Measles remains a common disease in many parts of the world. According to the World Health Organization (WHO), more than 20 million people worldwide are affected by measles each year. Measles outbreaks are common in many areas, including Europe. For many U.S. travelers and expatriates, the risk for exposure to measles can be high, but the illness can be prevented by a measles-containing vaccine.

Current Measles Activity

Since the beginning of 2009, CDC has received reports of several outbreaks of measles worldwide, including―

• An outbreak of measles in the Swiss cantons of Vaud and Lucerne
• Reports of increased numbers of measles cases in Victoria and Queensland, Australia
• An outbreak of measles in Vietnam, including the city of Hanoi

From December 1, 2008, through January 31, 2009, CDC received reports of nine imported cases of measles; six of these cases were imported from the United Kingdom.

Because of the risk of measles in both developed and developing countries, all international travelers should be up-to-date on immunizations, regardless of the travel destination. In addition, U.S. citizens living in other countries (expatriates) should make sure they are vaccinated against measles, especially in areas where outbreaks are occurring, such as the countries listed above.

Recommendations for Travelers and Expatriates

• Be up-to-date on all routine vaccines, including measles (see the child and adolescent vaccination schedule and routine adult vaccination schedule).
• If you are traveling with a child, make sure he or she is up-to-date on all recommended vaccines. Measles-containing vaccine, usually given as the combined measles-mumps-rubella vaccine (MMR), is generally given at 12 months of age in the United States, but is recommended for children as young as 6 months of age who are traveling outside the United States. If your child is older than 6 months of age and is traveling internationally, talk to the doctor about getting the measles vaccine.
• Keep a copy of your immunization records with you as you travel.
• If you are an expatriate, make sure that you are immune to measles. If you are not immune, consider getting a measles-containing vaccine from a reliable local health-care facility.
  • U.S. Embassies or Consulates maintain lists of local medical facilities. See the Doctors/Hospitals Abroad webpage for more information.
  • The International Society of Travel Medicine (ISTM) has member clinics in many different countries with doctors who can speak English and are familiar with treating expatriates. You can search the ISTM clinic directory for more information.

Information about Measles

Measles is one of the most highly contagious infectious diseases. It is spread by contact with an infected person, through coughing and sneezing. Measles virus can also 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. Many times people with measles are hospitalized. Although it is rare, measles can become severe enough to cause swelling of the brain (encephalitis) and even death. Measles can cause especially severe disease in infants and in people who are malnourished or who have weakened immune systems from a medical condition (such as a result of HIV infection, leukemia, lymphoma, or cancer) or from certain drugs or therapies.

Information about the Vaccine

Vaccines that protect against measles are live-virus vaccines. Currently, the recommended vaccine and the only available vaccine for purchase is the measles/mumps/rubella vaccine (MMR). Since offices may still stock other types of vaccines with reduced components (e.g. measles-rubella), you can ask your provider to ensure that you receive the recommended MMR vaccine and not another vaccine that has fewer components.

 

Information for Health-Care Providers

It is important to ensure that travelers are immune to measles before they travel internationally.

• Children 6–11 months of age who are traveling outside the United States
  • Patients should receive a first dose of measles-containing vaccine. (See above.)
  • Remember: Measles or MMR vaccines given before 12 months of age should not be counted as part of the routine series. Children who receive measles or MMR vaccines before age 12 months will need 2 more doses of MMR 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
  • People who have received 2 doses of MMR or live measles-containing vaccine are considered immune to measles.
  • People 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.
  • People who cannot be considered immune based on the above criteria should receive MMR vaccine. See the adult vaccination schedule to determine if one or two doses (separated by at least 28 days) are needed.

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.

Resources

For more information, see the following links:

• Measles (CDC Health Information for International Travel 2008)
• Mumps (CDC Health Information for International Travel 2008)
• Rubella (CDC Health Information for International Travel 2008)
• MMR Vaccine, Recommendations of the Advisory Committee on Immunization Practices (ACIP) (MMWR Recommendations and Reports, May 22, 1998)
• MMR Vaccine Information Statement (CDC)
• Vaccines and Vaccine-Preventable Diseases (National Center for Immunization and Respiratory Diseases website)

Information Sources:

• World Health Organization. WHO measles media centre. Accessed February 5, 2009.
• Progress in Global Measles Control and Mortality Reduction, 2000—2007. MMWR 57(48);1303-1306 (December 5, 2008).
• Alert on Victorian measles cases (February 6, 2009): Department of Human Services, Victoria, Australia
• Measles case prompts health warning (PDF) (January 31, 2009): Queensland Health (Australia) Media Releases
• “La rougeole provoque de nouvelles flambées en Suisse et un décès” (February 4, 2009, in French): Office fédéral de la santé publique (OFSP) (Swiss Federal Office of Public Health)