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 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. If

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 .