The cough was dry and insistent, like someone knocking urgently at a door. It echoed through the waiting room where I sat with Hana Abboud, a public health nurse in London, Ontario, last Tuesday.
“It’s the sound that makes my stomach drop these days,” she confided, lowering her voice. “After 15 years in community health, I never thought we’d be back here watching for measles.”
Three new cases of measles have been confirmed in southwestern Ontario, bringing renewed concern to a region already stretched thin by respiratory illnesses. Public health officials announced yesterday that all three individuals reside within the same household, though they haven’t disclosed which specific municipality within the health unit’s jurisdiction these cases originated from.
What makes these cases particularly noteworthy is that none involve recent international travel—suggesting community transmission may be occurring locally.
“When I started nursing, we talked about measles like polio—something we’d essentially eliminated,” Abboud told me as we walked through the clinic where she works. The walls were papered with colorful vaccination posters. “Now I’m fitting N95 masks for staff and reviewing our isolation protocols.”
The Ontario Ministry of Health confirmed these cases bring the province’s total to eleven so far in 2024, a concerning increase from previous years. Dr. Kieran Moore, Ontario’s Chief Medical Officer of Health, emphasized the critical importance of vaccination during a press briefing earlier this week.
“A single case of measles can infect up to 18 unprotected individuals,” he explained. “We’re seeing the consequences of vaccine hesitancy that began years before the pandemic but has unfortunately accelerated.”
Driving through London’s east end later that afternoon, I passed a community center hosting a pop-up vaccination clinic. Only three cars dotted the parking lot. Inside, nurses waited with coolers of MMR vaccines, prepared for a rush that hadn’t materialized.
The current situation reflects broader changes in Canada’s vaccination landscape. National immunization coverage data collected by the Public Health Agency of Canada shows MMR vaccination rates have declined by approximately 5 percentage points since 2019, leaving pockets of vulnerability throughout the country.
Measles itself presents a paradox in public health communication. Its initial symptoms—fever, cough, runny nose, and red eyes—mimic many common illnesses, making early detection challenging. Yet its complications can be devastating: pneumonia, encephalitis, and even death, particularly in young children.
“We’ve become somewhat desensitized to respiratory symptoms after COVID,” explained Dr. Victoria Shen, an infectious disease specialist at Western University. “But measles requires a different level of caution because it’s vastly more contagious than coronavirus.”
What distinguishes the current situation from occasional imported cases in previous years is the potential for sustained community spread. With vaccination rates below the 95% threshold needed for herd immunity in several southwestern Ontario communities, public health officials worry these three cases could represent the beginning of a larger outbreak.
The household at the center of the current cases has been placed under isolation orders, and contact tracing efforts are underway. Health officials are particularly focused on identifying any exposure in high-risk settings like schools, daycares, or healthcare facilities.
Emma Richardson, a mother of three in nearby St. Thomas, described the anxiety rippling through parent groups. “My youngest is only ten months old—too young for the first MMR dose,” she said as we spoke outside her children’s elementary school. “I thought these were worries from my grandmother’s generation, not mine.”
Richardson’s concerns highlight the particular vulnerability of infants, who typically don’t receive their first measles vaccination until 12 months of age. In areas with active transmission, health authorities sometimes recommend an early dose for babies as young as six months, though they’ll still need the regular scheduled doses later.
Local clinics have reported increased demand for MMR vaccine verification and catch-up doses since the announcement. Pharmacist Darren Cho told me his London pharmacy filled more MMR vaccination appointments in two days than in the previous month.
“People forget that before the vaccine, nearly everyone got measles in childhood,” Cho said. “In the 1950s, Canada saw around 300,000 cases annually. We’ve lost that collective memory of how common—and serious—this disease actually is.”
The southwestern Ontario cases come amid a troubling global resurgence of measles. The World Health Organization and UNICEF reported a 79% increase in measles cases worldwide in 2023 compared to the previous year, with inadequate vaccination coverage driving the trend across multiple continents.
For communities in southwestern Ontario, particularly those with vaccination rates below protective thresholds, public health officials are emphasizing vigilance: watch for symptoms, check vaccination records, and seek immediate medical attention if measles is suspected—but call ahead rather than sitting in waiting rooms where the virus could spread.
As evening fell and I prepared to leave London, I called Abboud one more time. She had just finished a community information session about the cases.
“Only twelve people showed up,” she sighed. “But that’s twelve more families who understand what’s at stake now. This isn’t about creating panic—it’s about remembering what we’ve forgotten: that vaccines didn’t just happen to align with the disappearance of these diseases. They caused it.”
The next few weeks will reveal whether these three cases remain isolated or signal a wider outbreak. Either way, they serve as a powerful reminder that even eliminated diseases can return when we let our guard—and our vaccination rates—down.
