With the busy summer travel season approaching, some Canadians may be worried about catching measles in public places, such as airports and other indoor settings, amid a resurgence of the highly contagious disease in Canada and around the world.
“We live in an unprecedented time of human mobility at a global level, and we will see inevitable cases of measles imported into Canada,” Dr. Isaac Bogoch, infectious diseases specialist at the Toronto General Hospital, said in a video interview with CTVNews.ca on Thursday.
“It’s happening and it will continue to happen. And while we can’t necessarily control what happens outside of our borders, we certainly can have influence of what happens within our borders, and it’s our duty to lower barriers to routine childhood immunizations.”
Here’s what Canadians need to know about the chances of catching it.
Measles in Canada and globally
Within Canada’s borders, the disease has been spreading, with an ongoing outbreak that began in New Brunswick last October affecting a total of 2,088 people as of May 31. This outbreak is the largest in the country since 1998, with related cases in Ontario, Alberta, British Columbia, Manitoba, Northwest Territories, Nova Scotia, Prince Edward Island, Quebec and Saskatchewan.
Measles has been “eliminated” in the country since 1998, which indicates it’s no longer found in a large area, according to the Canadian government’s latest monitoring report.
However, measles cases occur sporadically, typically coming from other affected regions. Cases have climbed to a 27-year peak in Canada, with 2,698 confirmed this year compared to only 17 in 1998. One death was reported in Ontario this year.
“We are in the midst of an outbreak in parts of Canada right now, and there are potential exposures in public places, airports, community centres, restaurants, public places where people may visit,” Bogoch said. “But if people are immune to this infection, preferably through vaccination but also through recovery from infection, the risk is negligible.”
Many parts of the world are experiencing a growing number of measles cases. For instance, data from the European Centre for Disease Prevention and Control show the number of measles cases in the European Union and European Economic Area have risen since 2013.
In the United States, more than 1,100 measles cases were reported this year, and the U.S. Centers for Disease Control and Prevention recently updated its travel notice to warn people that they can get the disease from many travel settings such as airports, train stations, crowded events and tourist attractions, CNN reported on June 5.
Even with the outbreak in Canada, the country’s travel health notice says the risk is at the lowest level. The level 1 advisory encourages travellers to practise health precautions, including avoiding insect bites, properly washing their hands and having updated vaccinations.
It said vaccination is the best way to protect yourself and others from the disease.
“My main concern is that there may be people who are non-immune who can receive a free, widely available vaccine that has decades of safety data and decades of effectiveness data associated with it and that it’s a preventable disease,” Bogoch said.
How do you get measles?
The virus is spread through coughing, sneezing or breathing the same air as an infected person. It can remain contagious in the air or on infected surfaces for up to two hours, according to the World Health Organization.
Who is most at risk?
Most people are immune to measles, but the virus will circulate more in certain cases, with those who are unvaccinated and not immune to it mainly getting infected, Bogoch said.
He noted that pockets of Canada may have under-vaccinated communities. He listed an example of many cases in Ontario occurring in a largely unvaccinated Mennonite Christian community in the southwestern part of the province.
“It sadly spreads like wildfire, and that’s exactly what we’re seeing happening right now,” Bogoch said.
People who get infected with the virus are typically those under age 20, he added.
“It’s primarily, almost exclusively … people who have not received two doses of vaccine,” Bogoch said. “You can significantly lower risk of infection by receiving a routine childhood immunization. Two doses of a measles vaccine is extraordinarily effective in preventing measles infections.”
Where are people more likely to get measles?
While people can contract measles at airports, train stations and other crowded public areas, Bogoch said there isn’t one primary place of infection.
“Measles is transmitted primarily in indoor settings through the air,” he said. “It’s a virus that is able to stay suspended in the air for a prolonged period of time, and the infectious dose is tiny.
“So if someone is non-immune and is exposed to the virus in an indoor setting, there’s a very high likelihood that that person will get infected with measles.”
With the disease mostly transmitted in indoor settings, the risks aren’t necessarily higher during the peak summer travel season.
“It can be transmitted at any time of year,” Bogoch said. “For example, in the winter months, there might be more people crowding in indoor settings because it’s cold outside.”
Symptoms and treatment
Symptoms can show up as a fever, cough, runny nose and watery eyes before a rash with red and blotchy spots appears.
There isn’t any specific antiviral treatment for measles. People can be treated with medications to help relieve symptoms. Most people recover, but severe cases may require hospitalization.
Bogoch said the vast majority of those born before 1970 were already infected with measles since the virus was common back then, so they generally won’t have to worry about getting it and have “lifelong protection.”
Most who have received two doses of the measles-mumps-rubella (MMR) vaccine, which is routinely given to children, have a “very, very small” risk of infection, Bogoch added.
Advice for travellers
If you’re travelling anywhere outside Canada where the measles risk may be higher, Bogoch recommends getting health advice before leaving the country.
“There’s measles, but of course, there’s a lot of other things that you can be mindful of and take precautions to ensure you have a healthy, safe and happy trip,” he said.
