New Brunswick Premier Blaine Higgs says vaccination "can't be optional" and that more public education about immunization is needed.

His comments come amid a measles outbreak in the Saint John area, a whooping cough outbreak in the Fredericton area and a province-wide gonorrhea outbreak.

"Many parents have made a choice not to vaccinate their kids and I think whether it be in a daycare, in the school system, that this has to be something that we look at — that it can't be optional," Higgs told reporters Tuesday, shortly after public health announced a ninth confirmed case of measles.

The latest case of the highly contagious respiratory disease is linked to one of seven other previously confirmed cases at Kennebecasis Valley High School in Quispamsis.

At some point you look at the risk and you've got to make a decision. - Blaine Higgs, premier

Measles is transmitted through the air or by direct contact with an infected individual.

"In a public system where others are at risk, there are protective measures that are well-proven and we have to see that people use them."

New Brunswick does have a policy requiring students to prove they are immunized against several diseases, including measles and whooping cough, before they enter the school system.

The aim of Policy 706 is to "minimize the risk that an outbreak of a vaccine-preventable disease will occur" and to make sure students are protected if such an outbreak happens.

Students can be granted exemptions for medical reasons with a form signed by a doctor, or for "parental objection" if the parent signs a form acknowledging their child can be excluded from daycare or school in the event of an outbreak of a vaccine-preventable disease.

New Brunswick health authorities have advised staff and students at Kennebecasis Valley School they must receive a measles booster shot if they want to continue going to the school. (The Canadian Press)

The current vaccination rates among students are unclear because Education Minister Dominic Cardy recently discovered the policy hasn't been enforced "for a very long time." The seven school districts haven't been collecting the entry data, "despite the fact that it's mandated," Cardy has said.

"At some point you look at the risk and you've got to make a decision," said Higgs. "And that's where we are right now, I think, with the protection of the measles and that's maybe where we are with others who just say, 'I don't want to be vaccinated.'"

Maine to end opt-outs

Neighbouring Maine, which is dealing with its first case of measles since 2017 and whooping cough outbreaks, plans to end non-medical vaccination opt-outs in September 2021.

Last week, Democratic Gov. Janet Mills signed into law, a bill that eliminates religious and philosophical exemptions.

Higgs said he doesn't know whether mandatory vaccinations could breach the Canadian Charter of Rights and Freedoms, but he intends to look into the matter.

"We've always talked about health being a priority, so we have to weigh the pros and cons … how do we make it a priority and protect everyone?"

The government will consult with medical professionals about how to minimize the risks to students and staff, he said. "And we need to follow some rules around that."

Outbreak a 'crisis'

Liberal Edmundston-Madawaska-Centre MLA Jean-Claude D'Amours described the measles outbreak as "a crisis."

He called on the premier Tuesday to call Health Minister Ted Flemming back from vacation.

"We are really walking on thin ice right now. We are facing a crisis," he told reporters.

Jean-Claude D’Amours, Liberal Edmundston-Madawaska-Centre MLA, said it's 'sad to see' the health minister on vacation in the midst of the measles outbreak and called on the premier to 'do the right thing' and bring him back. (CBC)

Higgs said Flemming will be back on Thursday. In the meantime, the government is dealing with the outbreak, he said.

"I'm very comfortable right now that we have it in hand."

Health officials have said they expect the number of cases to continue to climb.

"This is really serious," said D'Amours.

'Very concerned'

The province's chief medical officer, Dr. Jennifer Russell, said she's "very concerned."

"We are putting all of the resources we can into this issue," tracking down people who may have been exposed to a confirmed case and protecting those at risk, she said.

"Pretty much everybody" in public health in the Saint John region is working on the outbreak and additional resources are being brought in from other regions as relief, said Russell.

"In this type of a setting, to sustain that kind of workload and that effort, you have to rotate people in."

Dr. Jennifer Russell, the province's chief medical officer of health, said the measles outbreak is changing daily and she anticipates more cases will be confirmed. (CBC)

Measles symptoms, which usually begin within eight to 12 days after infection, may include fever, cough, runny nose, red or sore eyes, sleepiness, irritability and tiny white spots in the mouth.

Within three to seven days, the telltale red blotchy rash usually develops on the face and then spreads to the rest of the body.

Anyone who is exhibiting symptoms and decides to seek medical attention should call ahead before visiting their doctor's office, a clinic or emergency room so proper measures can be put into place to prevent the possible spread to others, officials have said.

People infected with the measles virus can be contagious about four days before the telltale rash appears until four days after. (Submitted by Emmanuel Bilodeau)

Measles can be more severe in adults and infants. Complications can include ear infections, pneumonia, blindness and swelling of the brain, which can cause seizures, deafness, brain damage or death. If contracted during pregnancy, it can cause miscarriage, premature labour, and low birth weight.

Most people are protected from measles with two doses of the measles, mumps, rubella (MMR) vaccine.

The measles outbreak in the Saint John region started on April 26 with an individual who had recently travelled to Europe and visited two hospital emergency departments before being diagnosed. (CBC)

People born before 1970 are considered immune.

The first confirmed case of measles in the region, announced on April 26, was an individual who had recently travelled to Europe and visited the Saint John Regional Hospital's emergency department before being diagnosed.