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Three weeks after the first confirmed case of measles in southern Alberta, Coaldale Christian School welcomed back all its students and gave them a message to take home: "Parents, please immunize your kids."

Tuesday's request was relayed in a letter from principal Joop Harthoorn, who had to enforce a 21-day quarantine for non-immunized students after measles was confirmed in a Grade 9 boy, the first of now 19 cases in the region. The student had contracted the contagious airborne disease on a trip to the Netherlands, where nearly 2,000 people have been infected since May.

Mr. Harthoorn said he would have sent a letter encouraging immunization before the confirmed case had he been aware there was a risk of a measles outbreak. According to the principal, Coaldale Christian School was never notified that measles might hit the southern region of the province, where immunization rates are dangerously low, 50 per cent in some places.

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"[Alberta Health Services] apologized to our school board," Mr. Harthoorn said. "We don't blame people, but [a warning] would have helped."

Vivien Suttorp, Alberta's South Zone medical officer of health, apologized to the Coaldale School Board for "not specifically communicating with the school principal to discuss the impact of measles in case it was identified in the school."

And yet Dr. Suttorp and AHS did provide warnings, and lots of them, well before the first confirmed case.

In August, Dr. Suttorp met with Southern Alberta school superintendents and outlined what was happening in the Netherlands and in B.C.'s Fraser Valley, which had 12 cases. The opinion was measles could easily be transported into Alberta. Provincial health officials have pointed to several reasons for the low immunization rates, saying some people have grown complacent about the disease and its risks and are more concerned about the vaccine's potential side effects. Others refuse vaccinations due to cultural and religious beliefs.

"We have Dutch connections very clearly in this community," Mr. Harthoorn said of the town of Coaldale. "We would have escaped this whole thing except for unique circumstances [the Grade 9 boy's visit to the Netherlands combined with the lack of measles awareness]. … I have sent a note to advise parents to get their kids' booster shots done, but we don't make it mandatory. It's not mandatory in Alberta. There is freedom of choice."

After meeting with school superintendents, Dr. Suttorp said she visited and spoke at schools with extremely poor immunization rates, some as low as 15 per cent. She did not go to the Coaldale Christian School because its immunization rate was said to be "reasonable." All schools throughout southern Alberta were supposed to have received information on measles and the importance of immunization in early September. An AHS news release was made public on Sept. 25 telling southern Albertans to "get immunized; protect themselves from measles."

Somehow, none of that got through to Coaldale.

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Asked if he recalled receiving measles literature or e-mailed news releases, Mr. Harthoorn replied: "I can't remember seeing anything like that, but it could be my oversight. If we get a letter [from heath officials] we attach it to our newsletter and send it home with the kids."

Both Dr. Suttorp and Mr. Harthoorn said the AHS and Coaldale Christian School were "communicating and collaborating" as soon as the case was confirmed. Efforts are being maintained elsewhere in the province, with two more vaccination clinics in Lethbridge later this month another planned for nearby Medicine Hat.

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