Vaccination vigilance urged
Health officials fear measles cases linked to lower rates of immunization
A highly contagious viral infection once eradicated from the Western Hemisphere has crept back.
Health experts are concerned the recent outbreak of measles in the province is partly due to dropping immunization rates.
“We had it eradicated, but until you actually eliminate it in the entire planet, it can always come back,” said Dr. James Talbot, Alberta’s chief medical officer of health. “So for all of the vaccine diseases, until they go the way of smallpox, which is the only one we’ve successfully eliminated so far … you have to maintain your vigilance. The reason there is no disease is because people are immunized, not because the disease went away.”
Twenty-one measles cases have been confirmed across the province, including six — two of them infants — in Edmonton and nine in Calgary.
The disease is often carried to Canada by people who catch it while travelling. Talbot said health officials do expect more cases to crop up this year, but are hopeful it won’t be easily transmitted if it stays in the urban centres where immunization rates are relatively high.
If it do es get i nto communities with low immunization rates, Talbot said we could see “a burst of disease.”
In2013,therewere44cases, a significant increase from previous years. From 200305, Alberta was measles free. With the exception of those years, there were between one and six cases in the province between 2001 and 2012.
The problem is worse in British Columbia, with more than 350 cases of measles confirmed there this year.
“We’re sometimes victims of our own success when it comes to immunization. The more successful we are, the less the public appreciates how effective it is. It’s almost like preventing a terrorist attack, you have no idea what the various police and security forces are doing when there’s no attack,” said Stephen Shafran, interim divisional director and a professor with the University of Alberta’s infectious disease division.
In 1935, Canada had 83,127 reported cases of measles in a population of 10.8 million.
Before 1954, measles in Canada killed 50 to 75 people a year, sent 5,000 to hospital, and caused 400 cases of encephalitis, which causes inflammation of the brain.
When the measles vaccine was introduced in 1963, cases plummeted. In 2005, there were six reported cases in Canada.
“There’s this tendency not to appreciate how important vaccines are when we don’t see the disease around,” Shafran said.
But now, in Alberta, and elsewhere in Canada, immunization rates are lagging. According to a report published last year by UNICEF, the average rate of immunization in developed countries for routine vaccines is close to 95 per cent.
Out of 29 developed countries, only Canada, Austria and Denmark had immunization rates below 90 per cent.
In Alberta in 2012, 84 per cent of children received the first dose of the mumps, measles and rubella vaccine, commonly called MMR, down from 88 per cent in 2008, according to the most recent data from Alberta Health.
Some areas in the province dip much lower — including the County of Leth bridge with a vaccination rate of 61 per cent and 52 per cent in High Level for MMR in 2012.
The blotchy red rash associated with measles is not the only “old-fashioned” disease to make a resurgence. Pertussis, known more commonly as whooping cough because of the sound one makes when they’ve caught it, swept through the province in 2012.
Two weeks after Harper White head was born, she was coughing so hard she would choke and turn blue from lack of oxygen.
Her family brought her to a hospital in Calgary where she was diagnosed with pertussis, a bacterial infection of the lungs and airways. She was too young to be vaccinated for it.
“She was so little, her immune system couldn’t keep up and she ended up contracting pneumonia,” her aunt Dani Whitehead said. “I think about her every single day.”
Harper died in 2012, a month after she was born.
“When she first started coughing, we just thought it was a regular cold be cause she wasn’t choking at that point,” Whitehead said. “Whooping cough didn’t even occur to me until after the doctor said it. I didn’t even know it was a big thing. I just assumed everyone gets vaccinated for it when they’re kids.”
That year, there were 332 reported cases of pertussis across Alberta. In 2013, there were 314.
“I really encourage people to take a second look at all the facts and really think about what the consequences could be,” Whitehead said.
While no vaccine is 100-percent effective at the individual level, if immunization rates are high enough at the societal level, the small number of people who don’t respond to it will be protected by what is called “herd immunity.”
Say, for example, that a vaccine is 98-per-cent effective. Out of every 100 people who are immunized, only two will not respond to the vaccine. Those two people will be protected by the herd because for every 100 people they run into, only two will be like them, making it less likely they’ll become infected and transmit the virus.
When one person decides not to get vaccinated, it could affect any vulnerable individual they come in contact with, such as an infant too young to be immunized or someone whose immune system is compromised and has no defence.
“If you’re a diabetic and you don’t take your medication — insulin or otherwise — the only one that suffers is you, maybe your family. It doesn’t affect other people, but for communicable disease, we’re all in this together as a human species,” Shafran said.
Why some people choose not to vaccinate themselves and their children is complex. Shannon Vandenberg, who teaches in the nursing program at the University of Lethbridge, studied that topic for her master’s thesis, which she defended last year.
“It’s a difficult decision. It’s one that they don’t just come to overnight. There’s a lot of thought involved; they’re analyzing the risks involved,” she said.
The eight mothers she interviewed in southern Alberta were influenced by many factors, including emotional reasons, like fear and guilt, safety concerns, beliefs versus facts and information, she said.
“I did find a mistrust among the mothers and that was mistrust of health-care professionals, government and pharmaceutical companies, which was really interesting to me,” she said.
“They felt that health-care professionals, our information is biased, we’re giving information by the book, we don’t always agree with it ourselves.”
Because of that mistrust, many people have turned to naturopaths, homeopaths, chiropractors, websites, and even celebrities, like anti-vaccine crusader Jenny McCarthy, for information. More recently, Alicia Silverstone, of the film Clueless, published her anti-vaccine views in an advice book for parents.
Sunni Petrakis said her decision to opt out of vaccinating her daughter had nothing to do with the celebrities behind the cause.
While she was pregnant with her first child, she did research online and became worried about toxins and chemicals in vaccines. Petrakis tries to live a natural lifestyle, grocery shopping at farmers markets and staying away from medication when she’s sick. She’s vigilant a bouth-and-washing and taking vitamins.
“If you are interfering with your own natural antibodies, then later on you’re just going to have a weaker immune system anyway. I think a lot of people are way, way too trusting in the government,” she said.
Choosing to be part of the anti-vaccine camp can be a hard position for friends and family members to understand. Even though her mother and grandmother have yelled at her to get her daughter vaccinated, Petrakis said at the end of the day, she feels she’s doing what’s best for her child.
When she needs to vent or find support from others who share her views, she turns to a local Edmonton Facebook group.
People “need to show compassion toward other parents, instead of being so judgmental about it because it’s really frustrating in that respect,” she said.
“I don’ts ee anything wrong with what the people who are vaccinating are doing.”
But Talbot said the belief that you can rely on your immune system to combat these sorts of diseases is false.
“Anybody who thinks their immune system is operating at such a peak that they can prevent themselves from getting measles ,mumps, rubella, pertussis, is just not paying attention to the facts.”