N.W.T.'s top doctor on measles risk, and being 'a victim of our own success' as vaccination rates drop

The office of the chief public health officer in the N.W.T. has issued potential exposure notices for two Yellowknife businesses and three schools after confirming a case of measles in the city this past weekend.

The virus is spreading across the country, with more than a thousand cases reported so far, over 200 of which are in Alberta.  

Dr. Kami Kandola, the N.W.T.'s chief public health officer, spoke with CBC's Trailbreaker host Hilary Bird Tuesday morning about the risks and what people can do to stay safe. 

This interview has been edited for length and clarity.

When did this case of measles first come to your attention?

We were alerted about the confirmed case of measles on Saturday, May 3rd, and on May 4th we gathered all the exposure locations and prepared letters for the schools and contacted the schools and one of the businesses before we launched a formal public health advisory and that was launched on Monday.

Do you have any sense of how this person got the virus?

This was linked to a confirmed case through a flight.

OK, so they were on a flight that a person in another part of the country had confirmed a measles case?

Exactly.

Do you know if this person was vaccinated?

This person did not have protection against measles, so that put that particular individual at risk. And of concern for myself is that we've seen a decline in measles uptake in our young children. 

In 2019 almost 90 per cent of two-year-olds had at least one measles-containing vaccine and that had dropped down to about 82 per cent in 2024. 

You need about 95 per cent coverage to have what we call herd immunity. So we're far below that target, which makes us susceptible when we have an introduction of measles.

If someone has been vaccinated and they were at one of these exposure sites, what is the likelihood that they could get measles?

If someone has immunity to measles, either by getting two doses of a documented measles-containing vaccine or contracting measles, they have excellent, almost 100 per cent, protection against acquiring measles through an exposure. 

And what about if they weren't vaccinated?

Unfortunately, measles is airborne. It is highly contagious and it can be suspended in the air two hours after someone with measles leaves that room. So if someone was exposed to measles and was not protected, nine out of 10 people in that situation end up getting measles. 

So this is why it is really important that people who are not protected stay home. Call 811 or Yellowknife public health for further guidance. But stay home until they receive further instruction.

In the document that you released yesterday, you have asked some people to isolate at home. Is that who you're asking to isolate? People who are unvaccinated who may have been exposed?

It's two types of people [who we're asking to isolate]. For the people who have no history of vaccination, who never received a vaccine, that's a really small number of people, but they're very susceptible to measles. 

But there's another group of people who think they were vaccinated but they just can't find their records.

They still both have to stay home until they have documented proof that they've either received the vaccine or had measles itself.

Typically anyone who got their vaccines in Northwest Territories, we would be able to quickly look in the electronic medical record and check their vaccination status. But for those who received their vaccines outside of the N.W.T., they need to contact their health-care providers or their clinics and get a record to document that they received the vaccines. And I feel that the vast majority of people fall in that category. They know they've received the vaccine, they just don't have the documentation. 

So what I'm urging people in Northwest Territories, we know there's been over 1,000 cases of measles in Canada and in multiple provinces. Please don't wait until you're exposed to try to figure out if you have been vaccinated or not.

Individuals who know they got the vaccine, know they had measles and they have proof, they can go to school and work. 

Can you talk to us about the symptoms of measles?

So measles is a virus. Once you're exposed, within 10 to 14 days, you'll wake up and won't feel well. It seems almost like a cold or flu-like symptoms. You'll develop a cough, you'll have a runny nose and then you also have pink watery eyes. 

Some people, if you look into the cheeks, it looks like they have grains of salt stuck on their cheeks or under their lip. If you see that, only the measles virus provides that. 

Usually within four days you'll wake up and have a blotchy rash. It will start from your head and travel down your body to your arms and legs and all those symptoms together. 

When you get those symptoms, when you get sick, you should be staying at home. Call 811. Don't go to the ER or the health centre unless you are experiencing worsening symptoms and your health is compromised, then call 911.

What is the likelihood that unvaccinated people would recover from a virus like measles?

It depends. The highest risk is to those that are immunocompromised in terms of severe complications. So by and large, people are immunocompetent and not in high-risk category — they could have a miserable time with measles, but they may not go on to develop severe complications. 

Children, infants, pregnant people are at higher risk for severe complications.

It is highly preventable with a vaccine, but once you're exposed and you are not protected, most people will feel miserable but will recover. But some people can go on and develop serious complications like pneumonia, ear infections and what is of concern, inflammation of the brain.

If someone is listening to this who isn't vaccinated, where can they go to get vaccinated if they'd like to?

All across N.W.T. there are health centres and public health clinics that provide measles-containing vaccine, in the public health clinics in Inuvik and in Hay River, also in Yellowknife. And then there's community health centres elsewhere for those who have not been exposed but want to get vaccinated. Right now, Yellowknife Public Health is focusing on individuals who are exposed, looking at vaccine records, but you can still call Yellowknife and book an appointment if you're not exposed to update your measles, mumps, rubella vaccine.

If someone is vaccinated, how worried should they be during this time here in Yellowknife?

If you're doubly vaccinated, you can rest assured that you have almost 100 per cent chance of being protected by measles. There have been rare, rare cases of people who are double vaccinated and develop measles, but they tend not to have a very severe case of measles and it's less transmissible to other people.

I'm not concerned for that population. If you're ill, just stay home just in case you're one of those very rare people who end up getting measles even though you're double vaccinated. But this is a very rare scenario. By and large, it's those who are not vaccinated that's fuelling the measles outbreak across Canada.

Vaccination rates for children under two years old have been dropping here. Why do you think that is?

There is a lot of vaccine fatigue, vaccine hesitancy. People went through COVID, young parents growing up, they have never seen measles. So we've been a victim of our own success. So if you don't see measles and you don't know how sick your child could be and the potential serious complications you get with measles, you tend to rest on other people getting the vaccine to protect you. But unfortunately that's not working.

We can't rely on herd immunity or a large number of people being vaccinated. So the more people that don't get vaccinated, the more at risk you or your children are.

For people who were born before 1970, what should they be doing?

Before 1970, we didn't really have an effective measles-containing vaccine so most adults in that age, they acquired measles naturally. So once you get measles, you're protected for life.

So our expectation is anyone born before 1970 would have already acquired measles naturally. People born before 1970, would be considered adequately immunized but if they are traveling to an area that has high levels of measles, they should get at least one dose of measles-containing a vaccine.