Childhood vaccinations

Vaxxers, anti-vaxxers debate but Manitoulin-Sudbury in line with Ontario average and ‘herd immunity’ maintained

MANITOULIN—The recent measles outbreak in the United States, Quebec, southern Ontario and now Manitoba has left many Northerners with questions regarding their health and safety.

“To date in 2015, there have been eight confirmed measles cases in Toronto, Niagara and York, all with fever onset dates during the last week of January and first week of February,” stated a February 11 memorandum from Interim Chief Medical Officer of Health David L. Mowat. “At this time, there are no epidemiological links among cases and no identified sources, however the investigation is still ongoing.”

“There is also considerable measles activity occurring in the United States,” continues the memorandum. “Between January 1 to February 6, 2015, 121 individuals from 17 states and Washington, DC have been reported to have measles, with most of those cases part of a large multi-stage outbreak linked to an amusement park in California (Disneyland). The majority of the cases were unvaccinated. Today, Quebec identified 10 measles cases directly related to the US outbreak and the risk of measles importation from any area of the world where measles is occurring remains a concern.”

The Expositor spoke with the Sudbury District Health Unit (SDHU) on student immunization rates and policies, the importance of immunization and the protocols in place if a measles case is reported in the area.

SDHU Manager of Clinical Services Lisa Shell explained that the Ontario Public Health Standards requires that public health units (PHUs) maintain immunization records for school pupils and conduct an assessment of immunization at least annually. Under the Immunization of School Pupils Act (ISPA), students with incomplete immunizations against diphtheria, tetanus, polio, pertussis, varicella, invasive meningococcal disease, haemophilus influenza type B, measles, mumps and rubella, must be vaccinated or provide an exemption statement (religious, conscientious or medical) or risk school suspension.

“The SDHU follows all district students through until they are 18,” said Ms. Shell of the health unit’s role in tracking student immunization. “We review the immunization records annually for every student. The students need to be up to date for their age. If a student is missing a dose or information on an immunization at the annual review we will contact the parent either by phone or a letter. Under the ISPA we can suspend a student’s attendance if the parents don’t provide the immunization information. Students who have been exempted can attend school, however if there is a confirmed case of, say, the measles, the medical officer of health would advise the SDHU to review its files and any students without that vaccination would be excused from school until the outbreak is over or they are immunized.”

Statistically, Ms. Shell said that the SDHU is “encouraged” by the coverage rates for students for the 2012-2013 school year (the most recent statistics), but that the health unit is working hard to improve the rates further.

“For diphtheria, tetanus, polio and pertussis, we have a 65 percent coverage rate (percentage vaccinated) for seven-year-olds for 2012-2013,” said Ms. Shell. “For measles, mumps and rubella, the coverage rate is 96.4 percent. For 17-year-olds, the coverage rate for diphtheria, tetanus, polio and pertussis is 97.71 percent and 98.1 percent for measles, mumps and rubella.”

According to the Immunization Coverage Report for School Pupils from Public Health Ontario, the Sudbury/Manitoulin district is mostly in line with the provincial statics for 2012-2013, other than the provincial vaccine coverage for diphtheria, tetanus, polio and pertussis which was 74.6, 74.6 percent and 74.2 among seven-year-olds, respectively.

The provincial vaccine coverage for seven-year-olds for measles, mumps and rubella was 88.3, 87.9 and 95.2, respectively.

Among 17-year-olds provincially, immunization for diphtheria, tetanus, polio and pertussis was 84, 84, 94.3 and 69 percent and 95.4, 93.7 and 97.1 percent for measles, mumps and rubella.

Ms. Shell said there is no ‘magic number’ of the population that needs to be immunized to prevent outbreaks, but ideally “we would like to see 100 percent.”

“If we were at 100 percent vaccine coverage we wouldn’t see periodic outbreaks like we are now in southern Ontario with the measles,” shared Ms. Shell.

“If you are not immunized you are still protected by everyone around you if they are immunized,” Ms. Shell explained of the ‘herd effect.’ “Take the example of measles, if you aren’t immunized, your exposure is dependent on the protection of everyone around you. The more people that are immunized, the less chance there will be of an outbreak. Immunization is the single greatest public health success. Before 1970 we assumed everyone had the measles or was exposed, but with the vaccination we haven’t seen an outbreak in the last couple generations.”

As to questions regarding parents who choose to not immunize their children, Ms. Shell responded, “If parents have questions, by all means they should have a discussion with their public health unit.

“The last confirmed case of the measles in Sudbury was in April of 2014,” concluded Ms. Shell. “We received regular updates from the province and the Ministry of Health and Long Term Care and are prepared in case of a suspected or confirmed case with protocols in place.”

The anti vaccination (anti-vaxxers) movement continues to attract star attention such as Alicia Silverstone, who believes that vaccines cause autism (though there is no scientific evidence to support this), or that vaccines have other harmful effects on their children.

Pickering mom Jennifer Hibben-White’s Facebook post last week shaming anti-vaxxers went viral, gaining national media attention, after her 15-day-old son Griffin was potentially exposed to measles in a doctor’s waiting room.

“If you have chosen to not vaccinate yourself or your child, I blame you,” Ms. Hibben-White wrote. “You have stood on the shoulders of our collective protection for too long. From that high height, we have given you the privilege of our protection, for free. And in return, you gave me this week. A week from hell. Wherein I don’t know if my baby will develop something that has death as a potential outcome.”

The Expositor was unable to contact any Island ‘anti-vaxxers’ for an interview, however The Expositor did speak with Dr. Stephen Cooper, chief of staff for the Manitoulin Health Centre regarding the importance of immunization.

“The question of whether or not to immunize your child is a philosophical one; the public good versus individual rights,” said Dr. Cooper. “There is a good chance that if one person doesn’t get immunized the community will protect them against disease, but if everyone is unimmunized there is clearly a problem. I believe people not only benefit as individuals from vaccinations, but their community as a whole. This is why I encourage people to get immunized or immunize their children.”

“I think vaccinations are a great thing,” concluded Dr. Cooper, giving the example of polio and how most people today haven’t ever met someone who’s had polio thanks to the vaccine. “When I was a student at Alberta Children’s Hospital in Calgary, we were seeing three to five deaths a month due to epiglottitis caused by haemophilus influenza type B. The incident was five per 100,000 cases prior to the introduction of the vaccine in 1992 and dropped to 0.7 per 100,000 after,” he further cited.

Ms. Shell urges anyone who is unsure of their immunization record to contact the SDHU. “If you attended school in Ontario we have access to the immunization database province wide and may be able to get your record.”

According to Public Health Ontario, clinically compatible signs of symptoms of measles include a fever greater than 38.8 degrees Celsius and at least one of the following symptoms: cough, runny nose or conjunctivitis (inflammation of the eyes) and generalized rash.