Health officials brace for measles outbreak to grow as Saint John cases climb to 8

With three more measles cases confirmed late Sunday in the Saint John area, bringing the total number to eight, health officials are bracing for the outbreak to continue to grow.

All three new cases are linked to Kennebecasis Valley High School, where four other cases of the highly contagious respiratory disease were previously confirmed, Department of Health spokesperson Bruce Macfarlane said Monday.

Two of the new cases are KVHS students or staff who were exposed to a previously confirmed case at the Quispamsis school, said Macfarlane.

The third person was exposed to an infected individual from KVHS while visiting the Saint John Regional Hospital's emergency department as a patient, he said.

The ER is where the outbreak began on April 26, after someone who had recently travelled to Europe visited several times over several days.

No information about that individual has been released, but none of the confirmed cases to date are health-care workers, said Macfarlane.

It would be naive of us not to say that we will have more cases.- Kimberley Barker, regional medical officer of health

Health officials are contacting people who may have been exposed to the virus within the past 72 hours and urging them to get a dose of the measles, mumps, rubella (MMR) vaccine for added protection if they haven't already received a shot in the past 28 days.

However, the number of cases is expected to climb, according to regional medical officer of health Dr. Kimberley Barker.

"In an outbreak setting, as you can see, you begin to catch people that participated in sports … went to a restaurant, went to a sleepover — it just grows exponentially," she said during a news conference at the Saint John Hilton Hotel.

"And so it would be naive of us not to say that we will have more cases."

Barker said no one could say how long the increase in cases would last.

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

The incubation period can be up to 18 days.

"I think sometimes people say, 'Eight cases of measles, you know, what's the big deal?' … But for those eight cases, we've had to contact nearly 2,000 people that may have come into contact with that," said Barker.

An outbreak would be declared over at approximately 40 days after the last case, she said.

Classes continue at Kennebecasis school

As of Monday, about 30 students and four staff at KVHS have been told to stay home because of lack of immunity or missing proof of immunization, said Zoë Watson, the superintendent of Anglophone South School District.

If any of those students continue to be excluded, she said the district will ensure they have whatever support they need to progress through to the end of the school year.

Otherwise, classes and most activities are continuing as usual — at least for now.

"As this is an evolving situation, our focus over the last week has been on assisting public health in containing the spread of this virus," said Watson. 

"Alternate arrangements may certainly have to be made in the coming days as a result of the measles outbreak and those situations will be addressed as they arise."

Watson encouraged parents throughout the district to ensure their children's schools have up-to-date contact information in case they need to be reached.

An upcoming elementary drama festival may be relocated to another school, she said.

But hundreds of people attended an academic awards ceremony at the school last Thursday evening and "a couple of rental activities" proceeded Sunday morning, just hours before public health held another special immunization clinic in the gym because two more cases were confirmed on Saturday.

More than 950 people at the school have been immunized at four special clinics in recent days, said Watson.

KVHS has more than 1,000 students and more than 100 staff.

"The safety of the students and the adults in that building is our priority and we'll continue to work through those," she said.

Barker said she has received "a number of calls" from concerned and confused parents, but closing the school may not necessarily eliminate the exposure risk.

"These kids are going to congregate somewhere else, whether it's in a mall or in somebody's basement … So from our perspective, trying to minimize alternative venues where these kids might congregate would mean keeping them at school and continuously monitoring and offering vaccination."

Quebec trip cancelled

Meanwhile, Rothesay Park School has cancelled its Grade 8 trip to Quebec May 29-June 2 because of the measles outbreak, principal Tammy Doherty advised parents in an email on Monday.

"We have not taken this decision lightly and realize how disappointing this will be to our students," Doherty wrote.

But following consultation with the district office, which has been working closely with public health to contain the outbreak, it's considered necessary to both protect students and reduce the risk of spreading the disease, the notice states.

"Our greatest concern would be that a student could start to present these symptoms while travelling away from home and their regular health care provider, and in extended close proximity to their classmates."

People who have had two doses of the MMR vaccine are considered 97 per cent protected, which is usually adequate, said Dr. Jennifer Russell, the province's chief medical officer of health.

But if they've been exposed to an active case, there's a three per cent chance they could become infected. 

"So that means three in 100 people," she said. "When almost everyone is vaccinated, the rare cases that do occur tend to be in these people."

So public health is urging anyone exposed within the past 72 hours to get a third shot as added protection during the outbreak.

Only those who haven't received an MMR vaccine in the past 28 days are eligible.

"Vaccination is still our best possible protection against measles," said Russell.

"It is important to note that if nobody in the school had been vaccinated, then 90 per cent would have become ill. It's that contagious."

Monitor for symptoms

Public health has contacted individuals who were at the ER last Saturday between 3 p.m. and 7:30 p.m. to invite them to attend an immunization clinic, said Russell.

If anyone was there at that time and hasn't been contacted, they should call Tele-Care at 811, she said.

Anyone who attended the ER at the following times is asked to monitor for measles symptoms and to check their immunization records:

• May 19, 10:45 p.m.-1:35 a.m.
• May 22, 8 p.m.-11:05 p.m.
• May 24, 9:45 a.m.-12:30 p.m.

Measles symptoms, which usually begin within eight to 12 days after infection, may include fever, cough, runny nose, red or sore eyes, sleepiness, irritability and tiny white spots in the mouth.

Within three to seven days, a red blotchy rash usually develops on the face and then spreads to the rest of the body.

'Stay home'

Anyone exhibiting symptoms or believes they have been exposed should "stay home," said Dr. John Dornan, the regional chief of staff for the Horizon Health Network.

"This is very unusual for us to tell people to do that, but when you walk into a busy emergency room or a busy family doctor's office, you risk exposing other people there that might not have adequate immunization," he said.

"People say, 'Is measles just a rash?' Sometimes it isn't. Often it is, but it can be a very significant concern for infants and for adults."

Complications can include ear infections, pneumonia, blindness and swelling of the brain, which can cause seizures, deafness, brain damage or death. If contracted during pregnancy, it can cause miscarriage, premature labour, and low birth weight.

"So in a word, stay home," said Dornan.

People can get "good, sound advice" over the phone by calling Tele-Care at 811 or their family doctor's office, he said.

In some cases, staff from the extramural program might be able to make a home visit to help make a diagnosis or take a swab.

Measles is diagnosed through blood and urine tests and swabs of the nose and throat.

Anyone who decides to seek medical attention should call ahead before visiting their doctor's office, a clinic or emergency room so proper measures can be put into place to prevent the possible spread to others, officials said.

A dedicated phone line has been set up to help people check their immunization record — 643-6251.