Travel Warning – Measles Outbreak

Published by Chris Harvey June 14, 2012

Centers for Disease Control and Prevention

Outbreak Notice Measles Update

Squaremouth recommends travel insurance for all of your overseas trips.

Updated: May 25, 2012

What Is the Current Situation?

In the United States, measles was declared eliminated in 2000 due to high vaccination coverage and effective public health response. That means measles no longer occurs year round in the United States. However, measles is still common in some parts of Europe, Asia, the Pacific, and Africa. Travelers who have not been vaccinated are at risk of getting the disease and spreading it to their friends and family members who may not be up to date with vaccinations. Because of this risk, all travelers should be up to date on their vaccinations, regardless of where they are going. Measles is one of the most contagious diseases, and even domestic travelers may be exposed on airplanes or in airports.

Europe

As of May 14, 2012, the Ministry of Health of Ukraine reported 9,173 suspected measles cases in 2012, mostly in the western regions of the country. The Ukraine Ministry of Health has reported strengthened preventive measles measures including vaccination planning, surveillance and reporting. CDC urges all travelers who are going to the 2012 European Football Championship in Ukraine be immunized against measles.

As of May 23, 2012, 1,268 cases of measles have been reported from Romania in 2012. There were 4,015 cases reported in Romania in 2011.

As of May 23, 2012, in France, 358 cases of measles have been reported in 2012. There were 15,206 cases reported in France in 2011.

In the United Kingdom, as of April 29, 2012, 1,279 suspected measles cases have been reported in 2012, mostly in Liverpool, Knowsley, and Sefton.  There were 1,083 measles cases reported from the United Kingdom in 2011. CDC urges all travelers going to the 2012 Olympic and Paralympic Games or Wimbledon in London be immunized against measles.

As of May 23, 2012, Spain has reported 182 measles cases and Italy has reported 133 measles cases in 2012.

Travelers to Europe, Africa, and Asia have been sources of imported cases in the United States. Particular hotspots may come and go, but all travelers should protect themselves by being vaccinated.

What Is Measles?

Measles is spread by contact with an infected person and through coughing and sneezing. Measles virus can remain active and contagious for up to 2 hours in the air or on surfaces.

People with measles usually have a rash, high fever, cough, runny nose, and red, watery eyes. Some people who become sick with measles also get an ear infection, diarrhea, or a serious lung infection, such as pneumonia. Although severe cases are rare, measles can cause swelling of the brain and even death. Measles can be especially severe in infants and in people who are malnourished or who have weakened immune systems (such as from HIV infection or cancer or from certain drugs or therapies).

How Can Travelers Protect Themselves?

Talk to your doctor to see if you need a measles vaccination before you travel. People who cannot show that they were vaccinated as children and who have never had measles should probably be vaccinated.

The first dose of measles vaccine is routinely recommended at age 12–15 months in the United States. However, children traveling outside the United States are recommended to get the vaccine starting at age 6 months. If your child is aged 6–11 months and will be traveling internationally, talk to a doctor about getting the measles vaccine.

The only vaccines available in the United States are the measles-mumps-rubella (MMR) and the measles-mumps-rubella-varicella (MMRV) vaccines. MMR has been used safely and effectively since the 1970s. A few people experience mild, temporary adverse reactions, such as joint pain, from the vaccine, but serious side effects are extremely rare. There is no link between MMR and autism.

Information for Health Care Providers:

Ensure that travelers are immune to measles before they travel.

  • Children 6–11 months of age who are traveling outside the United States
    • Children in this age group should receive at least 1 dose of MMR.
    • MMR vaccines given before 12 months of age should not be counted as part of the routine series. Children who receive MMR vaccines before age 12 months will need 2 more doses of MMR or MMRV vaccine, the first of which should be administered at 12–15 months of age (12 months if the child remains in a high-risk area) and the second at least 28 days later.
  • Children 12 months or older, adolescents, and adults who are traveling outside the United States
    • International travelers in these age categories who have received 2 doses of MMR or other live measles-containing vaccine are considered immune to measles.
    • International travelers in these age categories are also considered immune to measles if they have had the diagnosis of measles documented by a physician, have laboratory evidence of immunity, or were born before 1957.
    • International travelers in these age categories who cannot be considered immune according to the above criteria should receive 2 doses of measles-containing vaccine (separated by at least 28 days).

If a patient has symptoms of a fever, cough, red eyes, runny nose, and a red, raised rash and has a history of any recent international travel, measles should be considered in diagnosis.