For Canadian health-care officials, it was never a matter of “Will we get a measles outbreak?” It was about knowing that one of the world’s most infectious diseases would find a way to spread into parts of Canada, especially in areas where immunization rates are dangerously low.
And that’s how it happened.
What started in the measles-plagued Netherlands wound up in Southern Alberta and B.C.’s Fraser Valley. What is still racing through the Philippines, infecting thousands and killing 23, has been found in Southern Ontario.
The other side of the planet got it first; we got it later. Health experts could see it coming.
On Saturday, a case of measles was confirmed in an infant in Brampton, Ont. The child tested positive for the virus after being on a March 25 flight from Abu Dhabi to Toronto. Health officials have issued an alert to all the passengers on the same flight.
In Calgary, after two Western Canada High School students were stricken with measles, 100 unimmunized students at Western Canada were ordered to stay home until they could provide proof of vaccination. Last week, two students from the school were stricken with the measles. They also visited a pair of Calgary restaurants on March 24 and 25, which prompted a public warning for other diners on those two occasions. Manitoba now has four cases of measles, while Southern Ontario has had cases from Hamilton (three) to Ottawa (four).
“What’s going on is not unusual, particularly in Southeast Asia and Africa,” said Shelley Deeks, medical director, immunization and vaccine-preventable diseases with Public Health Ontario. “It is continually happening there, which is why it is so important for Canadians to maintain a high vaccination rate and for travellers to make sure they’re up-to-date on their vaccinations.
“We have to want it gone everywhere,” Dr. Deeks added, “before we can feel comfortable.”
Measles was never gone completely, not in countries such as Vietnam, Turkey and Italy. In the Netherlands, the most recent run of measles began in the country’s designated Bible Belt, an area occupied by conservative Protestants who refuse to vaccinate their children. That belief allowed the disease to go on a rampage, infecting more than 2,000 people with at least one death connected to the outbreak.
In Southern Alberta, it was a student who spread the disease after a visit to the Netherlands. The importation resulted in 42 confirmed cases in southern Alberta before the outbreak was declared over. As for the Fraser Valley and its 353 cases, it began with two students at a Christian school in Chilliwack, B.C.
But the numbers have been more severe in the Philippines due to a lack of immunization and health care in the country’s poorer regions. Health-care infrastructure there was pushed to the limit after massive Typhoon Haiyan struck six months ago.
Health assistant secretary Eric Tayag of the Philippines said many victims of Haiyan came to Metro Manila and “they may have lacked anti-measles shots or not have been vaccinated at all.” But, he quickly added, “We are not pinning the blame on the calamity victims.”
With the measles virus on the loose, its introduction into Canada was inevitable. People travelled, contracted the disease, then brought it home to share. And where immunization rates were low, there was plenty of measles to go around for all.
“In Ontario, my impression is all the cases have been identified and so are people who have returned from travelling to other countries where there have been outbreaks,” said Danielle Martin, vice-president of medical affairs and health solutions at Women’s College Hospital in Toronto. “That’s why we have to keep educating people on the need to be vaccinated.”
The Measles & Rubella Initiative – a global venture that involves the World Health Organization, the United Nations Foundation and the American Red Cross, to name but three partners – reports there were 122,000 measles deaths worldwide in 2012, about 330 deaths a day. On the bright side, more than one billion children in high-risk countries have been vaccinated against measles since 2000.
It’s one victory in an ongoing battle.
A brief history
Measles is the most contagious and deadly of what were once called the routine childhood illnesses.
Before a vaccine became widely available in 1963, virtually every child contracted the measles; traditionally, there were epidemics every two to three years, affecting up to 350,000 children and filling hospitals.
Measles is recognizable by lesions in the mouth known as Koplik’s spots, and a rash made up of large, flat reddish-brown blotches. For most, measles will run its course after a week of itching. But the real danger is fever, which can lead to pneumonia, meningitis and encephalitis.