Canada may lose its measles elimination status because of ongoing viral transmission. 

As of October 27, there were 5109 measles cases, according to Canada’s Measles and Rubella Weekly Monitoring Report. In the week of October 12-18, there were 19 new measles cases. In addition, 136 children are in the hospital, including in ICUs, with measles. Two deaths have been reported, both of which occurred in cases of congenital measles in children who were born preterm.

The re-emergence of measles results from several converging factors, Shelly Bolotin, PhD, director of the Centre for Vaccine Preventable Diseases at the University of Toronto, told Medscape News Canada.

“There has been a substantial increase in measles cases worldwide, and since measles is so infectious and the world is so interconnected, Canada has been impacted, too. We have also seen a decrease in trust in government since the pandemic, which can make it more difficult to control outbreaks once they occur,” she said.

The decrease in vaccination during the pandemic is not thought to be a major contributor to the outbreaks that have occurred, Bolotin added. “Firstly, this is because public health units have been working hard to raise vaccine coverage, and secondly, it’s because the vast majority of cases in Canada’s multijurisdictional outbreak belong to communities where some members have historically been undervaccinated,” she said.

The resurgence also indicates that other vaccine-preventable diseases could also make a comeback. “Measles is one of the most infectious diseases, and elimination requires nearly the whole population to be immune, so measles outbreaks are often an early sign of susceptibility gaps in the population. In addition to measles, we have also seen a recent resurgence of pertussis, and it’s possible we will experience increases in other vaccine-preventable diseases,” Bolotin said.

She emphasized that the toll of the measles outbreaks in Canada has not been trivial. “This outbreak is a reminder of the importance of vaccination to keep communities safe and that vaccination protects not just ourselves, but also those around us.”

A Wake-Up Call

“I don’t know if we are going to lose our elimination status,” infectious disease specialist Isaac Bogoch, MD, professor of medicine at the University of Toronto, told Medscape News Canada.

“It would be unfair to revoke our measles elimination status because we have done such a good job of curtailing these outbreaks. But I do think it’s a giant wake-up call that we were even close to having this revoked. Because even in Ontario alone, we had 2400 locally acquired cases, and that is unacceptable. Absolutely unacceptable,” Bogoch said.

“I’m a bit of an optimist, and so I see this pending loss of elimination status as a signal about what happens when vaccine access, trust, and coverage all slip below a threshold needed to contain an infection as contagious as measles,” Cora Constantinescu, MD, pediatrician and infectious disease specialist at Alberta Children’s Hospital and associate clinical professor at Cummings School of Medicine, both in Calgary, told Medscape News Canada.

“This is an opportunity to bring this issue to the forefront of the news and also for the public and governments to appreciate how the vaccine has kept our communities safe for so long,” she added.

It’s also a good time to talk about how much measles is costing Canadian society in general and its healthcare system in particular. “I’d like to see a cost analysis to the healthcare system, which needs to be done,” said Constantinescu.

To reach out to vaccine-hesitant patients, Constantinescu and her colleagues have started a clinic focusing on them. “These are very committed parents who want to do the best for their children. We become partners with them. We aim to build a relationship based on trust. We meet them where they are,” she said.

Challenging Conditions

In British Columbia, measles vaccinations have increased notably since the outbreaks began in that province. There has been a 30%-40% increase in the number of measles-mumps-rubella vaccines that have been administered, according to Jia Hu, MD, interim medical director of Immunization Programs and Vaccine Preventable Disease Services at the BC Centre for Disease Control, Vancouver. “People sometimes need a reminder that, unfortunately, measles is around and that vaccination provides protection,” Hu said.

If measles continues to rage throughout the world, it will be nearly impossible to eradicate it completely, at least under current conditions, Anna Banerji, MD, associate professor of medicine at the University of Toronto, told Medscape News Canada.

“How can you eradicate a virus that is spreading around the world unless you have widespread vaccination? There are always going to be people coming to Canada with measles, tuberculosis, or another infectious disease, and as long as we have vaccine hesitancy, we will still have these episodes. We have the means to vaccinate everyone. The measles vaccine is cheap, and if we really wanted to eliminate it, we could vaccinate every kid easily,” Banerji said.

Bolotin, Bogoch, Constantinescu, Hu, and Banerji reported having no relevant financial relationships.