A measles alert sign hangs outside the entrance to the Cohen Children's Medical Center, where the state health department confirmed that a baby tested positive and that there is a possibility of exposure to others at the facility, in New York, on March 14.Shannon Stapleton/Reuters
Infectious disease specialists are drawing attention to an accelerated measles, mumps, and rubella vaccine schedule for babies over six months and children under 4 in Southwestern Ontario, or those travelling to areas with continuing measles outbreaks.
The new immunization recommendations were issued in a recent memo from Ontario’s Chief Medical Officer of Health Kieran Moore and apply to individuals who live, work, travel, worship or spend time in the areas covered by the Grand Erie and Southwestern public health agencies, near Hamilton and London respectively.
Dr. Moore said babies aged six to 11 months should receive one dose of the MMR vaccine and two additional doses are still recommended after turning 1. Children who are aged 1 to 4 who have received a dose of the measles vaccine should receive a second dose as soon as possible and at least four weeks after the first shot. Infants under six months are too young to receive a dose.
He also said adults born in 1970 or later are encouraged to ensure they have received a second MMR shot. An immunization program for infants was introduced in 1983 when a single dose was given at one year of age. Public Health Ontario said a second dose was added in 1996.
Currently in Ontario, two doses of measles vaccine are routinely given, with the first dose administered at one year of age and the second dose at four to six years.
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Ontario is seeing a significant rise in measles cases – the most in more than a decade. Last week, Public Health Ontario reported nearly 200 cases in recent weeks. There is also growing concern about measles in other parts of the country with recent cases in New Brunswick, Quebec and Alberta.
“The sad part about this is it’s completely preventable,” said Isaac Bogoch, an infectious disease specialist at Toronto General Hospital who also works in the University of Toronto’s Department of Medicine.
Dr. Trevor Arnason, Interim Medical Officer of Health at Ottawa Public Health, said the guidance issued by Dr. Moore is in line with advice issued to individuals travelling to areas outside of North America that have not achieved measles elimination status.
The advice is traditionally not issued for domestic travel because measles was deemed eliminated in Canada in 1998.
Dr. Arnason said Dr. Moore’s memo was shared with primary-care providers who are largely responsible for routine immunizations. The city health unit encourages the routine vaccine schedule in Ottawa, where there is not an outbreak.
Globally, there is a resurgence of measles, such as in Europe. There have also been outbreaks in the U.S. in New Mexico and rural parts of Texas.
Dr. Piotr Oglaza, chair of the Ontario Medical Association’s section for public health physicians, said when he was in medical school in Europe three decades ago, doctors learned about measles in textbooks because the disease was eliminated through immunization. He called the current resurgence mind-boggling, adding it underscores the need for continued public-health efforts.
In January, Canada’s Chief Public Health Officer Theresa Tam said that while international travel was the initial source of the outbreaks, more recent measles infections were the result of exposure to the virus in Canada.
Dr. Tam said the majority of measles cases reported domestically are among unvaccinated people, many of whom are children and infants. In Southwestern Ontario, Dr. Moore said the majority of cases are among unvaccinated individuals.
Data indicate childhood vaccination coverage in Canada is sliding. A recent study published in the Canadian Journal of Public Health found a decline in measles vaccination coverage in children in 2023 compared with 2019.
Symptoms for the disease include fever, cough, runny nose, red and watery eyes, and a rash that appears like red spots or blotchy patches. It can result in serious health complications that, while rare, include respiratory failure, encephalitis (swelling of the brain) and death.
Dr. Oglaza and Dr. Bogoch explained factors behind lower vaccination coverage include paused immunization programs at schools during the height of the COVID-19 pandemic. They also note issues such as medical misinformation and the lack of access to primary-care providers.
Dr. Bogoch said it is necessary to reduce barriers and to “bring vaccines to the people rather than bring people to the vaccines.”
Pierre-Philippe Piché-Renaud, an infectious disease physician at SickKids in Toronto, said the MMR vaccine works exceedingly well at preventing measles. The best way to protect children and families against the disease is through immunization, he said.