Reporting delays could be why vaccination rates for 7-year-olds so low, Toronto public health says

As many as one quarter of seven-year-olds in the public school system last year were listed as not fully vaccinated, Toronto Public Health (TPH) has confirmed, but the agency says it may reflect reporting problems rather than any anti-vaccine movement.

According to the city, 76 per cent of seven-year-olds during the 2017-18 school year had their immunization shots up to date. But that number rises for eight-year-olds to 88 per cent and nine-year-olds to 90 per cent.

"What we don't have is a real time registry where when a physician or a nurse provides a vaccine to a child that vaccine is automatically put into public health database, said Dr. Vinita Dubey, the city's associate medial officer of health.

"Because if we had that we would know what the true coverage rate is for seven-year-olds at any one time."

She says the second measles, mumps and rubella (MMR) vaccine is usually given between four and six years of age and the onus is on parents to report to TPH that their child has had the shot.

"So sometimes it's because we haven't received the information from the parent," Dubey told CBC Toronto. "It's a pretty manual process."

Dubey says the vaccine rates improve when parents have had time to respond to TPH requests for proof of vaccination.

"It makes sense for people to assume that Toronto Public Health automatically has it from your health-care provider. But that is not the case," she added.

"Right now, there is no good electronic means for a record in a doctor's office to get directly into public health record."

In a statement to CBC News, Public Health Ontario says parents are responsible for reporting their child's immunization information to public health units. That can only happen after they get a letter in the mail letting them know that provincial legislation requires students to be either immunized, or provide a medical or religious/conscientious exemption.

Dubey says TPH numbers show that less then two per cent of students remain unvaccinated for medical, philosophical or religious reasons. 

"That rate tells us the number of parents that have flat-out refused to vaccinate their children," said Dubey. "That rate is still low, but we do know that there are parents who have questions about vaccines."

Dubey says a better measure of vaccination rates is to look at seven to 17-year-olds, of which 89 per cent are up to date with their measles vaccinations.

Dr. Nadia Alam, president of the Ontario Medical Association, told CBC's Metro Morning that the importance of up to date vaccinations is top of mind, given measles outbreaks in Vancouver, Ottawa, Michigan and New York State.

"Herd immunity is kind of like a wall. Every person who gets a vaccine is another brick in the wall," said Alam.

"So if you have 90 per cent herd immunity within a community, 90 per cent of people are vaccinated within a community, then there's very little chance of an outbreak happening."

On March 20, York Region Public Health and Toronto Public Health warned that people at Vaughan Mills Mall may have been exposed to measles.

'Measles 'incredibly contagious'

"Measles is incredibly contagious. It spreads like wildfire from person to person. If you're in the vicinity of someone who's who has measles you have a 90 per cent chance of catching it," said Alam.

So far this year, there have been only two confirmed cases of measles in Toronto, which Alam says could be one reason why some may not think vaccines are as important.

"A lot of us haven't seen these illnesses for a very, very long time. Public vaccination campaigns have been so successful in Ontario that we don't often see measles any more, we don't see mumps, we don't see rubella," said Alam.

But Dubey adds that could change if health officials are complacent.

"We have to make sure that we get on top of addressing the concerns of parents so that we do not run into a place where 20 per cent of parents are choosing not to vaccinate their children, for example," she said.

Medical Officer of Health Dr. Eileen de Villa will present a report to the Toronto Board of Health on what can be done to counter anti-vaccine messages on Monday.