As we experience a worrying increase in measles cases, a Toronto doctor remembers this little girl who was left blind, unable to communicate and incontinent after contracting the virus.
Dr. Barry Goldlist was a medical student in 1973 when he saw this ten-year-old girl at the Children’s Hospital in Toronto. The girl had developed subacute sclerosing panencephalitis (SSP), a rare and fatal disease of the nervous system that usually strikes people infected with measles before their second birthday.
“It was horrible to see this little girl brain dead. She finally died in that hospital,” recalls Dr. Goldlist.
“We were told that one in 1,000 people who contracted measles developed a serious complication and that one in 10,000 could die from it. We say that it is quite rare, but millions of children contracted it before the [campagne de] vaccination. So, even if the percentage was small, the absolute numbers were considerable. »
Before the measles vaccine was introduced in Canada in 1963, these infections were common because the virus causes one of the most contagious diseases. Dr. Goldlist points out that many of his colleagues have recently spoken about their experiences as children. For example, her sister-in-law, who recalled a measles rash all over her body when she was a preschooler.
“Even though she was wearing soft flannel pajamas, she couldn’t button them because it hurt too much when it touched her skin,” Dr. Goldlist said.
The doctor also knows a woman in her 50s who lived with brain damage after being infected with measles at the age of three, which later left her unable to hold down a job.
Disinformation and misinformation
He and other health professionals worry that myths and misinformation about routine childhood vaccines could leave many children vulnerable to preventable infectious diseases, in what has become a highly emotional issue. They say that people’s failure to see or remember the suffering and devastation caused by measles has also contributed to some indifference, or carelessness, towards vaccination. .
Although measles was declared “eliminated” in Canada in 1998, after the adoption of a two-dose vaccination schedule, pockets of outbreaks occurred in some communities with little or no vaccination, sometimes linked to religious beliefs. religious as well as travel to countries where vaccination programs are not as robust.
Meanwhile, reportedly missed or postponed measles vaccination doses during the COVID-19 pandemic have led to a surge in cases worldwide, but anti-vaccination beliefs, shared in parenting groups online and elsewhere, had begun to gain support well before that date.
The World Health Organization (WHO) and the US Centers for Disease Control and Prevention said in a joint statement late last year that increasing measles outbreaks and deaths in many countries was “staggering,” but not unexpected given declining vaccination rates. In low-income countries, where the risk of death from measles is highest, vaccination rates are only 66% because of disruptions during the COVID-19 pandemic, the WHO said.
The Public Health Agency of Canada said for its part that the 2021 National Childhood Immunization Coverage Survey shows that 91.6% of two-year-olds have received at least one dose of a vaccine against measles. But just over 79% of children aged seven have received both doses.
Canada has set a target of 95% coverage for all recommended childhood vaccines by 2025.
The Public Health Agency of Canada said Wednesday that 29 cases of measles have been reported since the start of the year in at least four provinces: Quebec (19), Ontario, British Columbia and Saskatchewan. .
These cases were primarily travel-related, but included cases unrelated to travel or other infections, raising concerns about possible community spread.
“Collective immunity”, breastfeeding
Dr. Janice Heard, a community pediatrician in Calgary, says some parents choose not to vaccinate their children, or are hesitant to do so, because they believe myths that measles or other illnesses no longer exist, are “not that serious,” or that breastfeeding protects babies from infection.
“I don’t think people realize that these diseases that we prevent with childhood vaccines and adult boosters put many people’s lives at risk and can have many long-term consequences.” , said Dr. Heard, who is also a member of the public education advisory committee at the Canadian Pediatric Society.
“Ten percent of children who get measles will have complications — and they’re not small complications: we’re talking about things like seizures, pneumonia and long-term brain damage that never goes away. »
Breastfeeding provides a small dose of antibodies and is encouraged, but a baby exposed to life-threatening illnesses, such as whooping cough, will not be protected, Dr. Heard reminded. Vaccines stimulate the child’s immune system to produce antibodies on its own and develop immunity against diseases, she added.
Some parents think their children will be protected because others have been vaccinated, recalls Dr. Heard. “However, a very high percentage of vaccinated people is needed, more than 90%, to confer collective immunity to the population that is not vaccinated.
“And there are some diseases where herd immunity doesn’t work, but people don’t think about it, like tetanus for example. If you are not vaccinated, you are not protected,” she stressed about this infection caused by bacteria commonly present in the soil, and which can enter the body through an injury or a cutoff.
For Dr. Heard, therefore, it is important that the medical profession tackles misinformation and “vaccine hesitancy”, one parent at a time, through education and a non-judgmental approach.
Doctors who are also parents
Dr. Cora Constantinescu, a pediatric infectious disease specialist at the Alberta Children’s Hospital in Calgary, understands the fears some parents have about routinely vaccinating their children.
When it came time to vaccinate her almost one-year-old son against the measles-mumps-rubella trio, she hesitated because she wondered if it might be risky.
Car Mme Constantinescu was working for the Public Health Agency of Canada at the time, examining relatively rare “adverse events” related to vaccination. Her son had already received routine doses at two, four and six months, because she was convinced then that they were essential interventions.
“But all of a sudden I started to question the validity and importance of these vaccines. And I started to worry about the potential side effects,” admits Dr. Constantinescu, whose son is now 12 years old.
“I was a huge proponent of vaccination, but then I had my first child and realized that even I needed help and support. I was just wondering, ‘Will my child, who somehow never gets the disease, be that exception?’
She finally got her son — and her two younger children — vaccinated against measles. His experience as a “concerned parent” led to the creation of a “vaccine hesitancy clinic” in 2016 at the Calgary hospital, where parents’ fears are listened to and a feeling of trust is established.
Parents want the best interests of the child
Many parents who are hesitant about vaccination change their minds when they receive support, Dr. Constantinescu says — even those whose anxieties are caused by misinformation.
“I have a number of parents who started with one or two vaccines, then felt more comfortable and brought their children “up to date.” It’s a long process and requires patience,” she stressed.
“It breaks my heart a little: almost all the patients who come experience a very emotional appointment and they all say: “I am not anti-vaccine. I want to help my child.” For me, it’s the parents who need us the most, because they really strive to make the right choices. »
As measles spreads in several countries, Dr. Constantinescu believes it is important to learn lessons from the pandemic by calling on “vaccine champions” to talk to parents, including religious leaders or elders. — as many indigenous communities have done.
She recognizes that health professionals remain a reliable source of information and must communicate the threat of illness to a specific person or family, rather than focusing on collective responsibility.
“Altruism is good, but the reality is that parents make decisions that are primarily in the best interest of their child,” she explains. I fear losing the silent majority of people who are for vaccines and who would have had their children vaccinated anyway. And I think we need to emphasize that when it comes to the routine vaccination schedule.
“It’s not just about correcting erroneous information: if that were the case, we would have done it. You have to first show support, build trust, and then give a little information. »
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