Measles in Canada: Where we're at and how we got here
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As an MD, I remember when Canada officially eliminated measles back in 1998 thanks to widespread vaccination with MMR. A program so successful that in 2022 this country had just three reported cases. Barely three months into 2025, Canada is seeing the worst numbers in years. Current cases of measles have been confirmed in BC, Alberta, Saskatchewan, Manitoba, Ontario and Quebec.

As of March 26th, Ontario reports 557 confirmed and probable cases since the beginning of the year and 46 hospitalizations. Nearly half of Ontario's current cases are located in the province's southwestern health region. And that is where we begin. Hi, my name is Dr. Ninh Tran. I'm the medical officer of health for Southwestern Public Health. Dr. Ninh Tran, welcome to White Coat Blackheart. Thanks for having me.

What is the current measles situation in southwest Ontario in your district? So, yeah, so we're still experiencing a significant outbreak of measles. As we continue to see cases, they continue to be prevalent.

mainly in those who are not up to date their vaccination, particularly those who have never been vaccinated against measles. And most of our cases, over 70% are in those who are 18 and under. How does the current outbreak that you're dealing with right now compare to previous years? It's certainly nothing that I've ever seen in my time here. And from what I understand, we haven't seen any sort of activity like this in several decades.

How serious are the cases that you're seeing? You know, with measles, there are and can be complications. So although most of our cases are able to recover at home, some do need to seek medical attention and to be admitted to hospitals.

How accurate are your numbers? I'm wondering how much of an underestimate they might be of what's actually going on. It's certainly an underestimate. Not every single person who experiences illness is going to be able to identify. Not everyone, even if they identify themselves, will seek medical attention. And not everyone who seeks medical attention are necessarily going to get tested. So we know it is an underestimation for sure.

From the moment you knew you had measles in the region, you were advised that there was measles in the region as medical officer of health. How hard have you been working to try and contain it?

Yeah, we've been working extremely hard. We've had staff from different teams to work on measles, and that includes significantly ramping up our case and contact management, so following up with cases, cells understanding where they've been, looking at finding ways to notify those who might have been exposed. And then for those who've been exposed, there are some potential options in terms of

post-exposure prophylaxis that can potentially help rejuvenate

help reduce the severity and transmission, but it has to be identified in a timely manner. We've also increased our capacity for immunizations as well. So we're really working extremely hard. Dr. Tran briefly mentioned something called post-exposure prophylaxis. It's a way to protect people who are susceptible to measles from the worst symptoms. Within three days of being exposed to the virus, you can give them the MMR vaccine.

Within six days, you can give them immunoglobulin.

Now, back to our conversation. You know, hearing you talk about this, you're trying to keep up your energy, but you sound tired. I think we're all tired. I think I have other reasons, to be honest, like to be tired as well. I'm a new parent, but I think that might be contributing to it. But I think it is to be fair that since we've been dealing with this for the last few months, staff are tired. They're working hard and the pace is certainly quite fast.

Describe the people who are getting measles in your region. Most of our cases are in children, and the vast majority of our cases are not up to date on their immunization status. And that's very similar to what we're seeing provincial-wide. What's the level of immunization in your community as far as you know? So the best information that we have and that there's real data on would be

in school-aged children. So for the end of the school year, according to the Public Health Ontario data, our numbers are around 93.5% for 17-year-olds and then roughly about 87% for 7-year-olds. But in order to really stop measles from spreading, we talk about something called herd immunity, a vaccination rate about 95% or higher

And what are you doing to boost immunization in the community? So we're doing various a number of things. One of the things we've done is made eligible and declared ourselves an area of concern so that it

infants who are 6 to 11 months would be eligible to get an additional dose. You still need two doses from the age of one and above. We've got measles within our community, so we declare ourselves an area of concern so that individuals who really live, play, spend a lot of time in our catchment area would be eligible. And we've provided that information to parents.

to our healthcare providers. So there's some uptake from that. We're also asking and recommending individuals rather than wait till they're four to six years old to get their second dose to get it earlier. You need at least four weeks from your first dose, but we'll help further the protection. We're doing, you know, certain other communication and outreach to provide information

information and to encourage immunizations. The other part is there are individuals who might not be interested for vaccination, but they would be interested in staying at home and isolating and reducing transmission.

Given how infectious measles is, how hard is it for you and the people who work with you to stay on top of contact tracing? It's quite a challenge. It takes a lot of work.

That's why you see on our webpage, we have public notification exposures. We have a webpage to actually help individuals understand their risk assessment, if they've been exposed and what to do under different scenarios and with an algorithm, whether they've been vaccinated, their age and sort of contact information, you know, depending on whether they're developing symptoms. And then we're, you know, also monitoring

making calls to cases as well as to as many contacts as we can. As you mentioned, it is highly infectious, so it takes a lot of work. Where are you in this current outbreak? Are you at the beginning of the end, the end of the beginning? Where are you? It's hard to say. I think we certainly have got a ways to go. I wouldn't say that the outbreak is going to end any time immediately. To

and an outbreak, you generally need what's called two incubation periods. So measles can take up to 21 days from exposure to develop symptoms. So in general, you would likely need to wait 42 days anyways, in order to declare it over. I think, you know, over the last couple of weeks, I think, you know, the number of cases has been a bit less than it was earlier in March. But again, we take it day by day. We know we're in it for a little while more. I know it's a

It's hard for everybody. Thank you for coming on to White Coat Blackheart to explain what's going on in southwestern Ontario. And I hope that your outbreak ends much sooner than later. Thank you very much. And thank you for taking the time to cover this really important health topic. What makes this a really important health topic is not the stats, but the people behind them. People like Marissa Lattin.

Her seven-month-old son Lennox has cystic fibrosis and as such is more vulnerable to the respiratory complications of measles. Earlier this month, Marissa says she took Lennox to the hospital for tests.

Here's what happened next. That was on a Friday. And then the following Thursday, I got a phone call, a frantic phone call from the nurse practitioner that we see all the time. And she said, you know, do you remember exactly what time you were in the blood lab? So I said, we were in there at 1145. She says, okay, I don't know how to tell you this, but while you were in the blood lab, there was two children were now found measles positive. And I'm like,

Okay, what does that have to do with anything, right? Like, I didn't think anything of it. And she says, no, no, measles is an airborne disease. It's highly contractible. We're going to isolate you because of Lennox's immune system issues. And because he's only seven months, he hasn't had his MMR vaccines. You know, he's going to have to have globulins and needles and this and that just to prevent measles.

what was going to happen. You know, it wasn't walking the front door. It was, okay, come around to the back and people in full suits and, you know, come on here. Then we had to sit in a room and be isolated. And my kid got two five milliliter intermuscular needles into his thighs, which are like very long needles into his teeny, like he's seven months, they're tiny little thighs just for them to come back in and tell me, oh, well, here's the thing. Even though we gave him all of this,

He can still get it. He's still way too young to have his MMR vaccines. He still runs the risk because of his immune system. Yes, we've given him these things to try and prevent it, but we still have to watch him now for at least 21 days. And that was a Thursday. And then Friday, of course, a complication with one of his issues arose.

I had to go back into the hospital on Friday night, which would have been just a regular routine. We were having issues with this feeding tube. They would check it on the in and out in two hours. It ended up taking nine hours because he had to be isolated. And then everybody that came in had to be in a full gown and a full basically outfit. And then instead of, unfortunately, instead of worrying about the issue that we were there for, everybody was really focused on the fact that he could have the measles.

And all of this is preventable, but it's of actions of others that makes it unpreventable, if that makes sense. Honestly, it's really, really frustrating because all of these things can be avoided, you know, because vaccines have come into play that had stopped all of this. Nobody thinks about the immunocompromised vaccine.

Or, unfortunately, the people that are going through treatments for cancer, they're immunosuppressed. He's doing fine currently. And unfortunately, that's the thing people keep calling me and say, oh, how is he? How is he? Well, he's fine now. But that doesn't mean tomorrow something could pop up, right? At the hospital, they did give him everything that would prevent him from

from contracting the measles but we still can't confirm anything we still have a couple weeks ahead to go you know for vaccines that were made 20 30 40 years ago there is multitudes of of data that's showing their effectiveness and that's what really made me angry

Infants routinely receive their first dose of MMR vaccine at 12 to 15 months of age. In case of outbreaks, infants can receive their first dose of MMR as early as 6 to 11 months of age, but will need two more doses of vaccine to be fully immunized. We'll be right back.

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You're listening to White Coat Blackheart. This week, the worst outbreak of measles in years has descended upon Canada. A resurgence that could be traced to declining rates of vaccination amidst growing vaccine hesitancy in the aftermath of COVID and mistaken beliefs about the safety of MMR vaccine. Dr. Lenora Saxinger knows all about this. She's an infectious diseases specialist in Edmonton, the province with the third greatest number of measles cases thus far.

Dr. Lenora Saxinger, welcome to White Coat Blackheart. Thanks for having me. What is the current measles situation in Alberta as far as you know? Well, I mean, I think that we're in the kind of 20 range of cases. And so it's not necessarily for sure going to be a large epidemic, but we certainly are seeing some spread from the initial introduced cases. And that's a big concern, of course, because we know that things can kind of start slipping out of control with measles fairly easily these days.

We've been seeing the number of outbreaks rise in different parts of Canada recently in the last few months. What do we know about how measles has been spreading in general? Usually what happens is introduction from somewhere and then spread along the context of the introduction case.

And then the degree of spread actually largely depends on how well immunized the population is, like the proportion of people that have been immunized or are immune. Usually outbreaks in Canada are kind of in the sort of tens, dozens range, occasionally hundreds.

We are seeing some larger outbreaks across North America, like some of them have gone up close to a thousand cases, and obviously that's becoming a lot more of an issue for local health care as well. Measles has such a long incubation time, and the early symptoms are quite non-specific. There can be quite a lot of contacts along the way, from first getting infected to it becoming clear that this is measles and being able to quarantine effectively. And so

I think that what we see a lot of is doctors are not necessarily used to the way this looks. People are not necessarily thinking about measles. They can get quite ill. They're seeking health care. So we do tend to see like public space exposures just during that phase of infection.

How much of this is due to declining rates of immunization with MMR in Canada?

A lot. I mean, of course, people have always been able to potentially pick up measles in places that have, you know, endemic transmission and bring it home. But, you know, whether or not they themselves get infected depends on whether or not they have either been infected themselves, in which case they should be protected.

or if they've had MMR vaccination. And then the spread, onward spread from that individual depends on how many susceptible people are in contact with them. The thing that makes measles especially hard is that it is so darn contagious. Like it is, you know, the textbook worst in terms of

and transmissibility to others. As I understand it, with COVID, one person could infect one, two, maybe three people. But when it comes to measles, one person could potentially infect 12 to 20 people. I got it right? That's exactly right.

And that is why we are constantly seeing these notices that if you were in this restaurant or that sports arena or this airport on this day between these hours, you're at risk and you need to check your immune status. We didn't hear these notices five years ago. Now we're hearing them almost constantly. That's absolutely correct. I mean, we're kind of fighting a bit of an uphill battle right now because there's been a drift in the vaccination rate.

And that makes a huge difference to the possibility of introduction and spread. What role does disinformation play in whether people are getting vaccinated or not these days, in your opinion? The disinformation around measles vaccine is, you know, longstanding, historic and extremely hard to get rid of. I kind of compare it to like the undead zombie of disinformation. It just won't stay down. It keeps coming back.

in spite of all the evidence that keeps on being produced, proving essentially that the vaccine is safe and has an excellent safety track record. And so that background level of distrust has been there a long time. And then during the pandemic, I think, you know, there was a real boost of anti-vaccine disinformation activity.

And that has continued till now. In some populations, that is a much more likely cause of under-vaccination. You know, there's always been groups who, for kind of religious cultural reasons, have not tended to be vaccinated. And then, of course, then there's people who aren't necessarily anti-vax, but there may be just, you know, a little bit hesitant because of all the things they've been seeing because it's such pervasive content, this, you know, anti-vax content.

And then there's people who just honestly are a little bit behind in getting their kids vaccinated or are not necessarily aware of whether or not they need more vaccination. And I do think that, you know, looking across the country, there definitely are pockets where this is a more common issue. And Alberta definitely has some of those. But, you know, our large urban areas tend to be on par with most places in Canada, which

Some of the smaller communities and zones, definitely we would see lower rates. And some of them are really quite low, actually. Like there's some communities with under 40%, probably, MMR vaccination rate by age seven. And that is a really vulnerable state for a community to be in. And what I'm hearing from public health officials, infectious disease consultants such as you, is that you really need 95% of the population to be fully vaccinated. That means two vaccine dosages less.

To have adequate herd immunity. And we've seen that rates are down in some previously well vaccinated communities to to the mid 80s to the late 80s, 80 percent, which is 87, 88 percent, which is not adequate.

Yeah, it's really a knife edge because, I mean, that means that a lot of people are doing exactly what they should be doing to protect themselves, their kids, their community. But a lot is not quite enough with measles because it's so contagious. And so you need this really high standard of immune coverage. They probably could be tuned up and that would improve our situation.

Lenora, I don't know if you've got kids in hospital right now in Alberta, but certainly there are kids in hospital in Ontario and Quebec. And I'm just wondering if you've heard chatter, if you're on discussion groups with pediatric infectious disease specialists or pediatric intensivists to know how severely affected kids are during these current outbreaks.

I don't have a bead on current outbreaks, but I have worked in international places where you do see significant measles disease. In some of those places, adult age range starts at age 12. And so, I mean, measles can be a very serious illness. And when they're hospitalized, they can be hospitalized because they genuinely need supportive care. Like they need fluids, they need hydration, they can have gastrointestinal problems with dehydration. They can have...

pneumonitis requiring oxygen. That's a little more common, I think, in older age groups and adults. Adults can have hepatitis, and the most feared complications are usually around encephalitis, blindness, deafness, you know, causing long-term cognitive problems. And

And those things used to be, you think one in a thousand encephalitis doesn't sound like that much until you apply it to a whole population because basically all kids used to be infected. And that's a huge burden of disability and illness that is preventable. So I don't think we're anywhere near going back to that state, but there are going to likely be cases of severe outcomes in kids and potentially also in adults if things don't come under control.

You posted a long and detailed thread on X that outlines the correct information. Why did you feel compelled to do that? Anytime something is in the news, there is a flurry of interest questions and also a bit of a flurry of disinformation. And I think that, you know, the public...

public in general, people are a lot more aware of, interested in, familiar with epidemiologic concepts and vaccine concepts. And I think that, you know, depending on where you live, there can be a bit of a vacuum of information in some places. And that's a bit of a worry.

One of the commonest pieces of misinformation that I'm seeing on social media these days is that somehow it is better to get measles than it is to get the MMR vaccine. Is that one of the ones you're trying to counter? You know, I should have actually specifically addressed that one because I've seen reports in the U.S. of people like considering measles parties. That was something that was part of a large outbreak in New York a few years ago as well. That is...

a terrible, terrible idea. I really think that that is a product of serious disinformation about the vaccines. I mean, MMR is a really old vaccine. It was developed in the late 50s. So it has a long track record. And it's one of the relatively few live vaccines that's a live attenuated strain, which is why it works so well. Like it really does provide long lasting comprehensive across the immune arms immunity. And

And choosing to put a child at risk of these relatively rare, but certainly seen bad complications rather than giving them, like you're giving them basically a fully armed virus versus a weakened virus for essentially the same effect. And I think that is really concerning if that were to be a development we were seeing in Canada. Yeah.

You know, just based on what you've just said, I think we have to bring RFK Jr. into the conversation. The current Secretary of Health and Human Services in the United States has said publicly in an interview in the last couple of weeks that MMR vaccine has waning immunity over time. Do you want to counter that? I do, actually. I mean...

You can have waning immunity to vaccines. You can have waning immunity to natural infection. I would say that the MMR vaccine, when given like two doses, will provide, you know, over 95% protection lifelong. And of course, that continues to be followed, honestly. As people get measles, we look at vaccine status and see if there's any concern there.

And so you can't really do much better than that because implicit in that idea is that getting the disease is actually better, but that also assumes that the disease is harmless and it certainly is not. And so I find that appalling.

How well is the Alberta government communicating what people should know about how to protect themselves against measles? I would say that the formal government messaging has been fairly bare bones. So, you know, part of what people are trying to do is, you know, fill the vacuum with good information rather than trying to fill the vacuum with bad information. And that can be a bit of a challenge. And finally, I know you don't have a crystal ball, but where do you see these outbreaks heading in Canada next?

as we move further into 2025? I think for the short to medium term, we will continue to see introduction of measles and like flares. So introduction flare patterning and how well we're able to contain the flares depends entirely on, you know, the background immune status of the community where it's been introduced and the networks where it's been introduced.

And hopefully that will also allow us to kind of raise the baseline level of MMR vaccination to prevent and dampen that effect. It's relatively uncommon for countries to lose eradication status. That means that rather than having introduction flare, there's ongoing transmission in communities across the country. So I think that that's not necessarily likely to happen, but there will be a higher risk of measles and

to people just going about their business in Canadian communities for a while because of these introductions and the delay in recognition because of the long incubation time.

You know, if it were ever to become so commonplace that people were regularly seeing the effect of measles illness, because I mean, frankly, even uncomplicated measles is miserable, and started to see those severe effects like the hospitalizations and the long-term consequences, that is usually when, you know, populations start saying, oh, maybe we were wrong.

What worries me about that is, you know, the pendulum might start swinging back away from disinformation in those people who are affected, but there's always going to be a cost to any delay in that. I can't lose sight of the fact that, frankly, most people are doing the right thing, like 80% plus is a lot of people who are doing the right thing.

The problem is that the smaller number of people who've been affected by disinformation or who are behind for other reasons tend to put the rest of everyone else at risk, especially, you know, like the under-vaccinated had one dose and it was the right thing at the time group, for example. Well, let's hope that the percentage of Canadians who are quote-unquote doing the right thing does not continue to decline. Dr. Lenora Saxinger, thank you so much for speaking with us. My pleasure.

I'd like to address one aspect of what Dr. Lenora Saxinger refers to as the undead zombie of disinformation about measles. I had measles when I was a kid, and I can assure you that while chickenpox parties were a thing, measles parties were not. I not only had measles, I saw cases of measles as a young resident at SickKids. It's a disease you don't want to get, and you don't want to spread. My advice is to make sure you and your kids get vaccinated.

That's our show this week. For more on measles, we've put our recent episode of The Dose at the top of our feed. White Coat Black Art was produced this week by senior producer Colleen Ross, with help from Jennifer Warren, Stephanie Dubois, and Prapti Bamania. Our digital producer is Ruby Buiza. I'm Brian Goldman, and I'm proud to bring you stories from the Canadian side of the gurney. See you next week. For more CBC Podcasts, go to cbc.ca slash podcasts.