Global health authorities are reporting a significant increase in measles in 2023 that continues into 2024, due in part to a decline in measles vaccinations during the pandemic. The World Health Organization (WHO) reported a 79% increase in the number of global measles cases in 2023 compared to 2022. While cases can occur anywhere in the world, there has been a notable recent increase in the WHO European region.
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. I strongly advise everyone in Canada to be vaccinated with two doses of a measles vaccine, especially before travelling. If needed, measles vaccination should optimally be given at least two weeks before departure, but there are still benefits if given less than two weeks before travelling.
Although measles has been eliminated in Canada, cases can still occur here when an individual who is not fully vaccinated has travelled to or from a country where measles is circulating. Imported cases can lead to subsequent spread of measles in Canada among unvaccinated or under-vaccinated people. As of February 23, 2024, we are aware of six measles cases in Canada, some of whom have required hospitalization. Most of these cases involve unvaccinated or under-vaccinated children who traveled internationally.
Measles is a highly contagious airborne virus that can cause serious disease. Over 90% of people who are not immune to measles and who come into contact with the virus will become infected. Infection can lead to severe complications, including deafness and brain damage caused by inflammation of the brain, and can be fatal. Children less than 5 years of age, adults older than 20 years of age, pregnant people and people who are immunocompromised are at higher risk of complications from measles.
The 2021 childhood National Immunization Coverage Survey shows that 91.6% of 2-year-olds in Canada have received at least one dose of a vaccine against measles, but only 79.2% of 7-year-olds had received two doses. The best protection against measles is vaccination with two doses of a measles-containing vaccine, which are almost 100% effective at preventing infection. The first dose of a measles-containing vaccine is usually given to children at 12 months of age. The second dose is usually given at 18 months of age or between 4 and 6 years of age.
Anyone who is not vaccinated against measles is at risk of being infected with it when travelling internationally. Currently, a travel health notice for measles is in place for all countries. It provides recommendations to Canadians on how to protect themselves from measles when travelling. Importantly, before travelling:
- Children and adolescents should ensure that they have received both doses of a measles-containing vaccine.
- Infants between 6 and less than 12 months of age should receive a dose of measles-containing vaccine if travelling to a high-risk area. A health care provider can advise on the best approach for your child.
- Adults should ensure they have received two doses of a measles-containing vaccine if they were born in 1970 or later, and one dose of a measles-containing vaccine if born before 1970.
For everyone travelling this spring, I urge you to be vigilant in monitoring for symptoms of measles. Initial symptoms include fever, red watery eyes, runny nose, and cough followed by a red rash that starts on the face and then moves to the rest of the body. If on your journey home to Canada from travel abroad you suspect you may have contracted measles, put on a well-fitting medical mask and limit contact with others, if possible. If you are experiencing symptoms, tell a flight attendant or cruise staff before you arrive in Canada or a border services officer as you enter the country. If you develop symptoms of measles after your return, call a health care provider immediately. If you need to be seen in-person, the health care provider can arrange to see you while preventing the spread to others.
With the resurgence in measles worldwide, it is more important than ever to ensure that you and your family are keeping up with routine vaccinations. If you are unsure of your vaccination status, check with your health care provider or local public health unit. They can help ensure that you and your family are protected. Together, we can close the gap in measles vaccine coverage, and stop outbreaks from occuring.
