As a result of complications, about one in five children who contract measles will be admitted to hospital and approximately one in 1,000 will die.
Canadians born before 1970 are assumed to have contracted measles and are likely immune. Most people who were vaccinated will be protected, but the quality of the vaccine has improved over the years and immunity can wane over time. People with compromised immune systems – such as those with cancer, heart disease, COPD, as well as pregnant women and babies – are most at risk.
Measles is highly contagious: A carrier typically infects 12 to 18 others who are unvaccinated and six to seven who are partially vaccinated. (By comparison a person with the flu infects one to three others.) The measles vaccine is typically administered in two doses along with mumps and rubella vaccine in a shot called MMR. The first dose is given at 12-15 months of age, and the second before entering school at age 4-5.
Why doctors should tell, and not ask
Parents are more likely to agree to vaccination when pediatricians leave no room for argument, according to a study published in December, 2013, in the journal Pediatrics.
The study, conducted in the Seattle area, found that 83 per cent of parents resisted vaccine recommendations when physicians used language that implied giving latitude, such as “What do you want to do about shots?”
In contrast, when pediatricians used presumptive language – “Well, we have to do some shots” – 26 per cent of parents balked, the researchers found.
Doctors call it the “tell, don’t ask” study, said Noni MacDonald, a spokeswoman for the Canadian Paediatric Society and a pediatric infectious disease specialist at the IWK Health Centre in Halifax.
The key, she said, is that doctors emphasize the positives of immunity, and not be dismissive of a parent’s concerns. For example, a doctor could explain to a parent concerned about mercury that a small number of vaccines may contain ethylmercury – which does not accumulate in the body and is considered safe – but vaccines never contain methylmercury, an entirely different compound that causes mercury poisoning.
“Too often we have not focused on the positive,” Dr. MacDonald said.
Doctors also need to tailor their messages to a parent’s socio-economic status, she noted.
Highly educated parents may respond more to evidence-based information about the risk of tetanus, for example, than to a doctor’s recollection of treating an unvaccinated child with tetanus who almost died. For many parents, she said, “stories are more compelling than facts.”
Should vaccination be mandatory for health care workers?
While it was once assumed all nurses and other health-care workers were immunized, that is no longer the case. Measles has an eight- to 12-day incubation period, during which health-care workers could be showing no symptoms of the disease yet be infecting immuno-compromised patients. According to the Public Health Agency of Canada’s Immunization Guide, some health-care jurisdictions are looking at making vaccination a condition of employment. Currently, it’s a patchwork system of differing requirements. Here’s a look at what’s happening at some of Canada’s top children’s hospitals:
At the Alberta Children’s Hospital in Calgary, it is “strongly recommended” that health-care workers get the measles vaccine, but it’s not mandatory, confirms Judy MacDonald, medical officer for Calgary. Although it was decided last year after outbreaks that health-care workers “need to have a higher bar” when it comes to vaccinations – and should be required to have two documented doses of the measles, mumps and rubella vaccine recorded and on file – no change to policy has been made.
At Sick Kids Hospital in Toronto, new employees must prove they have had two measles, mumps and rubella vaccinations to ensure workers comply with the measles surveillance protocol developed in part by the Ontario Medical Association. For employees hired before 2013, there is a medication catch-up process outlined in the surveillance protocol. The hospital then records who has been immunized and who hasn’t.
Ottawa’s Children’s Hospital of Eastern Ontario also keeps tabs on which staffers are immune. Vaccinations are encouraged but not compulsory.
Vaccination is not mandatory at the B.C. Children’s Hospital. Eva Thomas, corporate director for infection prevention and control, said that while they would like all their staff to be vaccinated, “we don’t know who has been [and who hasn’t].” Those records are with the occupational health department of the B.C. government.
Alan Maki with a report from Justin Giovannetti
Editor's note: This is a corrected version of the story that referred to the Measles and Mumps Initiative. The correct name is the Measles and Rubella Initiative.