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Concerns for Immunocompromised Individuals Amid Measles Outbreak

Laurie Miller, a 59-year-old heart transplant recipient from Stratford, Ontario, shares her experience regarding the heightened risks faced by immunocompromised individuals during a recent measles outbreak. Her story highlights the impact of infectious diseases on vulnerable populations.

After her husband suffered an all-terrain vehicle accident in mid-March, Miller took him to the emergency room. Shortly thereafter, her local public health unit notified her that a patient with measles had also visited the same emergency department.

While Miller is part of an age group that Health Canada suggests may have acquired some natural immunity to measles by being born before 1970, public health officials nonetheless advised her to leave work at the hair salon in the retirement home and self-quarantine immediately.

Since the outbreak began in October, Huron Perth, her local public health unit, has reported over 120 cases. As of Thursday, Public Health Ontario indicated that the number of measles cases in the province had exceeded 1,000, with 95 new cases identified in the previous week. Meanwhile, Alberta’s count stood at 122, with 14 cases confirmed as communicable, and Quebec announced that its outbreak had come to an end earlier this week.

For individuals with weakened immune systems, the standard measles vaccination poses a risk due to its use of a live attenuated virus, which could exacerbate their condition. “Many of us are immunocompromised,” Miller stated, referencing those with various health issues including heart, liver, lung diseases, and those undergoing cancer treatments.

Dr. Deepali Kumar, director of the Ajmera Transplant Centre at Toronto’s University Health Network, noted that the current outbreak is unprecedented, given the increased prevalence of immunocompromised individuals compared to previous outbreaks before the disease was declared eliminated in Canada in 1988.

A recent study published in JAMA revealed that the rate of immunosuppression among adults in the United States increased from 2.7% in 2013 to an estimated 6.6% in 2021. The rise is attributed to the wider availability of immunosuppressive therapies.

In Canada, Kumar estimates that around four to six percent of the population is immunocompromised, partly due to advancements in medical treatments.

“We haven’t had such a large measles outbreak coinciding with a significant immunocompromised demographic,” she remarked, highlighting the shift in public health dynamics.

This new landscape has prompted researchers to reassess protective measures for immunocompromised individuals. Following her exposure notification, Miller drove to Toronto General Hospital where she received an intravenous infusion of immunoglobulin therapy. This treatment uses antibodies from donors to provide temporary immunity against measles.

Despite her precautionary measures, Miller understands the risk she faces: measles is highly contagious, with the World Health Organization noting that one infected person can spread the virus to nine out of ten unvaccinated individuals in close contact.

Reflecting on her experiences at crowded places like grocery stores, Miller expressed the anxiety that the situation has created, saying, “It does stop you from doing things.”

Dr. Kumar remains concerned for immunocompromised individuals who may be exposed but fail to seek medical help promptly. Immunoglobulin therapy must be administered within a six-day window post-exposure for it to be effective.