Alberta's low vaccination rate is putting it at risk of a measles outbreak and the province should consider making vaccines mandatory, says an infectious disease expert.

The warning comes as Vancouver and Washington state deal with outbreaks of the highly contagious disease.

"Measles is a preventable disease and has been preventable for decades through immunization, and it's discouraging to see outbreaks occurring in developed countries such as Canada and the United States where vaccination has been available for many decades," says Dr. Jim Kellner, a pediatrician and infectious disease specialist who teaches at the U of C.

"Because of the persistence of those low levels of immunization, we are absolutely at risk for having a significant outbreak."

In Alberta, children are supposed to get two measles vaccinations — the first by 12 months of age and the second at age four. The MMR vaccine — which protects against measles, mumps and rubella — defends the body by making antibodies against the virus.

Having enough people immunized ensures that people who aren't immunized are also protected. - Dr. Jim Kellner, a pediatrician and infectious disease specialist

In 2017, 87 per cent of two-year-olds in Alberta had received their first measles vaccine and even fewer — 79 per cent of kids — had received their second dose by age seven, according to Alberta Health Services. The target rate is much higher, between 95 and 100 per cent, says Kellner.

"The concerning thing in Alberta as well is that those rates of immunization have been stuck at that level for quite a long time.

"Having enough people immunized ensures that people who aren't immunized are also protected," he said, like the elderly, children who can't be vaccinated for medical reason or infants that are too young, or people who are immuno-compromised.

While there have been no reported cases of measles in the province so far in 2019, there were six cases in 2018, AHS says.

Time to compel people beyond vaccine hesitancy: Kellner

Kellner says it's time to find a way to compel people to get past vaccine hesitancy and help them understand it is safe and will protect their health and others.

"I think starting with things like mandatory school programs is actually an idea that's time is here. It was here in the past and it's an idea whose time is here again," he said. "In addition, we do need to do a better job of positively encouraging people … that vaccines are both effective and safe."

CBC reported this week that the man whose family is at the centre of Vancouver's measles outbreak said he didn't vaccinate his children because he distrusted the science at the time.

Provinces such as Manitoba, Ontario and New Brunswick already require that children be vaccinated to attend public schools.

Mandatory vaccination worth considering: AHS

Dr. Jia Hu, Alberta Health Services' medical officer of health in Calgary, says it may be worth considering a mandatory vaccine.

"They've been shown to increase immunization rates," says Hu.

"I think there are concerns, you know, with implementing anything that's mandatory — those concerns sort of relate to patient autonomy — but I do think if we see the number of measles cases going up that's something we should definitely think about in Alberta."

According to AHS, the Calgary and Edmonton zones have the highest measles vaccination rates in the province while the North and South zones have the lowest.

Symptoms of measles begin seven to 18 days after exposure, and include fever, cough, runny nose, and a red blotchy rash that develops on the face and spreads down the body. It can cause complications like ear infections, pneumonia, or brain swelling which can lead to seizures, brain damage or death.

Approximately 110,000 people died from measles in 2017, mostly children under five years old, and the majority of those deaths could have been prevented by vaccination, according to the World Health Organization.