by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Measles and the International Traveller – latest from TravelSafe Immunization Clinic

Measles and the International Traveller - latest from TravelSafe Immunization ClinicMeasles and the International Traveller

Measles is a highly contagious disease spread by a virus easily transmitted through the air. It was once a common disease in Canada during childhood. Before the introduction of the measles vaccine the disease caused an estimated 2.6 million deaths worldwide, and was a significant cause of disability.

Measles is still common in many developing countries, especially in Africa and Asia. Outbreaks continue to occur worldwide. Current outbreaks include Mauritius, Mali, Uganda, Russia, Spain, New Zealand, Colombia, Czech Republic, Taiwan, Japan, Belarus, Liberia, Kosovo, Syria, Italy, Brazil, Ireland, Philippines, United Kingdom, and France to name a few. You don’t need to be traveling to a developing country to be at risk for measles!

Symptoms of measles begin 7-21 days after being exposed and can include high fever, rash, cold-like symptoms and red, inflamed eyes. Complications of measles can include diarrhea, ear infection, pneumonia, and encephalitis (swelling of the brain that can lead to seizures, deafness, or permanent brain damage). There is no cure for measles; treatment is only supportive. About 1 in 3000 people with measles will die from complications.


The efforts toward the elimination of measles in Canada

A single dose of the measles vaccine has been recommended in Canada for infants at 12 months of age since 1970. Between 1996-1998 a 2-dose vaccine program was implemented, and a second dose was then given to children and adolescents previously vaccinated under the 1-dose program. Receiving two doses of the measles vaccine is more than 99% effective to protect against measles, compared to 93% after one dose. However, some people missed out on this second dose of measles vaccine and as a result could still be susceptible to measles. In BC children currently receive their first dose of the measles, mumps, rubella (MMR) vaccine at 12 months of age, and a second dose between 4-6 years of age.

In 1992 Canada set a goal to eliminate measles by 2005. Although elimination usually implies a total absence of cases, this is not possible as importations can still occur from countries with less control over measles. Elimination of measles in Canada was therefore defined as the interruption of endemic measles transmission for at least 1 year, and failure to reestablish endemic transmission after importation (endemic refers to a disease that is regularly found among a particular population or certain area). The goal of measles elimination was achieved in Canada in 1998.

Despite Canada’s efforts to maintain elimination, there continues to be outbreaks of measles throughout the country. The 2011 outbreak of 725 reported cases in Quebec was the highest number of cases since 1995. There was also a large outbreak in 2014 in B.C.’s Fraser Valley with 433 reported cases. There have also been other outbreaks in various regions in Canada.


So why are there still measles outbreaks after it was eliminated in 1998?

There continues to be measles outbreaks in Canada mainly due to cases imported from international travellers who acquire the disease abroad which can then be spread to unvaccinated or partially vaccinated individuals. In recent years Canada has experienced falling vaccination rates due to a number of reasons including anti-vaccine views and incompletely immunized individuals. The vaccine coverage rate in Canada is close to 90% but it needs 93-95% to protect the population against measles.


International travel and the MMR vaccine

The measles vaccine is available only in combination with mumps and rubella (MMR vaccine). The best way to prevent the spread of measles and importing it to Canada is to ensure you are properly immunized before international travel, even to industrialized countries. Travellers should receive the vaccine according to the following guidelines:

  • Infants between the ages of 6-11 months should receive 1 dose of MMR. Infants who received the vaccine before 12 months of age must be revaccinated according to the routine schedule (dose #1 at 12 months of age; dose #2 at 4-6 years of age).
  • Children 12 months of age and older should receive 2 doses of MMR separated by at least 28 days.
  • Adults born after 1970 (1957 for health care workers) should receive 2 doses of MMR separated by at least 28 days (individuals born prior to 1957 are assumed immune to measles from natural infection). Those born between 1957 and 1970 are generally assumed to have acquired immunity from natural infection, however those without documentation of 2 doses of measles vaccine, or those who do not self-identify as having had the disease may be susceptible and should receive 1 dose of MMR.


Vaccine Safety

Common reactions to the MMR vaccine include redness, tenderness and swelling at the injection site. A mild fever, rash, or swelling of the glands in the cheeks or neck can occur about 7-12 days after receiving the vaccine. Temporary joint pain may also occur in teenage and adult women.

A published report linking the MMR vaccine to autism has never been replicated by any other study. The report has been widely discredited and has been retracted by the journal.

There are some people who should not get the MMR vaccine including individuals who:

  • Have had a severe allergic reaction to a previous dose of the MMR vaccine or any vaccine component
  • Are severely immunosupressed
  • Are pregnant or planning pregnancy (women should avoid pregnancy for 1 month after receiving the MMR vaccine)
  • Have had a blood transfusion or received other blood products in the last 12 months
  • Have had a drop in platelets after a previous dose of MMR

There is no need to delay the MMR vaccine if you have a cold or another mild illness.


Getting ready to travel?

There is an estimated 20 million people infected globally each year with measles, so travellers may be exposed to the virus in almost any country they visit. As an international traveler it is important to ensure your MMR vaccines are up to date. Protect yourself against measles and ensure you do not become an importer of the disease!

Don’t delay! If you are traveling soon make your appointment today!



by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

HPV – What is it and who needs the vaccine?

HPV – What is it and who needs the vaccine?

HPV – What is it and who needs the vaccine?

Human Papillomavirus infections, more commonly known as HPV, are the most common sexually transmitted diseases that can affect both men and women. It has been associated with different cancers in men and women including:

  • Cervical cancer
  • Vulvar and vaginal cancers
  • Anal cancer
  • Throat cancer
  • Penile cancer

It is also the cause of anal and genital warts.



Why should you be concerned?

  • Anyone who engages in any type of sexual activity including oral, genital or anal contact is at risk for HPV. It is not necessary to have sexual intercourse to be infected with HPV.
  • Not all HPV infections cause symptoms, so it is not always possible to know if you are infected. It is then possible to pass on the infection to others without even knowing it.
  • Every year in BC:
    • About 200 women will get cervical cancer and 50 will die from it.
    • About 110 people will get anal cancer and 40 will die from it.
    • 5,500 people will develop genital warts.


There are more than 100 types of HPV that can be considered either high risk or low risk. High risk HPV types can cause cervical, genital, and anal cancers as well as certain cancers of the head and neck. Low risk HPV types can lead to anal and genital warts.

HPV vaccines protect against the most common strains of HPV associated with cancers. In Canada, there have been 3 types of HPV vaccines that all protect against the 2 HPV types that cause about 70% of cervical cancer.

Cervarix vaccine (HPV2)

  • Prevents cervical cancer and pre-cancerous lesions caused by HPV types 16 and 18.

Gardasil 4 (HPV4):

  • Prevents cervical cancer and pre-cancerous lesions caused by HPV types 16 and 18;
  • Prevents anal and genital warts caused by HPV types 6 and 11.

Gardasil 9 (HPV9):

  • Prevents cervical, vulvar, vaginal, and anal cancers and related pre-cancerous lesions caused by HPV types 16, 18, 31, 33, 45, 52 and 58.
  • Prevents anal and genital warts caused by HPV types 6 and 11.

Gardasil9 is the HPV vaccine that is currently available at TravelSafe Clinic.



Who should receive the vaccine?

Gardasil 9 is recommended for both men and women. It is provided free for boys and girls in grade 6. It is also provide free to individuals between 9-26 years of age who are:

  • Boys born on or after January 1st, 2006
  • Girls born in 1994 or later
  • HIV positive
  • Transgender
  • Men who have sex with men, including those who may not yet be sexually active and are questioning their sexual orientation
  • Men who are street involved

It is also provided free to males who are:

  • 9-18 years of age in care of the Ministry of Child and Family Development
  • In youth custody services centres

If you fall into one of the above categories please contact the Public Health Unit in your area to schedule a vaccine appointment. You can find a health unit by searching your city or postal code at


The vaccine is also recommended but not provided free to:

  • Women born before 1994 who are 45 years of age and younger
  • Men 9-26 years of age who do not fall into one of the above categories
  • Men 27 years of age and older who are men who have sex with men.


The vaccine is available for purchase at TravelSafe clinic if you fall into one of the above categories.

If you do not fall into one of these categories but think the vaccine may be of benefit to you, please call your health care provider at TravelSafe Clinic for more information!


Vaccine schedule:

Healthy individuals 9-14 years of age:

  • 2 doses separated by 6 months

Immunocompromised individuals 9-14 years of age, and all individuals 15 years of age and older:

  • 3 doses at 0, 2, and 6 months



Still have questions?

Below you can find the answers to some frequently asked questions:


Why is the vaccine recommended at such a young age?

  • It is best to receive the vaccine before any exposure to HPV (i.e. before sexual activity begins).


If I am already sexually active should I still get the vaccine?

  • People who have already become sexually active should still receive the HPV vaccine because it is unlikely that a person would have been exposed to all the HPV types contained in the vaccine.


Is the vaccine safe?

  • The HPV vaccine has proven to be safe an effective. Hundreds of millions of doses of the vaccine have been administered worldwide.
  • Common reactions to the HPV vaccine are similar to reactions to other vaccines. These common reactions include redness, swelling and soreness of the injection site, as well as fever, headache, fatigue, and muscle or joint ache.


How well does the vaccine work?

  • In women who have never been infected with HPV the vaccines prevent nearly 100% of cases of cervical cancer caused by the HPV types contained in the vaccine.
  • The HPV9 vaccine prevents around 78% of cases of anal cancers in men caused by the two main types of HPV.
  • The HPV vaccine prevents around 90% to 100% of genital warts in both men and women caused by HPV types 6 and 11.


How long does the vaccine last?

  • It is currently not known how long protection from the vaccine lasts. There is no recommendation for a booster at this time.


I received 2 doses of Gardasil 4. Can my 3rd dose be with Gardasil 9?

  • Yes! If you have started with Gardasil 4 the series can be completed with Gardasil 9. However, only 1 dose of Gardasil 9 will not protect against the 5 additional strains of HPV that are not in Gardasil 4. A complete series of Gardasil 9 is recommended to ensure protection against these 5 additional strains.


I am a women who has had abnormal PAP screening. Should I receive the HPV vaccine?

  • The HPV vaccine does not have any effect on existing cervical lesions, nor does it prevent the consequences of any existing HPV infection. However, it is unlikely that a person has been exposed to all types of HPV contained in the vaccine so it may still be of benefit in preventing other types of HPV.


I have had the HPV vaccine. Does this mean I no longer need PAP screening?

  • It is still important to receive regular PAP screening as the HPV vaccine protects against most but not all cervical cancers.

Before you travel, protect your health.

Travel Safely with TravelSafe Immunization Clinic