q and a: what does the loss of measles elimination status mean for canadians?
7 minute read
dr. christine palmay, a family medicine specialist, encourages families to stay up to date with their vaccine schedule, including measles and influenza.
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canada officially lost its measles elimination status in november of this year, after nearly three decades. the loss of elimination status was due to outbreaks across the country, which led to 5,208 confirmed cases and two reported deaths.
many people may be worried, wondering what this means for canadians. healthing spoke to dr. christine palmay, a family medicine specialist, to break down why measles is making a comeback and what canadians can do to protect themselves and others from spreading this highly contagious illness.
q: what does elimination status really mean?
dr. palmay: it’s basically a time-recognized control of any outbreaks. so, as of october 2024, we started seeing these massive outbreaks all across canada, particularly in the under-vaccinated patient population, and because we weren’t able to rein that in for 12 months, our status was revoked, right? it’s more so a time duration where we haven’t been able to either reduce outbreaks or contain the ones that have started.
q: why have vaccination rates dropped to the point of all these outbreaks?
dr. palmay: it’s a combination. even before the pandemic, our measles vaccine rates were already dropping which is a separate concept to outbreaks. and then, of course, the pandemic happened, where access became an issue. children’s vaccination rates are limited simply because, you know, we weren’t accessing doctors in the same way, and they’ve actually done research, and it’s quite funny when they’ve polled canadians. it’s not actually a lack of awareness, but it’s more so a lack of access. you know, certainly, here we have a dwindling primary care force. pediatricians generally don’t become clinic-like pediatricians anymore—primary care used to be the hub for vaccines. we’re still trying to make up for lost time by including pharmacists and broadening the scope of the definition of primary care. but we still haven’t necessarily caught up, so that trend started pre-pandemic, then of course, the pandemic to a certain extent changed.
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it highlighted some anti-vaxxers, but the real tragedy is that it’s an access issue. so, i’ll give you an example. because of school closures and the pandemic, public health programs within schools also closed. so, there was a cohort of children that obviously advanced in their scholastic achievement, advanced to other grades and the public health clinics when they first opened, they weren’t all open, and they were open during school hours. well, that was brilliant planning, right? people really didn’t know that they were even due for vaccines.
during covid, what about baby checks? i mean, in the throes of covid, nobody was leaving their house, and the message was to stay home unless it’s absolutely necessary. in my humble opinion, vaccines are absolutely necessary. go for vaccines. the message was too black-and-white.
q: what should families know about measles now that the status is gone?
dr. palmay: as of today, it doesn’t really change day-to-day activities, right? the big concept is that if travellers are coming to canada, they’re going to be told that we’re no longer an elimination-free country and there’s going to be emphasis on vaccines. but i think that’s a herald for disasters down the way. we know that we’ve lost our vaccine status because of outbreaks, which are very much tied to unvaccinated communities. so, making sure that you’re getting your fundamental vaccines, not just measles. but the problem with measles is that it is probably the most contagious virus ever.
pre-immunizations, it was the biggest infectious disease killer, more so than influenza. so, if you walk in ontario, you know, those small ontario towns, i think every school should have a field trip, as morbid as it sounds, to a cemetery because you always see these little baby graves, right? presumably. i mean, there were a lot. to a certain extent, being born or birthing was a kiss of death until medical interventions came in. but a lot of those babies before 12 months died because of infectious diseases, and we’re so far removed from that. so, as of today, it means a warning. it means it’s not the time to even consider, but to rush to make sure your vaccine statuses are up to date.
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q: what specific factors could increase the risk of severe outcomes for the children?”
dr. palmay: i don’t want to be the bearer of bad news, but i think to a certain extent it’s tragic. people say it’s embarrassing that we lost our elimination. it’s a bit embarrassing, but it’s more tragic. but what’s going to be more tragic is if we don’t respond to this.
what happens in the throes of the canadian winter, where people are already challenged because of the myriad other vaccines? it’s also a time period where it means it’s a perfect storm. i’ve talked about this in influenza. everybody’s inside because it’s cold. everybody’s gathering because that’s what we do. we celebrate holidays, and the young are getting mixed up with the old and vice versa.
it’s this wonderful breeding ground for vaccine-preventable diseases. you think about influenza, but you think now influenza, rsv, covid-19, all those horrible types. but what about a pregnant woman who doesn’t know she’s pregnant because it’s in the early stages, and she gets together with her extended family and somebody passes it on? i mean, those things sound so far-fetched, like you go to the grocery store, you touch an apple, even though you don’t have influenza, the influenza gets transmitted on the apple, and then an old person takes the apple and goes home. that’s those horrible movies, 12 monkeys or whatever. it starts like that. it’s one case, and then you can see how the web expands, and measles is incredibly contagious.
q: how can people recognize the symptoms if they do develop measles?
dr. palmay: that’s an excellent question. they’re very vague to begin with. you know, watery eyes. you have a blotchy rash. you may or may not have a fever, of course. but the problem is that people are seeking, you know, medical attention, and you don’t want to do that for measles, unless you need to go to the hospital.
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the whole idea of consulting primary care is maybe getting on the phone and asking for advice. and if you really think that you have measles, public health has some wonderful signs and symptoms, but the idea is to stay home and use telehealth and only if you are significantly distressed, call an ambulance and mention that you think you’re contagious, because that will develop a whole quarantine.
q: can you get symptoms if you’ve been vaccinated? should you get vaccinated again as an adult now that we’ve lost elimination status?
dr. palmay: usually, vaccine status is protective. nothing’s 100 per cent, but our immunity also depends on a level of herd immunity in the community. and if i think it’s over 90 per cent needs to be vaccinated to really, really say we’re safe. that’s changing.
we don’t have a vaccine registry. that’s not only tragic, but that’s also an embarrassment. so, we can’t really track those yellow cars that may or may not be in some bottom drawer. i think pushing for a vaccine registry to track actual vaccine status is very important.
it’s not so simple. but the point being, if you’re not sure about your vaccine status, the rule of thumb is just to get vaccinated, right? so, i have many immigrants who come to this country, i mean, they don’t know, and if they don’t know, i vaccinate them. it depends on how old you are and whether you’re travelling. my suggestion is for people to contact their public health unit (to see if they’re vaccinated).
q: in terms of restoring elimination status, what does that look like?
dr. palmay: if we can contain outbreaks for a year.
q: what can the public do to prevent measles from spreading outside of getting their vaccinations?
dr. palmay: stay home if you think that you have measles, right? just pass on the message, particularly for those most vulnerable. check if you need a booster if you’re travelling to high-risk areas. so, for example, if you’re bringing your infant out of the country. our ontario coverage, your measles vaccine is at, as i said, 12 months and that vaccine, if it’s early, doesn’t count in terms of long-term immunity. but if you’re travelling to a country where there is a concern about an outbreak, give the vaccine early to your baby. they’ll still have to get the 12-month one. it just means we’ll have three doses as opposed to two.
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q: is canada considered a high-risk area now?
dr. palmay: yes, because we’ve lost our elimination status.
q: is there a chance that anything else can make a similar comeback? what about other eradicated diseases?
dr. palmay: absolutely, in theory, yes. it’s just that measles happens to be incredibly contagious, which is why it has penetrated through so quickly.
q: is there anything else you think is important for readers to know about measles and canada’s loss of elimination status?
dr. palmay: the whole concept of making sure that we’re just keeping up with vaccines in general, not just measles, not just influenza, but all those other childhood immunizations, the school-based programs, et cetera, it’s all very important.
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