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Measles Update

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

Updated: January 20, 2012

What Is the Current Situation?

Measles transmission has been interrupted in the United States though vaccination, but it is still common in many parts of the world, including Europe. 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 among the most contagious diseases, and even domestic travelers may be exposed on airplanes or in airports.

France and Europe

In France, more than 14,000 cases were reported from January through June 2011 (as of October 26, 2011).

More than 26,000 cases have been reported from 40 countries across Europe, including outbreaks in France, Spain, Serbia, Romania, Macedonia, and Turkey, among others. More than 23,400 cases and 8 deaths have been reported from countries in the European Economic Area (as of October 26, 2011).

Africa

The Democratic Republic of Congo has reported a total of 123,537 suspected measles cases and 1,519 measles deaths since the start of 2011 (as of November 9, 2011).

South Sudan has reported over 1, 511 suspected measles cases, and 39 measles-related deaths have been attributed to measles infections from January to October 2011.  Of these cases, 115 were laboratory confirmed. The highest rate of cases were found in Northern Bahr el Ghazal and Unity States; areas with the highest concentration of returnees from Sudan (north) following South Sudan independence in July 2011.

New Zealand

New Zealand has reported approximately 400 cases of measles since January 2011. Auckland has been the most affected, although cases have been reported on both the North and the South islands. No deaths have been reported. Cases are occurring among children, adolescents, and adults.

Ecuador

Ecuador has reported nearly 200 cases of measles since October of 2011. Ecuador has not had measles since 1996. Children under five are most affected by this outbreak. The Tungurahua province has the highest number of cases. Ecuador’s Ministry of Health is conducting a national vaccination campaign for children under five.

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.

Additional Information:

 
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