Provincial Measles Immunization Catch-Up Program March 20, 2019 Office of the Provincial Health Officer & Ministry of Health
Measles • Measles is a highly contagious viral infectious disease that spreads through the air by coughing and sneezing, as well as respiratory secretions. • Initial symptoms include: fever, cough, running nose and red eyes. • After 3- 7 days, raised rash on the face that will spread to the limbs and body, which will last 4- 7 days.
Right: Skin of a patient after 3 days with measles rash • Left: Child with classic measles rash after 4 days • (Source: U.S. Centers for Disease Control & Prevention)
Importance of measles prevention • Individuals who are under- and unimmunized (babies under one year of age, those who cannot be immunized for medical reasons, and those who refuse immunization) are most at risk. • Most healthy and immunized people will recover but those who are under and unimmunized, or with a weak immune system could experience serious complications.
Measles complications • Complications include: • Ear infection and pneumonia in approx. 10% of cases; • Encephalitis: brain infection and swelling that may result in permanent brain damage, approx. 1 in 1,000 cases; • Death from respiratory and neurologic complications, approx. 1 in 3,000; • Measles during pregnancy increases the risk of premature labour, spontaneous abortion and low birth weight infants.
Measles Outbreak • There is a global increase in measles with large outbreaks in countries including: • the U.S. (74 cases to date), • Philippines (over 12,700 cases and 203 death from Jan. to Feb. 2019), • France (124 cases in Jan. 2019), • Ukraine (13,760 cases in Jan. 2019), and • Vietnam (unavailable).
Measles is a rare disease in Canada. Since the introduction of the measles vaccines, the rates of infections have decreased significantly. • It has been considered eliminated since 1998. One case is considered an outbreak because of its rarity.
Measles in B.C. • Since this January, there are 19 confirmed cases to date. Most of these were associated with travel to other countries: • 14 in Vancouver Health region. Initial case unimmunized travellers returning from Vietnam. • 4 isolated cases, with 3 cases in travellers returning from the Philippines, and one likely associated B.C. case. • 1 case associated with travel to northwest US, where an outbreak is occurring. • Given the global situation, we would expect there to be more imported cases into B.C. in the coming months.
Measles in B.C. • Due to the outbreak in Vancouver, in the VCH region, 28 students/staff were excluded from school from 5 days after the first exposure to 21 days after the last exposure.
Measles vaccines • There are two measles-containing vaccines in B.C.’s publicly-funded immunization schedule: • Measles, Mumps and Rubella (MMR): given to infants at 12 months and children 4-6 years of age. • Measles, mumps, rubella and varicella (MMRV): given to children 4- 12 years of age who also need protection against varicella (chickenpox). • Efficacy of a single dose estimated to be 85% to 95%. With a second dose, almost 100% of children are protected. • For measles, at least 95% of B.C.’s population needs to be immunized to achieve herd immunity. In 2018, the immunization rate for 7-year-olds was 82%.
Measles Immunization Catch-Up Campaign • We have seen increased measles immunization rates in all B.C. regions since outbreak. • For example, Vancouver Coastal Health ordered 16,600 vaccines in February 2019, compared to 2,030 in February 2018. • In the last week: • Fraser Health: 982 doses administered vs. 453 in the same period last year; • Island Health: 603 doses administered vs. 276 last year; • Northern Health: 256 doses administered vs. 102 last year; • Interior Health: 904 doses administered vs. 302 last year.
Goal: To increase the measles immunization rate by making it simpler for parents to ensure their children are up to date in their measles immunization. • The program will be made available: • Immunization clinics in schools for K-12 children • Public health clinics, • Community health centres, and • Mobile community clinics in select regions. • Priority will be: • Kindergarten, Grades 1 and 2 (4- 6 year-olds), and • Grades 6 and 9 children who have not received any measles vaccine or have only received one to date.
Families may also get immunized by their doctors, and local pharmacies (for children 5 years older and above). For more info, visit ImmunizeBC at: https://immunizebc.ca/finder. • The plan was developed in consultation with the PHO, immunization experts from the ministry and the BC Centre for Disease Control as well as regional health authorities. • It will be implemented in all regions starting in April and continue to June 2019. • Health authorities including First Nations Health, will work with school districts and schools to identify children who are under or unimmunized against measles. • Health authorities and schools will contact parents/guardians with options for immunization.
Mandatory Reporting Regulation • Catch-Up Campaign is the first phase of B.C.’s goal to increase immunization. It will also help parents to have their children’s immunization records ready for the reporting requirement in Sept. • Regulation will be finalized in May and implemented for the school year starting in September 2019