Images

As measles cases explode around the world, Ottawa Public Health officials are racing to close a potentially worrisome immunization gap among young children in the city.

That effort is made more difficult because they don’t know how big the gap really is.

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According to the latest estimates from Ottawa Public Health, just 59 per cent of seven-year-olds in the city have been immunized against measles, something children usually receive in two doses as part of routine vaccinations.

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In contrast, 95 per cent of 17-year-olds in the city are fully vaccinated against measles. At least 95 per cent of the population must have immunity to the virus — through vaccination or previous infection — in order to prevent outbreaks of the disease that is characterized by a rash.

In a statement, Associate Medical Officer of Health Dr. Laura Bourns said the 59 per cent figure is an underestimate. Ottawa Public Health (OPH) does not have a more accurate number, but believes vaccination rates are lower than they were before the pandemic. Measles coverage rates for seven-year-olds ranged from 95 per cent in 2016-17 to 87 per cent in 2018-19. Nationally, the most recent measles coverage number for that age is 79 per cent.

Children are required to have had two doses of MMR (measles, mumps and rubella) vaccines by the time they start school. Public health focuses surveillance efforts on seven-year-olds because their second dose of the vaccine is usually given between ages four and six.

OPH and other health organizations are running special immunization clinics to help those who missed routine vaccines catch up.

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Public health is also notifying parents and caregivers of students whose records show they are missing one or more immunizations they need to attend school. It sent more than 16,000 notices late in 2023 and is preparing to send more to those who didn’t respond the first time. In some of those cases, it is likely the child was vaccinated but it didn’t show up in their records, information that will help clarify real immunization coverage rates in the city.

Bourns warned, in a statement, that it is important for high vaccination rates to be maintained.

“The re-emergence of certain vaccine-preventable diseases is being seen in different parts of the world and is a cause for concern,” she said. “Through immunization programs, we have been able to significantly reduce the incidence of many of these diseases in Canada. However, there is a risk of re-emergence of vaccine-preventable diseases like measles if high vaccination rates are not maintained.”

The pandemic disrupted routine childhood vaccination in Canada and around the world. In Canada, a shortage of primary caregivers has added an additional barrier to childhood vaccination for some families. Those are among the reasons that measles, which is entirely vaccine-preventable and was previously eliminated in Canada because of high vaccination rates, is making an explosive comeback globally.

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Measles is one of the most contagious diseases. If one person has it, up to 90 per cent of people close to that person who are not immune will become infected. Measles can live up to two hours in the air after an infected person has left the room, which makes gaps in immunization especially worrisome.

In recent days, public health organizations around the world have been warning about the rapid spread of measles and how quickly it can spread through travel. There have been thousands of cases throughout Europe, a sharp increase over last year. In the U.S., the Centers for Disease Control has warned people to remain vigilant and confirmed dozens of cases. There have been a handful of cases in Canada, including one confirmed this week in Montreal.

Dr. Kelley Zwicker is a pediatrician at CHEO and has been involved in founding the Ottawa Community Pediatricians Network. Photo by Ashley Fraser /Postmedia

Doctors on alert

Many physicians, especially those who treat children, are on alert to watch for a disease they might have never seen during their years in practice.

“I have seen one case,” said Dr. Kelley Zwicker, a pediatrician who works at CHEO and was involved in founding the Ottawa Community Pediatricians Network.

Zwicker said physicians need to remind themselves when they see children who are ill — and might have a rash and other symptoms — to think of measles as a possible diagnosis, something that many are not used to doing.

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“Measles is not what pops into our heads, it is not automatic yet.”

Dr. Michelle Barton, chair of the infectious disease committee with the Canadian Pediatric Society, said vaccination coverage figures are worrisome.

“The fact that we don’t have 95 per cent coverage is a real problem. We think we are really on the brink of potential challenges,” she said.

“We want to emphasize the public needs to be aware there are measles outbreaks going on globally. Everybody who needs to be immunized should be immunized. It is preventable and measles causes morbidity and it can cause death.”

OPH has information available for health-care providers on measles, including signs and symptoms, lab testing and other resources.

Tracking vaccination rates difficult in Ontario

Part of the difficulty for public health officials is that the system of keeping track of vaccination rates in Ontario is cumbersome and inefficient.

With the COVID-19 vaccine, public health officials could see in real-time how many people, and who, has been vaccinated. That is not the case with routine vaccinations such as measles.

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Although there are ongoing efforts to improve the system — some already in the works — many people still use yellow vaccination cards to record their, and their children’s, immunizations. That information must then be given to public health officials to confirm their children have the required vaccines to attend school, unless they have a medical or non-medical exemption.

Many families lose track of those cards or are not aware they have to pass the information on to public health. Public health surveillance helps ensure that information is passed along for children who are already vaccinated, and that children who are not have access to vaccinations. But a pause in that surveillance process between 2020 and 2022 because of the pandemic created a gap in reporting of immunization records to Ottawa Public Health.

“The result: The completeness of our immunization record system has decreased and coverage rates calculated using these data likely underestimate true coverage in the population,” said Bourns.

Between 2014 and 2019 there were nine confirmed cases of measles in Ottawa residents, the most recent in 2019. Because of high vaccination rates, those cases did not spread widely.

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Children receive two doses of measles vaccine: the first at 12-15 months and the second between four and six years of age.

Adults born before 1970 are assumed to have natural immunity to measles. Once infected, people are immune for life.

Adults born after 1970 should have one or two doses. A second dose of MMR vaccine is recommended for adults who are at high risk of being exposed or exposing others to the disease. Those unsure of their vaccination status should contact their primary caregiver, if possible.

What to know about measles

Symptoms of measles may develop between seven and 21 days after exposure to an infected person. They include a high fever, runny nose, cough and red eyes. Infected infants can become drowsy and irritable. Small white spots may appear in the mouth and throat. A red blotchy rash begins to appear on the face three to seven days after the start of symptoms, then spreads down the body to the arms and legs. The rash usually lasts between four and seven days. Measles is highly contagious from four days before the rash to four days after. Some people can suffer severe complications from measles including encephalitis, pneumonia or even death in some cases. Ottawa Public Health follows up with all people with suspected or confirmed cases of measles and their contacts. OPH might advise those exposed to stay home, get tested or treatment, or to get vaccinated. Family doctors and walk-in clinics offer vaccines for measles (which is combined with vaccines for mumps and rubella and is known as the MMR vaccine). OPH also has special clinics.

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