Vaccine Preventable Deaths

Measles remains a common disease in many parts of the world. Measles is a leading cause of vaccine-preventable deaths among young children.  2010 measles activity includes outbreaks in several countries in southern Africa. Over the past year, high numbers of measles cases have been reported in many countries, including Lesotho, Malawi, Namibia, Mozambique, South Africa, Zambia, and Zimbabwe. Several hundred deaths have also been reported.

An estimated 10 million cases and 164,000 deaths from measles occur worldwide each year. Measles is a leading cause of vaccine-preventable deaths among young children. Measles outbreaks are common in many areas, including Europe, making the risk for exposure to measles high for many U.S. travelers and U.S. citizens living in other countries.

Because of this 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, expatriates should make sure they are vaccinated against measles, especially in areas where outbreaks are reported.

Advice for Travelers includes; be up to date on all routine vaccines, including measles vaccine. (See the child and adolescent vaccination schedule and routine adult vaccination schedule at www.cdc.gov.) If traveling with a child, make sure he or she is up to date on all recommended vaccines. Measles vaccine, usually given as the combined measles-mumps-rubella (MMR) vaccine, is generally first 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 a child is older than 6 months of age and is traveling internationally, talk to a 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. (See the section under information for healthcare providers that outlines who is considered immune to measles.) If you are not immune, consider getting a measles vaccine from a reliable local healthcare facility.

Information sources that have reliable information on disease outbreaks and risks include;  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 countries with doctors who speak English and are familiar with treating expatriates. You can search the ISTM clinic directory for more information.

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 severe cases are 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 HIV infection, leukemia, lymphoma, or cancer) or from certain drugs or therapies.

Vaccines that protect against measles are live-virus vaccines. Currently, the recommended vaccine, which is the only vaccine available in the United States, is the measles-mumps-rubella (MMR) vaccine. 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 two 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 two doses of MMR or other 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.

Measles is one of the most highly contagious infectious diseases. It is spread by contact with an infected person and through coughing and sneezing. Measles virus can remain active and contagious for up to two hours in the air or on surfaces. 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.