As of Wednesday, Alberta had 1,790 cases of measles and the number continues to grow.Jeff McIntosh/The Canadian Press
Newly released documents paint a picture of how Alberta’s measles outbreak began with a handful of isolated cases and started to grow into what is now the worst in North America, as public-health measures to control spread in some cases proved ineffective.
The documents, obtained through a freedom of information request, offer the most detailed illustration yet of the early days of Alberta’s measles outbreak and how the government impeded some health officials’ efforts to stop it.
Cases began to pop up in the Western province in March and quickly spiralled − with outbreaks tracing back to travellers, a northern First Nations community and a Mennonite school, the documents show. The province had 1,790 cases as of Wednesday and the number is growing.
Canada’s outbreak began last October in New Brunswick before spreading to multiple other provinces. Ontario and Alberta were hardest hit.
The 432 pages of documents, which are partly redacted, include internal e-mails between officials at Alberta Health Services between March and May this year, in addition to minutes from emergency response and provincial measles task force meetings.
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During the first two months of the outbreak, there was little communication with the public from government and health officials regarding the extent of the crisis or how it was handled. The only formal communication was a statement from then chief medical officer of health Mark Joffe on April 11 that strongly encouraged vaccination and notices of possible exposure locations.
Days later, on April 14, Dr. Joffe’s contract expired, leaving Alberta without a chief medical officer of health as measles hit all regions of the province. He said during a university presentation the following month that “a complete failure of leadership at all levels” and public complacency contributed to Alberta’s measles outbreak. Both of these issues are touched on in the internal communications.
Internal e-mails and meeting notes show that senior leaders at AHS, in co-ordination with Dr. Joffe, were constantly in communication about the outbreak and how best to mitigate transmission through such measures as contact tracing, targeted health care guidance and outreach to affected communities.
The documents show it was common for AHS to have to wait for government approval to proceed, in some cases frustrating its efforts to more quickly implement, for example, visitor restrictions in hospitals. Meeting notes from May 13 say: “Until further notice, all presentations given to an external audience will require the minister’s approval.”
Maddison McKee, press secretary to Minister of Primary and Preventative Health Services Adriana LaGrange, said the government stands by its approach to the measles outbreak. “Alberta’s government has always taken the measles situation seriously,” Ms. McKee said in a Wednesday statement.
She said the province’s response is guided by public-health experts, pointing to vaccination clinics, expanded vaccine eligibility and Alberta’s awareness campaign, which began in May.
It was previously known that John D’Or Prairie, which is one of three communities that make up the Little Red River Cree Nation in Northern Alberta, was one of – if not the first – outbreak location in the province.
The community was able to get the outbreak under control quickly by holding vaccine clinics, sharing measles guidance and providing daily updates.
Internal e-mails between senior staff at AHS now show that some of the other early cases were linked to a Mennonite wedding in Ontario and probable or possible exposures through domestic and international travel, to places such as Kenya, India and Mexico.
The names, dates of birth and other identifying information of these measles patients, the majority of whom were children, are included in the documents. The Globe and Mail is not publishing any identifying details.
In the health zone that includes Calgary, the first confirmed case was a nearly two-year-old girl who was not immunized against measles. She was admitted to the Alberta Children’s Hospital in Calgary on March 14 with a telltale rash and fever.
The child had recently returned from a Mennonite wedding in Leamington, Ont., where she was exposed to a measles case, e-mails show. She had also recently travelled to Mexico. Her two-year-old cousin, who also attended the wedding, became the second known case in the Calgary area. The cousin was also unvaccinated.
Francesco Rizzuti, a Calgary zone medical officer of health, said in a March 20 e-mail to Dr. Joffe that six children, all 2 and under with various levels of immunization, had been sent for measles testing overnight. The majority had no known sick contacts. Travel to British Columbia, Manitoba and an “endemic area in India” were noted in files.
“Sadly, I think this could be our reality for a while,” Dr. Joffe responded.
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Among the first cases in the Edmonton zone were members of a family who had recently returned from Kenya, with a known travel exposure, the e-mails show. The first case, a 12-year-old boy, was confirmed in mid-March. His three siblings, all unvaccinated, were also believed to have been infected.
Additionally, internal e-mails detail an early exposure in Central Alberta. A seven-year-old girl attended Two Hills Mennonite School, riding the bus to and from school while contagious, according to a March 27 e-mail to Dr. Joffe from Alyssa Ness, Central Zone medical officer of health. She noted that there were possibly 173 susceptible contacts.
The Two Hills outbreak quickly unravelled and, by the second week of April, public-health officials determined control measures were not working and were considering a stop to individual contact tracing and no longer excluding infected individuals from public settings, the documents reveal.
Ifeoma Achebe, lead medical officer of health in the Central Zone, said in an April 8 e-mail to colleagues that parents were refusing to comply with public-health measures, causing multiple cases to emerge daily. She noted that the vaccination rate for the school was 23 per cent.
On April 10, Dr. Joffe said in an e-mail to public-health leaders that case and contact follow-up, in addition to directions regarding exclusion, would continue.
“We fully recognize that enforcement is not a realistic option,” he wrote. “Implementing public health measures, particularly in communities such as this, where vaccine hesitancy and refusal is high, efforts can feel futile. However, prioritizing the health and safety of the broader population must remain the primary objective.”
Two Hills Mennonite School did not respond to a request for comment; neither did Dr. Joffe. Roughly 120 cases have been identified in the Central Zone since March.
Ms. McKee said the province is encouraged by a gradual drop in cases over the past three weeks.