Measles Is Just the Start

In St. Thomas, Ontario, Asmaa Hussain is on the frontlines treating unvaccinated patients

It’s hard to keep up with Canada’s measles outbreak. Last month, the federal health database reported more than 1,500 cases across the country. More recent stats from Public Health Ontario counted more than 1,400 cases and 100 hospitalizations in Ontario alone. Of these, some 70 per cent are in Southwestern Ontario, 95 per cent of patients are unvaccinated and most all can be traced back to last fall, where a large Mennonite gathering in New Brunswick unknowingly became a superspreader event that’s still unfolding today.

Many people from the Mennonite community, if and when they decide to seek medical attention, come to St. Thomas Elgin General Hospital in St. Thomas, Ontario, about a half hour south of London. There, they’ll find chief of paediatrics Asmaa Hussain, leading her team through a measles outbreak she never thought she’d see in her lifetime in this part of the world. Declining vaccination rates have caused the return of the highly contagious disease: just 83 per cent of Canadian children have received the measles, mumps and rubella vaccine, whereas herd immunity requires 95 per cent to prevent outbreaks. Here, Hussain describes what it’s like to manage measles on the ground, if she’s ever successfully swayed people to vaccinate, and whether the end is near.

St. Thomas Elgin General Hospital has been in the thick of a measles outbreak for a few months now. What’s it like in there?

Since the end of November, we’ve admitted 17 patients with measles, two adults and 15 children. They’ve been spread over multiple months, so we haven’t had a significant overload of patients, but those that we do have require a significant amount of care. Each patient needs their own special negative pressure room that ensures the infection doesn’t spread throughout the hospital. March had our highest number of admissions, with nine patients, and now we’re trending down. Hopefully we’re through the worst of it here, but I don’t know. Nobody does.

You’re in Elgin County, home to a sizable Mennonite community—many of whom remain unvaccinated. Are you doing anything different from other hospitals?

Most hospitals have one negative pressure room; even though we’re a small hospital, we have three—one in emergency, one in the adult ICU and one in paediatrics. Once a patient passes the infectious period, we move them out of the room so we can admit another. When we have more patients than rooms available, we have to transfer them to another hospital. We also changed our protocols in terms of visitation. Much like we did during the pandemic, we limited the number of visitors and the number of people allowed to accompany every patient. We’ve relaxed these now, but when we were in the thick of it, only one person was allowed per patient, even for kids. We’ve got a big sign at our entrance that says, “If you have these symptoms, stay in your car and call us.” We’ll call the patient into the room when it’s ready.

Do you remember the first time you saw a case of measles?

I’d seen measles in Iraq before I came to Canada in 2007, but lots of doctors here have never seen it. For them, seeing the first measles patient was like, Oh my god. Knowing that patient has inevitably been in contact with many other people, you know that more cases are coming.

As for this outbreak, I saw the first case at the very end of November. I was on call at the hospital when a patient—a child—came in with respiratory problems. When I assessed him, I noticed an odd rash that looked very uncommon. I asked if they’d had any contact with someone with measles, and they said, “No.” I asked the patient if they were vaccinated, they said, “No.” So I checked with Public Health Ontario, who gave me the names of two reported cases two weeks earlier. I went back to this child’s parents, who confirmed those two reported cases were their neighbours. They said, “Oh, yes, but that was two weeks ago so we were safe.” I eventually found out they’d visited these neighbours a few days ago.

Seriously?! Were they deliberately lying to you or just clueless or what?

I’m not sure, but this kind of thing happens a lot. People interact with other people assuming they’re safe. Sometimes people are in denial. There’s definitely an element of guilt. People will say they took a level of precaution that they really didn’t, and they’ll only tell their doctor or come into the hospital when things have gotten bad. All of these are factors about why they didn’t admit to contact until I specifically asked about it.

Does that mean there’s a whole cohort of people and kids who had or have measles and we’ll never know?

Absolutely. The number of measles cases that we have in hospitals is probably barely scratching the surface. We suspect there’s a massive amount—multiples and multiples and multiples of who we actually see. For a lot of the admissions, we did, in fact, ask if and where there’d been measles exposure, and the parent would say, “Yes, my seven other children all had measles at home three weeks ago.” Many people will never get tested and never seek medical help and continue to spread the disease, knowingly or otherwise.

How are you not more frustrated? I would be infuriated.

Sometimes people make poor choices, but doctors have to treat the patient just the same. And while it’s true that a lot of the Mennonite community is unimmunized, I see people from all walks of life who have decided not to vaccinate. Vaccination rates over the last decade have been getting worse everywhere, including in Mennonite communities, and vaccine hesitancy has increased, especially since COVID. Mennonites are a bigger, more recognizable group that often chooses not to vaccinate. But I see all kinds of families who don’t vaccinate their children.

I understand how anti-vaxxers online get and spread misinformation, but where else does it spread?

Word of mouth is a big one. I’m told there are talks in Mennonite churches where people say vaccines aren’t safe or good. Many Mennonite parents are actually immunized, because vaccine hesitancy has only been growing in the past few years, so I’m not sure how much of the hesitancy is religious objection. It doesn’t matter to me anyway, because I always tell parents the same thing: we’re spoiled by not seeing measles in our lifetime so we’ve forgotten how terrible measles can be. Our parents saw it, so they chose to vaccinate their children, and I hope parents today make the same choice.

How do you convince them to make that choice?

All you can do is communicate the risks. We do everything we can to protect our kids—we strap them into car seats, we make them wear helmets when they’re riding a bike. Measles is just the same. In fact, it can be very serious, especially if your child is immunocompromised. Now maybe you think, my child is healthy so they’re fine, but in reality, you don’t know when your child might become unhealthy. You don’t know they won’t be diagnosed with leukaemia or require chemotherapy. If something like that were to happen, you’ll want to know you did everything you could. You don’t want to carry the guilt that you could have stopped it.

Have you ever successfully changed someone’s mind about vaccines?

No. I have the discussion all the time, and I’ve convinced vaccine-hesitant people who are on the fence and willing to listen and learn, but that’s it. Even for those who get measles, a mild case often serves to vindicate their ideas that it’s a simple infection and doctors are making too big of a deal over it. If the case is severe enough that they come to the hospital, they figure they’ve had it now anyway and won’t get it again. We’re lucky that we haven’t had any deaths from measles, and it’s true that most people will be fine, but what about the people that won’t be fine? We need to protect everyone, especially children.

What’s been the hardest part of the outbreak for you?

The hardest part is the “what if.” What if polio is next? What if it’s a bacterial infection causing meningitis? There are many vaccine-preventable diseases that are much more serious than measles—which is already serious itself—in that they cause widespread disabilities and deaths in children. So, the hardest part for me is worrying about if this is a sign of what’s to come.