Winnipeg Free Press - PRINT EDITION

Homegrown measles pop up

Normally brought into province by travellers

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Measles in Manitoba have always arrived from somewhere else, but that is changing.

Manitoba has reported four cases of measles this winter, with two cases in recent days.

The first two cases this winter were in adults who didn't go anywhere before they fell ill, said Dr. Michael Routledge, Manitoba's chief provincial medical officer. One case was reported in the Interlake, a second in southern Manitoba and two others in Winnipeg. "Most of the cases we've had over the years have been travel-related. But the fact they both picked up without travel is new," said Routledge.

Three of the four Manitoba cases involved adults, two of them aged between 40 and 49 and one aged between 20 and 29. Up to now, measles has been almost exclusively a childhood illness in Canada.

Not since 1992 has there been more than a single Manitoba case in any given year, but because the numbers are small, public-health doctors are reluctant to read much into them, except for one important factor.

"That tells me we've got measles circulating in Manitoba. That's what it tells us," Routledge said.

Government and privately sponsored refugees aren't a factor, so far.

Winnipeg physician Michael Dillon, a member of Canadian Doctors for Refugee Health Care, said since vaccines fall under the province's public-health umbrella, refugees are covered. That means federal cuts to extended health-care benefits to refugees don't matter when it comes to measles.

This winter's measles outbreak has raised questions about the need for a national vaccine registry in Canada.

"The bottom line is that people who are moving around for whatever reason, whether it's within Canada, people born in Canada or whether it's people who were born somewhere else and came to Canada, just having to move around means that things like immunization just get missed," said Routledge.

A national registry would identify pockets of lower vaccine rates among immigrants and travellers to areas such as the Netherlands and the Philippines.

The two locations are hot spots for measles identified by public health officials this winter.

A national registry would also offer a database for public health officers across Canada to spot emerging hot zones here.

With no national vaccine registry, the role for the Public Health Agency of Canada is now purely consultative, Health Canada noted this week.

It's a simple matter of jurisdiction, a Public Health Agency of Canada spokeswoman said by email.

"The delivery of immunization programs and the implementation of immunization registries fall under provincial/territorial jurisdiction," the spokeswoman said.

Ever since the SARS outbreak in Toronto in 2003, however, the issue of finding a national way to track the spread and control of infectious disease has been under discussion. So far, no one has reached any firm conclusions.

"There have been other groups that have looked at the question of a national immunization registry. I wouldn't say there are any firm recommendations about that, but some groups have proposed we should have one, for the obvious reason, that everybody would agree about," Routledge said.

In the absence of any national system, Routledge said provincial public health organizations have put together a tracking system of their own, called Panorama.

It's patchwork at best but, in time, it could form a national registry.

"Panorama is this public health information system that has been proposed for a number of years nationally. A number of provinces are starting to use it, not all of them," Routledge said.

"And we're just in the early stages of the Panorama system, just starting to try it out, actually."

Panorama is designed as an integrated electronic public health record that would improve and support management of communicable diseases, outbreaks, immunization and inventory of medical supplies for every province that adopts it.

It will replace the current immunization system in this province, called the Manitoba Immunization Monitoring System and related databases.

MIMS relies on doctors' billings and records from public health nurses; from it the province can report immunization rates of more than 80 per cent, among the best in Canada, Routledge said.

Republished from the Winnipeg Free Press print edition April 9, 2014 A4


Updated on Wednesday, April 9, 2014 at 10:38 AM CDT: Corrects attribution to Public Health Agency of Canada

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