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Update on Measles and International Travel - July 2019

Irene Papaconstadopoulos, MD FAAP

As per the CDC and the State of Hawaii Department of Health, before any international travel:

  • Infants 6 months through 11 months of age should receive one dose of MMR vaccine. This dose does not count as the 1st dose of MMR. Infants who receive one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose at least 28 days later).

  • Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days.

  • Teenagers and adults who do not have evidence of immunity against measles (See “Immunity” above) should get two doses of MMR vaccine separated by at least 28 days.

  • Immunization should be done ideally 2 weeks before travel. 

  • What about babies less than 6 months of age?  If a baby’s mother has had her MMR shots and/or had measles infection  she passes antibodies to her baby during fetal development while in-utero and continues to pass them passively while breastfeeding. Those antibodies provide protection for young infants and typically protect infants for up to 6 months. The reason babies don’t get the MMR shot sooner than a year of age is because of the persistence of these maternal antibodies — the vaccine won’t stimulate the baby’s own immune system to respond. 

About This Disease

Measles is a very contagious rash illness caused by a virus.  Measles can cause severe illness and serious health complications, especially in children younger than age 5 years, adults older than age 20 years, pregnant women, and people with immune system problems.  These complications include:

  • Pneumonia

  • Brain swelling, which could lead to permanent brain damage

  • Death

  • Subacute sclerosing panencephalitis (SSPE): a very rare progressive, disabling, and deadly brain disorder that results from a measles virus infection acquired earlier in life. SSPE generally develops 7 to 10 years after a person has measles, even though the persons seems to have fully recovered from the illness.

Signs and Symptoms

Symptoms of measles include:

  • High fever

  • Cough

  • Runny nose

  • Red, watery eyes

These symptoms are followed 3 – 5 days later by a rash that begins at the hairline, moves down  to the face and neck, and then spreads to the rest of the body.  The rash usually lasts for 5 to 6 days.

The fever, cough, runny nose, and red, watery eyes usually start 7 to 14 days after infection, with the rash appearing about 14 days after a person is exposed to measles.

Transmission

Measles spreads by direct contact with an infected person or through the air when an infected person coughs or sneezes.  It is so contagious that you can catch this disease just by being in a room where someone with measles has been, up to 2 hours after that person is gone.

An infected person can spread measles to others from four days before developing the rash until four days afterward.

If you are not protected against measles and are exposed to someone with the disease, contact your healthcare provider immediately:

  • MMR vaccine may prevent or lessen the severity of measles if given with 72 hours of exposure

  • Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within 6 days of exposure.

Impact in Hawaii

As of May 2019, no cases of measles have been diagnosed in Hawaii residents. 

Diagnosis

Measles is diagnosed by a combination of symptoms, physical signs, and laboratory tests.  People with symptoms of measles or who have been exposed to someone with measles should contact a healthcare provider immediately. Do not come to the office without contacting us in advance. 

Treatment

There is no specific treatment for measles.  Care of patients with measles consists mainly of ensuring adequate intake of fluids, bed rest, and fever control.  Patients with complications may need treatment specific to their problem.

Immunity

In general, persons with at least one of the following may be considered protected from measles:

  • Written documentation of adequate measles vaccination (see “Prevention” below)

  • Blood test showing they are immune to measles or have had the disease

  • Born before 1957*

Please note:  On rare occasions, measles can occur in people who have been fully vaccinated.

*Although birth before 1957 is considered acceptable evidence of immunity, healthcare facilities should consider vaccinating unvaccinated personnel who were born before 1957 and do not have laboratory evidence of immunity.

Prevention

The best way to prevent measles is to get vaccinated at the recommended age.

All children should receive two doses of the MMR vaccine which protects against three diseases:  measles, mumps, and rubella.  The first dose is given at age 12 – 15 months and the second dose at 4 – 6 years of age. After the 1st dose (at 12 months old), 95% of people are protected for life. The 2nd dose (usually at age 4) protects those not protected from the 1st dose and brings protection to 97-99%.

If you are not protected against measles (See “Immunity” above) and are exposed to someone with the disease, contact your healthcare provider immediately:

  • MMR vaccine may prevent or lessen the severity of measles if given within 72 hours of exposure

  • Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within 6 days of exposure.

July 2019

Additional Resources

https://www.cdc.gov/measles/index.html



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