Many young doctors in Canada have never seen a patient with measles, but those days may be numbered. On Mar. 10, a British Columbia religious school whose members oppose vaccination was temporarily closed due to fears that the measles virus may have infected more than 100 students. So far there are five confirmed cases. Earlier this year, there were small outbreaks in Prince Edward Island (6 cases), Calgary, Alberta (4) and Ottawa, Ontario (2). And in 2011, there were more than 700 cases of measles in Quebec.
All these cases in a purported measles-free country are prompting public health experts to call for more widespread vaccination.
"We're definitely urging parents to get their children vaccinated," said Sylwia Krzyszton, a spokesperson for the Public Health Agency of Canada (PHAC).
She says Canada's measles vaccination rate, based on national surveys, stands at an "estimated 95%" — sufficient for herd immunity.
However, in Fraser East, the region harbouring BC's current measles outbreak, only 88% of two-year-olds have up-to-date measles vaccination, which is "not great," says Dr. Monika Naus, medical director, Immunization Programs and Vaccine Preventable Diseases Service of the BC Centre for Disease Control. Even more concerning to her is the province's low vaccine uptake overall: seven percent of children are completely unvaccinated. "You know you can't eliminate measles when you need 95%."
Among the province's unvaccinated are the 450 students at Mount Cheam Christian School, the centre of this latest outbreak. The school is operated by the Reformed Congregation of North America, which is closely tied to the ultra-orthodox Netherlands Reformed Congregation in Holland. Its members reject vaccination on the grounds that immunizing their children challenges the will of God.
"The community is fully aware of measles and how it is transmitted and they have made a choice of taking non-vaccine measures," said Naus. This means self-quarantine for 21 days post-exposure for everyone in a household.
More than 100 children at the school were at risk of exposure, she says, but there are relatively few confirmed cases because children are discouraged from routine testing that would bring them to hospitals and clinics. "Counting will be through self-reported symptoms," says Naus.
"A large outbreak is unfolding at present," says Naus. "For now, it's limited to this community."