10 March 2011

Measles risk during travel

Overseas travel is an important factor in the international spread of measles. In the United Kingdom (UK), a pre-travel health consultation offers an ideal opportunity to ensure that all non-immune travellers are offered measles, mumps and rubella (MMR) vaccination.

Outbreaks of measles continue to occur in Europe [1]. Currently, the World Health Organization (WHO) reports that Denmark, France, Germany, the Netherlands, Norway, Serbia, Switzerland, the United Kingdom, and the former Yugoslav Republic of Macedonia have all reported measles cases in 2011. France reported more than 1,500 cases in 2009, more than 4,500 cases in 2010, and nearly 1,000 cases in January 2011 [1, 2]. Turkey recently reported an outbreak in Istanbul, as well as cases linked to a large outbreak in Bulgaria in 2010. Small outbreaks, associated with Uzbekistan, have occurred in the Russian Federation [1].

Measles is common in parts of Africa and Asia [3]. Large outbreaks and high case numbers were reported in Africa during 2010 in Lesotho, Malawi, Nigeria, South Africa, Zambia and Zimbabwe [1, 4]. In Asia and the Far East during 2010, outbreaks and high case numbers were also reported in Bangladesh, Indonesia and the Philippines [2]. Sporadic cases and clusters occur in the Americas, often related to importations.

Cases and vaccination schedule in the UK

MMR vaccine has been part of the UK childhood vaccination schedule since 1988 [5]. Following a decade of relatively low MMR uptake, there is now a population of UK adolescents who are only partially vaccinated or have never received MMR [6].

A total of 374 confirmed cases of measles were confirmed in the UK during 2010 [7]. Currently for 2011, the Health Protection Agency has reported 22 measles cases. Eight of these had a history of recent overseas travel to France, India, Turkey or Switzerland [7].

Advice for travellers

Measles is an acute viral illness that can be complicated by encephalitis and pneumonia [5, 6]. A pre-travel health consultation is an ideal opportunity to ensure the UK vaccination schedule is up to date. All unvaccinated, non-immune travellers are at risk from measles when visiting countries reporting measles, especially if staying with friends or family and mixing with the local population. Ideally, non-immune children and adults should receive two doses of MMR vaccine, at least one month apart, before travel.

Additional vaccine recommendations for specific countries can be found on the NaTHNaC Country Information Pages.

References

1. World Health Organization Regional Office for Europe. Vaccines and Immunization: Measles outbreak continues across Europe. 1 March 2011. [Accessed 10 March 2011]. Available at: http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2012/03/measles-outbreaks-continue-across-europe-who-says,-get-vaccinated

2. World Health Organization. Reported Measles Cases and Incidence Rates by WHO Member States, 2009, 2010, as of 9 February 2011. [Accessed 10 March 2011]. Available at: http://www.who.int/immunization_monitoring/diseases/

measlesreportedcasesbycountry.pdf

3. WHO/UNICEF Joint Statement: Global plan for reducing measles mortality 2006-2010. [Accessed 10 March 2011]. Available at: http://whqlibdoc.who.int/hq/2005/WHO_IVB_05_11_eng.pdf

4. Centers of Disease Control and Prevention (US). 2010 Measles Update. 9 September 2010. [Accessed 10 March 2011]. Available at: http://wwwnc.cdc.gov/travel/content/in-the-news/measles.aspx

5. Measles. Chapter 21 (updated 14 December 2010). In: Salisbury D, Ramsay M, Noakes K [eds.]. Immunisation against infectious disease. Department of Health, London, 2006. [Accessed 10 March 2011]. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_

digitalassets/@dh/@en/documents/digitalasset/dh_063649.pdf

6. Donaldson L, Beasley C, Ridge K. Professional Letter: The MMR catch-up programme. 6 August 2008. PL/CMO/2008/5. [Accessed 10 March 2011]. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/

Lettersandcirculars/Professionalletters/Chiefmedicalofficer

letters/DH_086837

7. Health Protection Agency. Confirmed measles cases in England and Wales - update to end January 2011. Health Protection Report. 5(8), 25 February 2011. [Accessed 10 March 2011]. Available at: http://www.hpa.nhs.uk/hpr/archives/2011/hpr0811.pdf

Links

• Health Protection Agency: Measles

• NaTHNaC Health Information Sheet: measles

• National Institute for Clinical Excellence: Reducing differences in the uptake of immunisations.

• World Health Organization Position Paper: measles