Students stand in the courtyard of Pattanasat Witaya School for the morning assembly in Narathiwat, Thailand, last week. Over the course of months, a measles outbreak that started at the school infected thousands in the country and killed nearly a dozen.Lauren DeCicca/The Globe and Mail
Last week, The Globe and Mail published a story investigating how a single visitor to Canada from Thailand – attending a wedding in Florenceville, N.B., last October – sparked the biggest measles outbreak in North America in a quarter-century.
To date, there are more than 4,700 current measles cases in Canada – and thousands more in the U.S. – related to that single imported case. In the first week of September (the most recent reported data), that number ticked up by 53 cases, showing that the outbreak continues.
The story, masterfully reported and beautifully written by The Globe’s Nathan VanderKlippe, should serve as a stark warning that the resurgence of measles is only just beginning.
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Measles was eliminated (meaning there was no continuous domestic spread for at least a year) in Canada in 1998, and in the U.S. in 2000.
Now, we have squandered that designation, putting a new generation of children at risk. Unnecessarily, one must add, because the measles vaccine is safe and effective.
But it’s only effective if it’s administered.
In our brave new world, where disinformation, distrust and conspiracy theories are common currency, the number of vaccinated children is falling steadily.
What makes Mr. VanderKlippe’s story truly chilling is how mundanely the outbreak began.
There are no monsters in this story. Just ordinary people, doing everyday things, and taking the benefits of vaccination for granted.
Patient zero was Lea Knelsen, a Canadian living in Thailand, who travelled around the world to attend her sister’s wedding in rural New Brunswick.
A gruelling trip like that one, with stops in Bangkok, Manila, Vancouver, Toronto and Fredericton, leaves you exhausted. Ms. Knelsen didn’t think much of it when she was feeling unwell upon arrival – she wasn’t going to miss the nuptials.
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Five days later, she was hospitalized with pneumonia, a common side effect of measles. Public health officials realized they were dealing with a potential measles outbreak.
Ms. Knelsen was not vaccinated. Not because she’s anti-vaccine. But because she thought childhood illnesses like measles were not a threat anymore.
“I always thought, ‘Oh, most of those diseases are not really around anymore. It never really crossed my mind that I would get something that was actually serious,” she told Mr. VanderKlippe.
Measles is a wily virus. It can take up to 14 days for symptoms to show up after exposure. The early symptoms are similar to a cold, so it’s hard to diagnose until you see the tell-tale red spots.
Measles is also one of the most highly contagious pathogens on Earth.
Every single unvaccinated person at the wedding also ended up contracting measles, and they fanned out far and wide, some to Mennonite communities where vaccination rates are low.
New Brunswick was hit first, recording 66 cases.
Ten days after the wedding, the first case was reported in Ontario.
In January, cases started being reported in West Texas, around the town of Seminole, where there is a large Mennonite community with ties to Canada.
By March, there was a large outbreak under way in Alberta.
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To date, Ontario has recorded 2,379 cases, Alberta 1,847, and Texas 762. (The dominant viral lineage in both Canada and the U.S. is “MVs/Ontario.CAN/47.24”).
The epidemiological sleuthing is not about laying blame but rather understanding how the virus spreads.
Measles can tear through communities quickly. But, because a lot of people, and children in particular, are still being vaccinated (thankfully), it can also be a slow burn – with just enough cases to keep the outbreak alive, and the virus spreading.
It’s a numbers game that we’re losing.
While most people who get measles will have minor symptoms and recover, that too is a numbers game.
The more people infected, the more likely some will have severe symptoms, and the more who have severe symptoms, the more deaths there will be.
To date, we know of two deaths in this outbreak – a newborn in Ontario, and a six-year-old in Texas.
That’s the other thing about measles: It’s most dangerous to children and pregnant women. Before vaccination, measles was the leading cause of deafness, blindness, and intellectual disability in children, and a leading cause of miscarriage in women.
We know, too, that measles messes with the immune system, leaving those who are infected vulnerable to other viral and bacterial illnesses.
But these are facts we seem to determined to learn the hard way, by letting the once-tamed virus run wild again.