Measles 2023/Global Outbreak and travel information

 

I have gotten several questions recently about international travel with kids under a year. It turns out that an early MMR is suggested for many travel destinations. Since plenty of folks are traveling this summer, I am sharing this updated info

Measles 2023/Travel information

Things to know about measles Measles, also known as rubeola, is a very contagious respiratory virus. This virus is so virulent that ninety percent of unvaccinated people will catch this virus once they are exposed. What is even more alarming is that it can remain on surfaces or even in the air for 2 hours after someone has sneezed or coughed! If someone travels on a plane while they are contagious...that is a potential nightmare. One of the reasons that it spreads so easily is that people are contagious as early as 2-4 days prior to showing any signs of the virus and may remain contagious until the rash is gone, or 4 days after the symptoms are all clear. Infected people present with high fever, cough, congestion and red eyes. . After several days they will also develop a significant rash all over the body. If you have a happy child with a rash, my guess would be that it isn’t measles. People with measles will look sick and likely have a high fever. The rash will not be one of the first symptoms. Complications are frequent They range from ear infections to pneumonia, encephalitis and/or seizures. 1-2 out of every 1,000 cases are fatal. Take a moment and reflect on what that means. This is a serious illness. This is not one of those illnesses to wish your child would catch in order to get natural immunity. Vaccination The routine measles vaccine is combined with mumps and rubella and is referred to as the MMR. The individual components have not been available separately for many years. The first MMR shot is routinely given to patients between 12-15 months and again between 4-6 years. Why do we wait so long before giving the first MMR protection to babies? Assuming that the birth mom has been fully vaccinated (or less likely has had the actual measles) infants are born with passive immunity to the disease. This immunity starts to wane and is considered mostly gone by the time the babies are between 12 and 15 months. If a child is vaccinated when they are younger than a year old and still have some maternal protection, the vaccine does not seem to be as effective for long term protection. For the second dose there is the option of combining it with the chickenpox vaccine called Varivax. That combo vaccine is called Proquad or MMRV.  Just one dose of the MMR vaccine is thought to be 93% effective. The second dose is given just to catch the occasional person who didn't get effective immunity from one dose and bumps the effectiveness up to 97%. It can be given earlier than 4 years, but I am not too concerned about the timing of the second dose as long as patients have gotten the first one. If you are traveling to a high risk area, the CDC will suggest getting the second shot early. The 2 shots simply need to be given at least 28 days apart and after the age of 1 year. The MMR is a live vaccine and it is true that in some rare cases the reaction can be a little rough. Interestingly, most kids are just fine the day of the immunization. Typically the reaction comes along between 7-21 days after the shot. This reaction may include high fever and rash. This is not thought to be contagious. It usually lasts only a day or so. If your child is allergic to eggs, doctors may be extra cautious when giving the vaccine. Some folks with a significant reaction to eggs may opt to get it at the allergist's office. I have NEVER had any patient have an allergic reaction from the MMR, or a serious post-vaccination reaction other than about 20% who seem to get the fever the following week. Before routine use of the measles vaccine, there were about 500,000 cases of measles in the United States each year, and about 500 deaths. Measles also led to about 48,000 people being hospitalized and another 1,000 people being left with chronic disability from measles encephalitis. Study after study has shown that there is no link between the MMR and autism, but there are still some folks reluctant to give their children the vaccination. In July 2016, SB277 was signed into law. It is now a requirement that all children attending schools in California have the measles vaccine unless they have a medical contraindication. Since the law passed, I have seen a steep increase in vaccination rates. This law probably has saved lives. Most schools just require 2 doses after the age of a year and don't care a bit about the timing. This has been a quiet year so far for measles cases in the US. Due to the recent pandemic, there were several years in which many routine immunizations were put off or skipped. Public health officials were on alert but we are lucky that that hasn’t bitten us in the butt so far. As of June 8, 2023 there have been a total of 16 measles cases reported by 11 jurisdictions. This is so much better than 2019 when there were 1,274 cases confirmed in 31 states.  Even a few cases can make parents of young kids nervous. It goes without saying that if you have a young baby in a crowd they are at risk. Because we live in such a global world, you never know where the next outbreak will be. For reference, the CDC defines an outbreak as “a chain of transmission that includes 3 or more cases linked in time and space.”  Travel considerations Unfortunately, measles remains a common disease in many parts of the world. Each year, an estimated 128,000 people die from measles. Take a moment to recognize what a huge number that is!! Quite a few countries and popular travel destinations have experienced measles outbreaks in recent years, including countries in Europe, Israel, India, Thailand, Vietnam, Japan, Ukraine, and the Philippines. This is only a partial list. Before your next trip, check your destination and CDC’s global travel notices. If you do travel, pay attention to your health for 3 weeks after you return to make sure you didn’t bring this home. PLAN IN ADVANCE! If you are traveling to a high risk area or there has been a possible measles exposure, the vaccine can be given as early as 6 months. You need to be aware that this early shot can’t be counted on for lasting protection. Your child will still require two shots after the first birthday. Your insurance company also might refuse payment if the shot is given outside of the routine schedule. If that happens, be aware that getting an early, extra dose may be an out of pocket expense. If your child is over a year and has had only one MMR so far, go ahead and see about getting them their second shot early if you are going to one of the higher risk countries. It takes about 10-14 days to get any significant protection from the first MMR. Hence planning is important. Hepatitis A is one more vaccine that can be giving early for travelers. Several years ago when I was working on my very first measles post, one of my adult friends said to me, "We all got measles and survived, what is the big deal?" My response was, "It is true enough that the vast majority of folks who get measles will recover intact and have lifelong immunity. However, one to two kids out of 1,000 will die; many more than that will be permanently harmed. That is too many when we are talking about something that can be prevented. That 1 child out of 1,000 matters."