Immunodeficient individuals, including transplant recipients, express concerns about potential measles exposure
Unfiltered Take on the Measles Outbreak and Immunocompromised Individuals
Toronto — Laurie Miller, a 59-year-old heart transplant patient, who had a close brush with measles in Stratford, Ont, shares her chilling account of the risks confronted by people with weakened immune systems during an outbreak.
She was advised to visit the emergency room in mid-March after an all-terrain vehicle accident with her husband. A few days later, a public health unit reached out stating that a measles patient had been in the same emergency room.
Miller was working at her hair salon in a retirement home when she received this call. Though she was born before 1970, a timespan Health Canada considers likely to have natural immunity to measles, the health official sternly advised her to vacate premises immediately and isolate at home.
Huron Perth’s public health unit has reported over 120 cases since an outbreak began in October. Public Health Ontario declared on Thursday that the total number of cases in the province has surpassed 1,000, with 95 new cases since the previous week. Alberta counts 122 cases as of Wednesday, while Quebec declared its outbreak over earlier this week.
People with compromised immune systems cannot be administered the measles vaccine since it contains a live attenuated virus, a weakened version of the virus, which could prove harmful to their system.
“There’s countless of us out there with immunocompromised conditions, not just heart, but liver, lungs, and cancer patients on chemotherapy. There’s even people with heart failure,” Miller points out.
Dr. Deepali Kumar, director of the Ajmera Transplant Centre at Toronto’s University Health Network, echoes this sentiment, suggesting that the number of immunocompromised individuals today is significantly higher than before the measles elimination in Canada in 1988. Research published in JAMA in February revealed the rate of immunosuppression in 2021 was an estimated 6.6 per cent among adults, compared to 2.7 per cent in 2013. The paper suggests the increase may be due to an increase in immunosuppressive medication availability to patients.
Similarly, Kumar surmises that about four to six per cent of the Canadian population is immunocompromised in some capacity due to advances in immunosuppressant treatments.
“We haven’t had so much measles circulating when we’ve had so many people that are immunocompromised,” Kumar concludes, pointing out this as a new era.
This new era has led researchers to reassess protection strategies for this susceptible population. On March 14, the day after she was notified of exposure, Miller visited Toronto General Hospital, as suggested by her healthcare team. She was administered an intravenous infusion of immunoglobulin therapy containing antibodies from donated human blood to provide immediate short-term protection against measles.
Though she hasn’t fallen ill, given measles' highly contagious nature, she’s been cautious, especially in crowded spaces.
Steff Di Pardo, a 29-year-old Mississauga resident diagnosed with ankylosing spondylitis, a form of arthritis and autoimmune disease, has experienced the frightening reality of this heightened vulnerability firsthand. The medical infusions she requires every eight weeks to manage chronic back and pelvic pain hamper her immune system, making her susceptible to infections like measles.
As a result, she's always aware of her surroundings and wears a mask, but she highlights that measles’ resurgence has amplified her vigilance.
Janna Shapiro, a post-doctoral fellow at the Centre for Vaccine Preventable Diseases affiliated with the University of Toronto, is investigating the risk of live vaccines for immunocompromised patients during the current measles resurgence. She suggests that the risk-benefit analysis may have to be re-evaluated in this context.
She aims to comprehend whether the immune system of children with leukemia is robust enough to defend them from a weakened form of the virus in the vaccine. Shapiro is also assessing other groups like kids treated with new inflammatory bowel disease drugs that did not exist or did not exist on such a scale before measles was eliminated in Canada.
“We’re trying to understand this and understand how to strategize and best use vaccines, as well as other tools, to protect these kids. However, the reality is that if everybody around them is immunized, then they’re much less likely to be exposed,” Shapiro concludes.
This Canadian Press report, first published on April 25, 2025, is supported through a partnership with the Canadian Medical Association. CP is solely responsible for the content.
Key Strategies to Protect Immunocompromised Individuals during Measles Outbreaks
- Post-Exposure Prophylaxis (PEP) involves administering immunoglobulin (Ig) therapy to immunocompromised individuals, who cannot receive the live measles vaccine, after exposure to the virus.
- Community vaccination is crucial, focusing on two-dose MMR vaccine recommendations for eligible individuals and public health campaigns to address vaccine hesitancy.
- Guidance and education, including healthcare provider training and patient advisories about measles symptoms and avoidance of high-risk settings during outbreaks, are essential measures.
- Laurie Miller, a heart transplant patient from Toronto, recounts the risks faced by immunocompromised individuals during a measles outbreak, as she was advised to isolate at home after exposure in an emergency room.
- Toronto General Hospital suggested Miller visit them after her exposure, where she was administered immunoglobulin therapy for immediate protection against measles.
- Dr. Deepali Kumar, the director of the Ajmera Transplant Centre, notes that the number of immunocompromised individuals today is significantly higher than before the measles elimination in Canada in 1988.
- Janna Shapiro, a post-doctoral fellow at the Centre for Vaccine Preventable Diseases, is researching the risk of live vaccines for immunocompromised patients during the current measles resurgence.
- Shapiro is investigating the immune system's response to a weakened form of the virus in the MMR vaccine for children with leukemia, as well as other groups like those treated with new inflammatory bowel disease drugs.
- Key strategies to protect immunocompromised individuals during measles outbreaks include Post-Exposure Prophylaxis (PEP) with immunoglobulin therapy, community vaccination, and guidance and education for both healthcare providers and patients.
- Community vaccination focuses on two-dose MMR vaccine recommendations for eligible individuals and public health campaigns to address vaccine hesitancy.
- Steff Di Pardo, a Mississauga resident with ankylosing spondylitis, highlights the increased vigilance required due to measles' resurgence, as she's always aware of her surroundings and wears a mask.
- Healthcare provider training and patient advisories about measles symptoms and avoidance of high-risk settings during outbreaks are essential measures to protect immunocompromised individuals.
