Measles outbreak in Saint John area declared over by Public Health

The outbreak of measles in the Saint John region is officially over, Public Health declared Monday.

The outbreak lasted more than two months after the first confirmed case was announced April 26. There were 12 cases in total, the last of which was announced at the end of May. 

Public Health officials said the outbreak wouldn't be declared over until two incubation periods — roughly 40 days — had passed since the last confirmed case.

On Monday, the 42nd day since the 12th case was confirmed, the province's chief medical officer of health declared the outbreak over.

But Dr. Jennifer Russell said the public should remain vigilant. 

"This can happen again," she said during a press conference in Saint John on Monday.

In particular, she urged people who are travelling to check their immunization records and ensure they've received two doses of the measles, mumps and rubella (MMR) vaccine. A second dose raises the effectiveness of the vaccine to 97 per cent.

The disease is transmitted through the air or by direct contact with an infected individual. 

"Though the outbreak is over, I encourage New Brunswickers to ensure their immunizations are up to date," Russell said. 

"Measles is a highly contagious respiratory disease and is vaccine-preventable."

Russell and Health Minister Ted Flemming thanked health officials for their outbreak management know-how.

"I extend my sincere appreciation to the dedicated team of health professionals who worked tirelessly during the outbreak," Russell said.

Russell said Health Canada guidelines recommend allowing at least 32 days to pass following the rash onset date before declaring an outbreak over. She said Public Health opted to wait for two full incubation cycles before making the call.

How the outbreak began

On April 26, Public Health announced the first confirmed case of measles in New Brunswick since 2017. 

The individual, who had recently travelled to Europe, visited the Saint John Regional Hospital's emergency room before being diagnosed and potentially exposed more than 2,000 people to the virus.

That figure grew significantly when the second case was confirmed May 13. 

A person from Kennebecasis Valley High School in Quispamsis was in the emergency room at the same time as the first confirmed case. Before the month was over, nine other cases were confirmed — eight of which were linked to KVHS.

On May 31, the 12th case was confirmed at Hampton High School.

The biggest challenge

Dr. Kim Barker, the regional medical officer of health, said the biggest challenge facing Public Health was that infected individuals weren't in small households but high-traffic places, like an emergency room and two high schools.

The extent of the outbreak prompted Public Health to speak to 7,500 people through contact tracing. The department said 2,370 people were immunized at 12 special immunization clinics during the near 10-week period.

In total, 15,870 doses of the MMR vaccine have been administered since April — more than three times the number distributed in an average year.

"We've described measles as one of the most contagious diseases in the world and something that the entire globe is struggling to eliminate," Barker said. "As such, it was a critically important time for the Department of Health to subsequently declare an outbreak and mobilize every resource possible."

The department said 850 government employees from 11 different organizations worked behind the scenes during the episode.

Barker said it the operation was "successful" considering there were only 12 cases, none of which were severe and none of which resulted in death.

Ready for the future

The provincial government is taking steps it believes will reduce the likelihood of another outbreak and improve its response if or when another occurs.

At the height of the outbreak, Education Minister Dominic Cardy introduce legislative amendments to the Education Act and Public Health Act that would make medical exemptions the only acceptable reason for children in public schools and licensed early learning and child care centres not to be immunized.

The proposed changes would take effect Sept. 1, 2021. At that time, all existing and new students would have to either provide proof they're immunized against various diseases, or provide a medical exemption form signed by a health-care professional.

In January, the province announced it will spend $12.5 million over four years on a new electronic health record system to improve management of vaccinations, immunizations and disease outbreaks.

The system, Public Health Information Solution (PHIS),will lead to the digitization of paper records, connect non-integrated health databases and give the Department of Health real-time tracking of the vaccine inventory.
Russell said Monday the system will save money, time and resources during an outbreak.