Decades ago, measles seemed like a disease on the run. Since vaccinations were introduced, millions of lives have been saved and what was once a common childhood illness is now a distant memory for many Canadians. But now, health officials warn that the world’s blanket of immunity has some holes in it. For the World Health Organization, “vaccine hesitancy” is one of the biggest global health threats of 2019. Here’s what you need to know about the disease and its resurgence in Toronto, Vancouver and around the globe.
Measles cases and deaths are on the rise and in many countries, it’s linked to falling vaccination rates. Dr. Natasha Crowcroft of Public Health Ontario discusses the importance of getting vaccinated and offers some reliable resources to be informed about measles and vaccinations.
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How is measles spread and what does it do? A visual guide
Measles spreads through
respiratory transmission – coughing and sneezing
Infection can occur when
someone breathes air
containing the measles virus...
Or touches an infected surface and then touches their eyes, nose or mouth
WHAT ARE THE SYMPTOMS OF THE VIRUS?
Symptoms begin seven to 18 days
after exposure
Three to seven days after symptoms begin, a red blotchy rash develops on the face and spreads down the body
Irritability and
sleepiness
Red eyes
Runny nose
White spots may appear inside the mouth or throat
Cough
Fever
SOME FACTS ABOUT THE VIRUS
The measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed
There is no cure
Most people fully recover within three weeks. But the illness can trigger dangerous conditions, such as swelling of the brain (encephalitis) leading to seizures, hearing loss or even death
MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: Centers for Disease Control and Prevention, Health Canada, WHO
Measles spreads through respiratory transmission – coughing and sneezing
Infection can occur when someone breathes air containing the measles virus...
Or touches an infected surface and then touches their eyes, nose or mouth
WHAT ARE THE SYMPTOMS OF THE VIRUS?
Symptoms begin seven to 18 days after exposure
Three to seven days after symptoms begin, a red blotchy rash develops on the face and spreads down the body
Irritability and
sleepiness
Red eyes
Runny nose
White spots may appear inside the mouth or throat
Cough
Fever
SOME FACTS ABOUT THE VIRUS
The measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed
There is no cure
Most people fully recover within three weeks. But the illness can trigger dangerous conditions, such as swelling of the brain (encephalitis) leading to seizures, hearing loss or even death
MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: Centers for Disease Control and Prevention, Health Canada, WHO
Measles spreads through respiratory transmission
– coughing and sneezing
Infection can occur when someone breathes air containing the measles virus...
Or touches an infected surface and then touches their eyes, nose or mouth
WHAT ARE THE SYMPTOMS OF THE VIRUS?
Symptoms begin seven to 18 days after exposure
Irritability and
sleepiness
Three to seven days after symptoms begin, a red blotchy rash develops on the face and spreads down the body
Red eyes
Runny nose
White spots may appear inside the mouth or throat
Cough
Fever
SOME FACTS ABOUT THE VIRUS
The measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed
Most people fully recover within three weeks. But the illness can trigger dangerous conditions, such as swelling of the brain (encephalitis) leading to seizures, hearing loss or even death
There is no cure
MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: Centers for Disease Control and Prevention, Health Canada, WHO
The battle against measles: A history
April 16, 1967: A lineup of children forms at one of the five measles immunization clinics in London, Ont., in the first one-day blitz on the disease in Canada.James Lewcun/The Globe and Mail
Measles is one of the most contagious viruses in the world, and if you grew up before the 1970s, chances are you contracted it as a child and recovered. But millions of children weren’t so lucky: By the World Health Organization’s estimates, 2.6 million people were killed by measles each year before a vaccine was introduced in 1963. Children under 5 are especially at risk, particularly those affected by malnutrition.
Vaccination didn’t eradicate the disease in Canada, as smallpox and polio were eradicated, but it made people much less likely to catch it from one another. Since 1983, Canadians typically get a combined shot as infants against measles, mumps and rubella (MMR). Statistics Canada estimates 89 per cent of Canadians are vaccinated against measles by the age of 2.
Chicago, 2010: Dr. Andrew Wakefield addresses a gathering hosted by the American Rally For Personal Rights.Charles Rex Arbogast/The Associated Press
But in the late 1990s, a global backlash against the MMR vaccine began thanks to British researcher Andrew Wakefield, who published a study in The Lancet medical journal in 1998 claiming a link between the vaccine and autism. The study, and Dr. Wakefield’s conclusion that MMR should be phased out, sparked a global panic. But investigations by journalist Brian Deer in the 2000s revealed that Dr. Wakefield, who patented and was trying to market his own alternative to MMR, cherry-picked patients to fit his conclusions and used dubious methods to gather the data. The Lancet retracted the study in 2010, and the British Medical Journal denounced the whole affair as an “elaborate fraud.”
But by this point, an array of activist groups were championing the idea that childhood vaccinations were dangerous, and that laws and policies requiring them should be struck down. Celebrity spokespeople such as actress Jenny McCarthy urged parents to stop vaccinating their children. U.S. public-health officials began seeing pockets where lack of vaccinations increased the risk of disease outbreaks.
In recent years, the WHO has been sounding an alarm about the global risks of “vaccine hesitancy” as more measles outbreaks emerge around the world. In 2017, a worldwide surge in measles cases led to an estimated 110,000 deaths worldwide. Those outbreaks could have been prevented if global coverage with the first dose of vaccine reached 95 per cent, the WHO said, but rates stalled at 85 per cent. Canada’s vaccination rates have been falling, but it’s hard to get reliable data on where herd immunity is weakest because there’s no standardized national network of immunization registries.
Most recently, the Vancouver area has seen a measles outbreak with as many as 23 cases, up from one case in 2017 and two in 2016. British Columbia, like most provinces, doesn’t legally require children to be vaccinated; it doesn’t even require their vaccination status to be registered, though the province’s Health Minister says there may be a system ready to do that by September of 2019. New Brunswick, Ontario and Manitoba do make measles vaccination mandatory, though parents can opt their children out on religious or medical grounds. One Ontario study based on the 2016-17 school year warns that in some parts of the province, three to five per cent of children aged 7 to 17 have no record of being vaccinated and have non-medical exemptions on file. So far this year, Ontario and Alberta have seen one confirmed case of measles each and warned that others may have been exposed.
What can I do?
A measles, mumps and rubella vaccine on a countertop at a pediatrics clinic in Greenbrae, Calif., in 2015.Eric Risberg/The Associated Press
Vaccinate your children: Canada’s health agencies stress that vaccines are safe and necessary to the herd immunity that keeps measles from spreading. If you have questions about your kids’ vaccinations, ask your family doctor.
Get informed about vaccination policies near you: Most provinces don’t legally require childhood measles vaccinations, but there may be other policies at the school-board level. Some provinces grappling with outbreaks, such as B.C., are also considering new measures to register immunizations and respond to outbreaks. Ask your local representatives or school officials to find out what’s going on where you live.
Get informed when travelling: The Public Health Agency of Canada issues health notices for disease cases around the world that might affect Canadians travelling there. So far, measles outbreaks in the United States, Europe, South America and Africa and the Philippines have only reached the “Level 1” stage, at which travellers are reminded to check their vaccinations before travelling and wash their hands.
More reading
From the archives: The Wakefield study and MMR scare
Profile: Meet Brian Deer, the man who broke the vaccine-autism scandal
Comment and analysis
Denise Balkissoon: Toronto parents vaccinate their kids. Then, they’re punished with paperwork
Public Editor: No need to offer ‘false balance’ to anti-vaxxers
Compiled by Globe staff
With reports from Carly Weeks