N.B.'s top doctor warns of March break measles risk
Dr. Yves Léger urges people to ensure they're fully immunized before international travel
With March break just days away, New Brunswick's acting chief medical officer of health is urging people to make sure they're fully immunized against measles before travelling outside the country.
Dr. Yves Léger says a global surge in measles cases, due in part to a decline in vaccinations during the COVID-19 pandemic, has him worried about the potential for travel-related cases in the province.
"Diseases that happen in other countries pose a risk to us as well, because people can easily go to other countries, pick up those infections and can be back here in New Brunswick and be contagious in a very short period of time," Léger said Wednesday.
Measles is a highly contagious disease that can cause serious illness and severe complications, including deafness, brain damage and even death.
The virus is transmitted through the air when an infected person breathes, coughs, sneezes or talks, or by direct contact with infected nasal or throat secretions.
New Brunswick's last incidence of measles — an outbreak in Saint John in 2019 that resulted in 12 cases — started through international travel. A person who had recently travelled to Europe became the province's first confirmed case of measles since 2017.
Public Health prepares for potential case
"In light of the situation that's happening across the globe, we've already started to beef up our preparations in anticipation of a potential case," said Léger. "Hopefully, there won't be, but we certainly would rather be prepared if that's the case."
Public Health officials have been reviewing their guidelines for how they manage measles cases, as well as contacts, to ensure they're up to date, he said.
They've also worked with the communications branch to increase social media posts about measles and to try to encourage people to ensure they're up to date with their vaccines, especially if they're travelling.
In addition, they intend to distribute a memo to health-care practitioners soon to raise their awareness, make sure they're keeping an eye out for any potential cases, and encouraging vaccines with their patients.
"It's always better to prevent than to try and treat or to manage … outbreaks," Léger said.
His comments echo a warning issued by Canada's chief medical officer of health last Friday. Dr. Theresa Tam urged people to ensure their measles vaccinations are up to date before any international travel.
"As we head into the spring break travel season, I am concerned that the global surge in measles activity, combined with the decline in measles vaccine coverage among school-aged children in Canada, could lead to an increase in imported measles cases, potentially resulting in transmission in communities in Canada," she said in a statement.
Although measles has been considered eliminated in Canada since 1998, meaning the disease is no longer constantly present, cases can still occur when people who are not fully vaccinated travel to or from a country where the virus is circulating. These imported cases can lead to subsequent spread of measles in Canada among unvaccinated or under-vaccinated people, Tam advised.
6 confirmed cases in Canada
As of Friday, the Public Health Agency of Canada was aware of six measles cases in Canada, "most" of which involve unvaccinated or under-vaccinated children who travelled internationally. Some cases have required hospitalization.
More than 90 per cent of people who are not immune to measles and who come into contact with the virus will become infected, according to Tam.
Children under five, adults older than 20, pregnant people and people who are immunocompromised are at higher risk of complications.
Not too late
Ideally, the measles vaccine should be administered at least two weeks before travel, said Léger.
But it can still provide benefits if your departure is sooner, he said.
"Your body will still start to produce some immunity during that time and will hopefully provide some protection even though it's not complete protection."
Since October 1995, all children born in New Brunswick have been offered two free doses of the measles, mumps, rubella and varicella (chicken pox), or MMR, vaccine, at 12 months and 18 months of age.
Together, the doses are almost 100 per cent effective at preventing infection, according to health officials.
Nearly 92 per cent of New Brunswick students entering school in 2022-23 were immunized, the Department of Health has said.
Léger described the vaccination rate as "pretty good," but would like to see it higher.
"It's not quite meeting the national target" of 95 per cent to be able to prevent cases from spreading, he said.
People born in 1970 or later who have not received two doses of MMRV vaccine should contact their health-care provider to be immunized.
Adults born before 1970 are generally considered immune to measles, through previous exposure to the virus.
The Canadian Immunization Guide recommends that adults who don't know whether they received two shots get a booster, especially if they're travelling.
Symptoms to watch for
People who do travel outside the country are encouraged to monitor for measles symptoms for the first couple of weeks.
Measles typically starts with cold-like symptoms, such as a fever, runny nose, cough and red, watery or sore eyes, said Léger. Tiny white spots may appear on the inside of the mouth two to three days after symptoms begin.
A red blotchy rash also usually appears on the face within three to seven days, then spreads to the rest of the body.
Anyone who suspects they have symptoms should get checked out immediately, said Department of Health spokesperson Katelin Dean.
They should wear a mask, and immediately inform their health-care provider of their recent travel, she said in an emailed statement.
Most people are sick for up to 10 days and then recover completely.
How the 2019 outbreak unfolded
The first confirmed case of the 2019 outbreak was announced on April 26, but the infected person had visited the Saint John Regional Hospital's emergency room before being diagnosed and potentially exposed more than 2,000 people to the virus.
The second case, confirmed on May 13, was related to the first. A person from Kennebecasis Valley High School in Quispamsis was in the emergency room at the same time as the European traveller, and the potential exposures multiplied.
About 460 teachers from Rothesay, Quispamsis, Belleisle and Hampton had attended the local branch meeting of the New Brunswick Teachers' Association at KVHS just days before that person was diagnosed. They were invited to attend a special vaccination clinic at the school.
Before the month was over, 10 more cases were confirmed, eight linked to KVHS.
About 400 people who attended an academic awards ceremony at the school on May 23 were exposed and urged by the Department of Health to watch for symptoms.
Two other schools in the Kennebecasis Valley — Harry Miller Middle School and Rothesay Park School — decided to cancel their Grade 8 trips to Quebec because of the long incubation period of the virus.
The Health Department set up a dedicated phone line to help people check their immunization records.
Public Health started reserving its vaccine supply for those considered most at risk — infants and people who had direct contact with somebody with measles.
The 12th case was confirmed on May 31, when the outbreak spread to Hampton High School, where another special vaccination clinic was held.
With files from Information Morning Saint John