Dropping vaccination rates for children in Ontario raise measles fears

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Just 70 per cent of seven year olds in Ontario were fully vaccinated against measles last year, according to Public Health Ontario.

That represents a steep drop in vaccination coverage compared to before the COVID-19 pandemic, according to the data. There have been similar declines for other routine childhood vaccines as well.

A decade ago, during the 2013-14 school year, 94 per cent of seven year olds in Ontario were fully immunized against measles. That number has steadily declined since then. Herd immunity for measles, which is among the most contagious infections in the world, is between 90 and 95 per cent.

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The numbers are causing concern but it is unclear how much of the drop is from lower immunization rates and how much reflects a difficulty getting timely data on immunization in Ontario.

In some parts of the province, according to the data, vaccine coverage is dramatically lower than the provincial average of 70 per cent.

In Peel Region, which is part of the GTA, fewer than one-quarter of seven year olds were fully vaccinated against measles last year, according to the data. Ottawa was also below average, with just 64 per cent of seven year olds vaccinated against measles and similar levels for other childhood vaccines. In 2016-17, 94.5 per cent of Ottawa seven year olds were fully vaccinated against measles.

Vaccination coverage is significantly higher among 17 year olds, averaging about 91 per cent across the province, according to Public Health Ontario. In Ottawa, 90.3 per cent of 17 year olds were fully vaccinated against measles according to the data.

The low immunization numbers are causing concern, but also some skepticism. It is notoriously difficult in Ontario to get timely and accurate data on vaccination rates for routine childhood immunizations, largely due to a complex and not-well-connected records system. Many children are immunized by their family doctor, but doctors’ offices don’t automatically transfer the information to public health units, parents are required to do so themselves, which leaves gaps.

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Public health officials also acknowledge there are growing gaps in vaccination rates fueled, in part, by COVID-related disruptions and a shortage of family doctors, among other things.

Ottawa Public Health attributed the low numbers for various routine childhood vaccines to a combination of vaccine uptake and reporting. In a statement, Marie-Claude Turcotte, director of community wellness and chronic disease prevention and chief nursing officer at Ottawa Public Health says OPH will have a truer picture of actual numbers at the end of the school year.

OPH is conducting a surveillance program that includes sending notes home to students who are not vaccinated, or whose vaccinations aren’t reported, and suspending those who don’t comply.

Turcotte said its records indicate that more than 15,000 Ottawa students born in 2007 and 2017 are missing one or more vaccines in the public health record.

Dr. Kumanan Wilson said immunization rates are lower than they should be for various reasons, and will likely get worse. Wilson is a general internal medicine specialist at The Ottawa Hospital, CEO and chief scientific officer at Bruyère Health Research Institute, and CEO of the company CANImmunize.

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But he suggested the Ontario Public Health numbers also reflect the difficulty of getting accurate data.

He noted that measles has been circulating around the world, including in Canada and the U.S. The province of New Brunswick has seen its largest measles outbreak in decades this fall. But there have not been similar outbreaks in Ontario — which suggests Ontario immunization levels are not as low as data suggests. National surveys put measles vaccination coverage at around 88 per cent, he noted.

Whooping cough has also been circulating across Canada in recent months. Eastern Ontario and Ottawa have been among the hardest-hit parts of the province. About 62 per cent of Ottawa seven year olds were vaccinated against pertussis (whooping cough) last year, compared to a provincial average of 69.8 per cent.

Wilson’s company has designed an app to help improve both vaccination rates and reporting, something that is being used in Ottawa. But he said Ontario needs a better, timely vaccine registration system that can provide clearer data about vaccination rates.

In September, the Ontario Immunization Advisory Committee released a position statement calling for a more comprehensive vaccine registry system in the province.

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“Currently, Ontario does not have a reliable, complete or timely system to record vaccinations for all people in the province. Most people in Ontario still have a paper-based “yellow immunization card” to document their past vaccines. Having an immunization registry would benefit individuals, families, healthcare providers, public health and researchers. It would help reduce the burden of diseases that vaccines can prevent, make it easier for people to get vaccinated, improve the delivery of Ontario’s immunization programs, and ensure better use of health resources,” according to a summary of the paper.

Wilson notes that calls for a better system have been ongoing for years.

“We have this ongoing, never-ending gap in the ability to capture immunization data despite enormous investments over the last decade.” Wilson is currently doing a research project looking at vaccine registries.

And it is becoming more important than ever to have good data about vaccination rates, because fewer people are getting vaccinated.

Among other things, there has been increasing vaccine hesitancy since the pandemic which has expanded to other vaccines as well. The imminent installation of health officials in the U.S. who amplify that hesitancy could make things worse, he said.

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The primary care shortage in Canada — which is also likely to worsen before it improves — is another factor driving lower vaccination rates.

“For some diseases, it is really important that almost everybody is vaccinated to prevent the spread of that disease. We have to figure out ways to get people vaccinated,” said Wilson.

In a statement, Public Health Ontario warned that when immunization coverage decreases, more people are susceptible to illnesses from vaccine-preventable diseases, and people with certain medical conditions as well as children too young to be vaccinated are at the highest risk for severe outcomes.

Ottawa Public Health has numerous initiatives to help increase immunization uptake and to better understand who is vaccinated, including special clinics and neighbourhood health hubs.

Information about routine childhood vaccinations is available from OPH at: www.parentinginottawa.ca/en/immunizations.aspx

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