A large amount of measles outbreaks have recently been reported in the area of Alymer, Ont.Brett Gundlock/The Globe and Mail
Rachel Smith is expecting to give birth any day in the epicentre of Canada’s worst measles outbreak in nearly 30 years.
However, the Aylmer, Ont., mother is not worried about her health or the health of her baby because she’s fully vaccinated against the virus. Her cousin, Esther Wiebe, is not worried either, but for a different reason – she and her three unvaccinated children have already recovered from measles and are now immune.
While Ms. Wiebe’s family was sick in February, her sister-in-law brought her own children over for the express purpose of exposing them to measles.
“My sister-in-law, she figured for the girls, it can be bad if they get it during pregnancy, right?” Ms. Wiebe said, as her children played with Ms. Smith’s daughter at a splashpad and park on a hot day this week. “There are more risks. So she wanted them to get it as girls and to not have to think about it again when they’re adults.”
Ms. Smith and Ms. Wiebe’s views reflect the wide spectrum of attitudes about vaccination, measles and pregnancy in Aylmer, a farming town of about 8,000 in Ontario’s Southwestern Public Health Unit, the jurisdiction that has recorded the most cases of measles in the province since the wildly contagious virus began spreading in October.
The Southwestern PHU, which covers a mostly rural swath of the province south and east of London, is also where a premature baby infected with measles in utero died recently, the first fatality linked to the outbreak. The infant’s mother was not vaccinated.
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News of the newborn’s death has rippled through the region in complicated ways. For some, it has served as a “wake-up call” to the potential severity of measles in pregnancy, said Michelle Barton-Forbes, the division chief of infectious diseases at the Children’s Hospital at London Health Sciences Centre.
For others, the circumstances of the fatality have reinforced their pre-existing beliefs that public-health officials are overhyping the dangers of measles.
When Kieran Moore, the province’s chief medical officer of health, announced the infant’s death in a statement on June 5, he said that, “while measles may have been a contributing factor in both the premature birth and death, the infant also faced other serious medical complications unrelated to the virus.”
The nuance in Dr. Moore’s limited description led some of midwife Jill Portelance’s patients to respond in a way that reminded her of a common refrain during the COVID-19 pandemic.
“When people would die from COVID, people would make the excuse of, ‘Oh, well, they had other things. They died of something else,’ ” said Ms. Portelance, who has delivered babies for 15 years in the city of St. Thomas in the Southwestern PHU. “I’ve already heard that from some of our clients – ‘that situation with the baby, it wasn’t because the baby had measles. It was because the baby was premature and it had these other problems.’ ”
Forty women in Ontario are known to have caught measles while pregnant during the current outbreak. Seven babies contracted the infection in utero, according to Public Health Ontario’s latest report on the outbreak.
Midwife Jill Portelance sees many patients from the Mennonite Community of St. Thomas, Ont.Brett Gundlock/The Globe and Mail
Nine provinces and territories have logged measles cases so far this year, but none has seen as many as Ontario, where more than 2,000 infections are linked to an outbreak that Dr. Moore said began at a Mennonite gathering in New Brunswick in October.
Just more than one-third of Ontario’s cases have occurred in the Southwestern PHU, although public health officials say the outbreak in the area is now tapering off as the virus runs out of unvaccinated people to infect.
Measles first gained a foothold in the area’s substantial Low-German-speaking Mennonite population, which has roots in Mennonite colonies in Mexico and South America.
The region’s medical officer of health, Ninh Tran, has been careful not to single out the Mennonite community, stressing that measles is spreading among people who are unvaccinated, regardless of their background.
Erica Van Daalen, the chief of staff at the St. Thomas Elgin General Hospital, agreed that health care providers must “tread lightly,” doing what they can to encourage their unvaccinated Mennonite patients, particularly those who are pregnant, to take precautions without alienating them.
Dr. Van Daalen said she imagined the death of the premature baby – who Dr. Van Daalen said was not born at her hospital – has surprised some in the community who have come to view measles as harmless because they’ve now seen so many friends and relatives, most of them children, catch it and recover.
That isn’t always the case with pregnant women with measles, who face a higher risk of hepatitis, pneumonia, hospital admission and death than people who contract the virus while not pregnant. A measles infection also raises the risk of miscarriage and premature delivery.
Hospitals in the affected areas have implemented visiting restrictions on maternity and pediatric wards, although the St. Thomas facility relaxed those rules as the outbreak eased.
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Hospitals have also, in partnership with public health units, offered intravenous immunoglobulin to unvaccinated pregnant women who know they’ve been exposed to measles, as well as to their newborn babies. Immunoglobulin, if given within six days of exposure, can prevent infection by providing antibodies to the measles virus.
Women who aren’t sure of their vaccination status can take a blood test to determine if they have antibodies to measles.
The measles vaccine is not recommended during pregnancy because it contains a weakened version of a live virus that could, in theory, infect the fetus.
Dr. Barton-Forbes said just under 10 pregnant women with measles have been cared for at London Health Sciences Centre since the outbreak began. The hospital has treated 88 confirmed measles patients, 66 of them children.
There has been a mixed reaction to offers of immunoglobulin for unvaccinated pregnant women.
“You have the folks who are really vaccine refusing,” Dr. Barton-Forbes said. “If they don’t trust vaccines, they don’t trust the antibodies.” Other unvaccinated women say yes because they view the infusion as medicine, not as a vaccine, which it isn’t.
Dr. Barton-Forbes and her colleagues often try to persuade unvaccinated women of the benefits of immunization for themselves and their children after a delivery.
That can be a difficult conversation when a women with measles has just given birth and is isolated from her premature newborn for the protection of other infants in a neonatal intensive care unit.
“The key is, when you go in, you have to sense what the emotion is and try to understand where the family is coming from,” Dr. Barton-Forbes said. “A lot of them are angry because you’re seeing them in isolation.”
Ms. Smith and Ms. Wiebe, the cousins at the Aylmer park who hold different views on measles vaccines, said they wish there was less anger and more understanding between the opposing factions in the local vaccine debate.
“I feel like everything in society right now is so black and white, and you can’t have conversations,” said Ms. Smith, who was overdue to deliver her second child. “You can’t have common ground, and that’s just not realistic, because that doesn’t breed healthy relationships.”