The Decibel - Major measles outbreak in Ontario, cases across Canada

Episode Date: March 17, 2025

Measles cases in Ontario are higher than we’ve seen in a decade, and we’re only three months into the year. Measles is one of the world’s most contagious viruses that can, in some cases, be deadly. While the virus has been effectively eliminated in Canada since 1998, rates of infection and hospitalization in Southern Ontario are growing, along with cases across Canada.But this is a vaccine-preventable disease. So why is it suddenly re-emerging?Today, Globe health reporter Kelly Grant is here to explain why we’re seeing this surge in measles cases, and the measures we can take to best protect ourselves – and others – from getting sick.Questions? Comments? Ideas? Email us at [e-mail].

Once you've seen the ugly face of vaccine preventable disease, it pulls on your strings, it pulls on your heartstrings. That's Michelle Barton Forbes. She's an infectious disease expert at London Children's Hospital, which is treating an outbreak of measles. The region has seen a surge of new cases. You definitely are pushed and pulled to do all that you can to try to protect children from the ugly side of vaccine preventable diseases.

Measles is an extremely contagious disease. One person can infect 12 to 18 other people. And the virus can stay in the air for up to two hours. In some cases, the infection can be deadly. This is a disease that was declared eliminated in Canada in 1998, but now we're seeing case numbers in Ontario soar. So today, Kelly Grant is here. She's a health reporter with The Globe. Kelly will explain why we're seeing such a surge in measles cases and what we can do to protect ourselves and others from getting sick.

I'm Manika Raman-Wilms and this is The Decibel from The Globe and Mail. Kelly, thanks so much for being here. Thanks for having me. So Kelly, you and I are talking around 11 a.m. on Friday, and I mention this only because the numbers may change over the weekend. But we just got updated numbers on the measles outbreak in Ontario. What did we learn? Well, I'm glad you time stamped this, because I should tell you that yesterday, the Public

Health Ontario folks put out a report that said there were 195 new cases of the measles identified in Ontario in the last two weeks. They have, just as we've been getting ready to do this interview, issued a correction to their report that's got a fair number of updates in the numbers. They're now saying that that increase was 173 cases in the two weeks. Whether we're talking about 195 or 173, that is a lot of measles cases in two weeks in Ontario. How does that compare to like what we've seen

before in Ontario? I think a good point of comparison would be to look at the decade leading up to the end of 2023. And in that time, we saw 101 cases of measles identified in Ontario. In the entire decade. Yes. And now we've got more than that just in the last couple weeks then, it sounds like. That's correct. And when I spoke with officials in the regions that are at the heart of this

outbreak, they feel certain that there are many more cases out there that have not been identified. Okay. And we are going to talk more about this current outbreak. But first, I just want to ask you, what is it like to get sick with the measles? That's a good question because most people have not seen a measles infection in their lifetime unless you know you were born kind of before 1970. You've probably never seen somebody sick with the measles. So what is it like? Well it starts off with symptoms that aren't all that different from the flu or a cold.

It's a fever, a lot of lethargy, a cough, red runny eyes. And then usually a few days later, you'll start to see that telltale red blotchy rash, which is what you often see in pictures illustrating stories about the measles. Okay, but actually before you get that telltale rash, it kind of sounds like almost like a flu or something. This is one of the reasons why measles is so hard to control in populations that are unvaccinated. You can be contagious before you have any symptoms, and then the early symptoms look

like many other illnesses that are not the measles. It's only when that rash shows up and that rash is a bit later in the course of the illness that people say, aha, this is the measles. And we know, of course, this is also a highly contagious disease. It sounds like more contagious than we are used to with like a cold or a flu. It is the standard for when people describe a virus that's extremely contagious. You know, usually the example they hold up is the measles. It's airborne. It's got real staying power. So

you can have a person walk into a room, breathe the measles virus, you know, have it in their secretions, and then walk out of that room. And somebody who walks into the room two hours later could catch the measles. This thing is crazy contagious. And how serious could this be if you do catch the measles? So I should emphasize that the majority of healthy children, because that's often who it is, and people who get the measles, it's a miserable illness, but they recover. But in rare cases, there are deaths.

As you may know, there have been a couple of deaths in the last few weeks in the United States from the measles, which, you know, that country hadn't seen a measles death in about a decade prior to that. But there's also children who suffer long-term disabilities, such as deafness, kids get encephalitis, so there's brain swelling concerns. In the case of this outbreak, several dozen children have been hospitalized. And, you know, they've needed things like IV antibiotics to deal with secondary pneumonia infections and breathing support, because that's, you know, one of the issues is that they'll wind up having trouble breathing. So it's a very serious illness. Okay so even with this outbreak in Ontario it sounds like it's been pretty serious for a number of people if they've ended up in hospital there. Who

is most at risk Kelly for experiencing the most severe effects of measles that you just described? First off the answer is people who are unimmunized. There is an extremely effective vaccine for this. If you have two doses from it, you're fine. So who is most at risk? It's, first of all, people who are unimmunized. And then it tends to be people who have underlying conditions that could make them more vulnerable

to viruses of any kind. It's pregnant women. It's very young babies and young children. And then anybody who's immunocompromised. So for example, when I was speaking with a pediatric infectious disease doctor at London Health Sciences, that's the home to the London Children's Hospital, she was telling me that one of their main concerns is trying to make sure that they're keeping kids who are, for example, undergoing chemotherapy for cancer,

ensuring that they do everything they can to keep the measles patients they are treating from running the risk of infecting any immunocompromised children. So that's really some of the people who are most at risk here. Yeah, OK. And so it sounds like kids, young kids in particular, are most at risk here. Do we OK. And so it sounds like kids, young kids in particular, are most at risk here.

Do we know why that's the case? The way the vaccination schedule works is that kids usually get a first dose of the MMR vaccine. That's the measles, mumps, and rubella vaccine when they turn a year old. And then they get a second dose when they start school. So that's usually between the ages of four and six. So what you may be looking at here in terms of risk

is babies who are too young to receive that routine vaccination or very young kids who've only received one dose. Okay, that helps us understand a little bit then why you would be at risk if you are younger. We've talked about the outbreak in Ontario, Kelly. What about the rest of Canada? Are we also seeing more measles across the country?

We are, although Ontario was certainly the epicenter and is seeing more cases right now than anywhere else. In the fall of last year, there was an outbreak declared in New Brunswick that wound up infecting 50 people before it was declared over in January. And that outbreak began with a traveler who picked up the measles and came back here on a flight from the Philippines, stopped in Vancouver, stopped in Toronto, and then came home to New Brunswick and discovered that they were infected. And that original travel case led to the outbreak in New Brunswick, which is now linked to this large multi-jurisdictional outbreak in Ontario and has also been linked to some cases in Manitoba.

There's also a few dozen cases right now in Quebec and a handful in British Columbia. Okay. And of course, we're also hearing about measles outbreaks in the states. What do we know about what's happening there? There's an uptake in cases in several different places in the United States, but the biggest outbreaks are taking place in West Texas and some neighboring communities along the border with New Mexico. And these outbreaks have been centered in conservative Mennonite communities there and there have been a few hundred cases and one death in West Texas and another in New Mexico.

And so you mentioned that the outbreak in West Texas is in Mennonite communities in particular. Are we seeing the same here? The short answer is we don't know for certain. I did ask the medical officer of health for southwestern Ontario whether it was being seen in Mennonite communities, there is a fairly substantial Mennonite community in this part of the province. And he declined to say, I think they're loathe to single out any specific communities. There have been a handful of exposure notices at Mennonite schools. However, the vast majority of the exposure notices have been at healthcare facilities. It's people bringing their kids into the hospital, not knowing they have the measles, and then later discovering that they do. When I asked that question about whether there

were any specific communities where we're seeing the most measles cases, what the medical officer of health for Southwestern told me was there's a simple answer to that and it's among the unvaccinated. So regardless of their religious beliefs or community ties, the most straightforward answers, it's spreading among people who aren't vaccinated. Okay, so it sounds like we are seeing pockets of spread throughout North America. It sounds

like we're not just seeing travel-related cases, and this is actually spreading locally. It is spreading locally. Now, I want to emphasize that we're certainly not back to the place we were prior to the elimination of measles. Pre-elimination, what that meant was that the virus circulated quite regularly. Post-elimination, it means that we still get sporadic cases. Those cases are usually introduced by people coming in from other countries where measles remains endemic. And then if those cases wind up in communities that have low vaccination rates, the measles spreads very quickly. So that's what we're seeing right now.

Can you tell me just a little bit more about the elimination of measles? Because as you said, yeah, we had eliminated it. But what exactly does that mean? So when we're talking about infectious diseases, elimination refers to stopping the regular spread of a disease within like a defined geographic area. So Canada through its very aggressive and successful vaccination program eliminated measles in 1998. But because other parts of the world have not eliminated measles, we still get sporadic cases that come in through travel. And then sometimes we wind up with these outbreaks that are a result of measles being introduced into communities that have low vaccination rates.

Elimination is different from eradication. Eradication means like wiping basically a disease off the globe. So the classic example is that smallpox has been eradicated. And now other than in labs, smallpox no longer exists in the natural world. And that was a result of the smallpox vaccination campaign. We'll be back after this message.

So Kelly, let's look at the reason behind this current surge in measles. We know that initial outbreak started when someone was infected abroad for the Canadian side of things. But why are we seeing so many cases this year? The answer is quite simply because of a lack of immunization. So when I spoke with public health officials in southwestern Ontario and an area that's called Grand Erie, which if you know Ontario at all, is sort of like south and east of London. We're talking places like St. Thomas, Elmer, Tilsonburg,

Ingersoll, Woodstock, Simcoe, Delhi, all kind of along Lake Erie in southern Ontario. What they said is like, if you want to ask the question of like, where are these cases, they are in people who are unvaccinated. That's why is this happening? It's because we don't have the wall of protection that we get when everybody in the community is vaccinated. So I guess this begs the question, do we know how many people in Canada are

currently vaccinated against measles? Not exactly. The reason being there's been a long time call for us to have a national vaccine registry that would do a better job of tracking this at a national level. But we do have some clues from the provinces that do a better job of properly tracking their vaccination rates. Because this is all tracked on a provincial level because of the health systems. And sometimes even more of a local level. You might is all tracked on a provincial level because of the health systems.

And sometimes even more of a local level. You might know at the public health unit level. Anyway, there is not a good and reliable national vaccine registry in Canada. That aside, I want to point to one study that looked at the vaccination rates in Alberta, Saskatchewan, Manitoba, and New Brunswick. And this study looked at where we were at in 2019 prior to the pandemic, and then 2023 when we were coming out of the worst of the pandemic. And they did see a pretty significant overall drop there. They looked at the measles, mumps, rubella vaccination rate for two-year-olds and seven-year-olds. So that's

really a who's had one dose and then who's also gotten their second dose. And between those years I described, those four provinces fell from having 89.5% of their two-year-olds with one shot down to 82.5%. And with their seven-year-olds, they went from 86.3% down to 75.6%. Okay, so we saw a drop during that pandemic time. Do we know exactly what we can attribute that to? I think we can attribute it to two different broad categories of issues. One of them is access, and that is that during the pandemic, particularly, you know, we had lots of health care closures.

We had people who were afraid of getting the virus and therefore wouldn't do things like come in to get their vaccines. Healthcare access in general was quite poor for preventative things like vaccination during the pandemic. And there's been a real widespread recognition in public health that we need to do catch up campaigns to get shots into the arms of kids

who miss their vaccination during the worst periods of the pandemic. Then there's another side to the access question, which is how hard it has become for people to get a family doctor. If you are a mom who gives birth in Canada and you've got a pediatrician, you've got a family doctor, you have somebody who's calling you and say,

come in for your two month well-baby visit, come in for your four month, come in for your one year visit, and you are receiving your vaccinations in the course of the care that your young children receive. If you don't have a family doctor, it becomes much harder for you to search out those routine childhood vaccinations.

So that's the access piece. Then there is the vaccine hesitancy, misinformation, post-COVID vaccine world, where in lots of communities and among lots of individuals, there is a renewed skepticism of vaccination in general. And so I tie both that hesitancy question and that access question as being a result of the pandemic. COLLEEN O'BRIEN I do want to ask you a little bit more

about misinformation. But when you were talking about those vaccination rates, Kelly, you mentioned numbers that sound like they're kind of currently in the mid to low 80s. Do we know how much of the population needs to be vaccinated in order to stop this kind of outbreak from happening? The standard number that is always used is 95% of the population to produce that wall of immunity that will protect those people who can't get vaccinated. Now, I should say my hope is that those lower numbers

that I cited from 2023, because of some of these enthusiastic catch-up campaigns that public health has been running, that those numbers have started to go up again. Ontario does have a law that for children to attend school, they have to have proof of their routine childhood vaccinations. And, you know, all of Ontario saw a really significant dip at the beginning of the pandemic. It dropped as low as this is kids again, like kids getting the routine childhood vaccinations,

like in 2021, it had dropped to as low as 67.4%. They're now back up, this is 2023-2024 school year, they're now back up to just a little over 70%. But you can see how like that is well short of the numbers that we need to ensure that everyone is protected from the measles. You mentioned that misinformation might be playing a role in these kind of lower vaccination rates. I want to bring in new research that we've seen from the Canadian Medical Association. It found that 43% of Canadians are highly susceptible to believing misinformation surrounding health and that this is having negative health outcomes for Canadians. Of course, in the US, we're also seeing the rise of anti-vaccine views.

People like Robert F. Kennedy Jr., who's now the Secretary of Health and Human Services in that country. I guess, Kelly, do public health officials, do they think that misinformation is having a substantial impact then on these vaccination rates? They do certainly think it is part of it. They often cite social media as being a place where it's difficult for the average person to sift fact from fiction. They also mentioned though that it isn't just misinformation on social media, although that certainly plays a part, but relatedly some of the access issues I talked about really do make a big difference. And sometimes they go hand in hand, right?

If you don't have a doctor, it's not just that you don't have somebody calling you to say, hey, it's now time for your child to get vaccinated. It's that you don't have a trusted person who isn't a rando on the internet to ask these questions. And if you're feeling nervous or apprehensive or scared of giving a vaccine to your child because of what you've read online, you're more likely to go ahead and get that vaccine if you have a trusted health professional

who can talk you through those worries. So the misinformation and access pieces, I think really go together and are contributing to some of these lower rates that we're seeing. And again, I also do just wanna stress that everything was disrupted by the pandemic. And in those years, the usual ways that kids got vaccinated were harder to access. So if there's an outbreak of measles, what is public health's

advice for you if you're in that community? The first one is if you are vaccinated, if you've got two doses of the vaccine, you're fine. You know, as you were, continue with your life as normal. If you are not vaccinated, their first piece of advice is definitely to get vaccinated. Now, there are some sort of edge cases that I wanna talk about a little bit here. So what do you do if you've got a baby, right? You're living in a community where there is

measles circulating and you've got a baby who's not yet been vaccinated. In the communities in Southern Ontario, where this outbreak is at its worst, the public health unit has started running special vaccination clinics for babies who are six months to 11 months old to say come in you can get one shot. It's worth getting that protection. If you've got a baby who's younger than six months old because they can't get vaccinated at that age, the advice is to just you know be, be very careful. And you know,

perhaps don't take your baby into places where you see that there have been like previous measles exposures. Then we've got the group of kids who have had one shot, but have not yet had their second shot. And again, in the communities where we're seeing a lot of measles circulating, public health is recommending that parents go ahead and get that second shot early. There's no harm in getting a second shot early,

as long as there's at least four weeks between the first and second shot so that you can maximize the immunity, then they're saying come on in and get it early. And then for adults who were born after 1970, if you've had two doses, you're fine, but if you don't know if you've had two doses, you're fine. But if you don't know if you've had two doses, then again, if you are in a community

where there is a lot of measles circulating, they are recommending you check and see if you need to get that second dose. Okay. I think this idea of this highly contagious disease spreading more widely can be kind of scary for a lot of people, frankly, right? How worried should we actually be about these outbreaks?

If you're vaccinated, don't worry, you're fine. I mean, we should be worried about it from the sense that, like, there are vulnerable children who are not vaccinated, and, you know, they run the risk of getting very sick. This does put pressure on hospitals because, you know, you have to put these people into negative pressure rooms to ensure that the measles doesn't spread. You have to be very concerned about whether or rooms to ensure that the measles doesn't spread.

You have to be very concerned about whether or not measles could spread into hospital to other people who are immunocompromised. And speaking of immunocompromised, I should also mention that there are people who would like to get vaccinated, but have certain conditions where they can't take a live attenuated virus. So you've got your really little babies. You have people who are sick and have immunocompromisedising conditions who would like to be vaccinated and can't be. And those are the people that we hang out to dry when other people don't get vaccinated. Just to end here, Kelly,

I wanna actually come back to Michelle Barton Forbes, who we heard from in the intro of this episode. What did she tell you about what it was like helping children who are sick with measles throughout this outbreak? She said it was very tear-jerking, was the word she used, to see kids unnecessarily sick with this very serious disease. And, you know, she said in particular that it was especially hard to watch as somebody who came from, as she put it, the developing world. You know,

she's from Jamaica originally. I would see people wanting to get their vaccine at all costs, but maybe it was financial limitations that prevented them from getting to the institution to get what they needed. And, you know, here we are in Canada, where we're so fortunate to have free public access to these vaccines. So to see people not choose to take advantage of that and then wind up with these very sick kids, she said it's hard to watch.

Kelly, thank you so much for taking the time today. Thanks for having me. That's it for today. I'm Maynika Ramon-Wilms. This episode was produced by our intern, Amber Ransom. Our producers are Madeleine White, Michal Stein, and Ali Graham. David Crosby edits the show. Adrian Cheung is our senior producer, and Matt Frainer is our managing editor.

Thanks so much for listening, and I'll talk to you tomorrow.