25 April 2012
Measles risk during travel - update
International travel is an important factor in the global spread of measles. In the United Kingdom (UK) a pre-travel health consultation offers the ideal opportunity to offer non-immune travellers measles, mumps and rubella (MMR) vaccine.
Recent epidemiology in Europe
Between January and December 2011, a total of 35,768 cases of measles were reported in the World Health Organization (WHO) European Region . As of 12 April 2012, 4,506 cases of measles have been reported during 2012 in this Region .
The majority of cases have been reported from Ukraine where an outbreak of measles is continuing. Between January 2011 and January 2012, 3,642 cases were reported, most of which (3,318) were reported during the months of December 2011 and January 2012 . Unless control measures are implemented, transmission is expected to continue during the UEFA European Football Championship in June 2012 .
Recent reports from the rest of the world
In 2011, 47,699 cases of measles were reported in the WHO African Region . Nigeria (19,062 cases) and Zambia (13,150 cases) were the two countries reporting the largest number of cases for last year . Between 1 January and 12 April 2012, 4,049 cases were reported in the Region .
In the WHO South East Asia Region, 55,232 cases were reported during 2011 , with the majority from Maldives (25,970) and Bhutan (17,228) . Between 1 January and 12 April 2012, 5,686 cases were reported in the Region .
Cases and vaccination schedule in the UK
MMR vaccine has been part of the UK childhood vaccination schedule since 1988 . Following a decade of relatively low MMR uptake, there is a population of UK children and adolescents who have never received MMR or were incompletely vaccinated . Catch-up vaccination was recommended for this age group during 2008.
A total of 1,086 cases of measles were confirmed in England and Wales during 2011. The number of measles cases confirmed between January and March 2012 is 253, compared to 200 during the same period of 2011 . The majority of the 2012 cases (136/253) were reported in the north-west of England where an outbreak is continuing in the Merseyside region amongst unvaccinated adults and children .
Advice for travellers
Measles is an acute viral illness that can be complicated by encephalitis and pneumonia. A pre-travel health consultation is the ideal opportunity to ensure the UK vaccination schedule is up-to-date. 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.
All children should be up to date for MMR; for those travelling to countries currently experiencing an outbreak, the first dose of MMR can be given from 6 months of age (with a further two doses at the recommended ages).
Non-immune older children and adults should have received two doses of MMR vaccine, at least one month apart, before travel. For travellers who have received one dose of a measles containing vaccine at the recommended age, a reinforcing dose can be given at any time from one month from the first dose .
Football fans travelling to Ukraine and Poland for the UEFA European Football Championship in June should ensure that they are up to date with MMR vaccination before travel.
Additional vaccine recommendations for specific countries can be found on the NaTHNaC Country Information Pages.
1. World Health Organization Regional Office for Europe. Update on measles in the WHO European Region. WHO Epidemiological Brief. March 2012. [Accessed 25 April 2012]. Available at: http://www.euro.who.int/__data/assets/pdf_file/0009/160758/
2. World Health Organization. Reported measles cases by WHO region 2011, 2012 as of 12 April 2012. [Accessed 25 April 2012]. Available at: http://www.who.int/immunization_monitoring/diseases/
3. European Centre for Disease Prevention and Control. European monthly measles monitoring (EMMO). 19 March 2012. [Accessed 25 April 2012]. Available at: http://ecdc.europa.eu/en/publications/Publications/SUR-EMMO-European-monthly-measles-monitoring-March-2012.pdf
4. World Health Organization. Reported measles cases and incidence rates by WHO member states 2011, 2012 as of 12 April 2012. [Accessed 25 April 2012]. Available at: http://www.who.int/immunization_monitoring/diseases/
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 25 April 2012]. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalass
6. Donaldson L, Beasley C, Ridge K. Professional Letter: The MMR catch-up programme. 6 August 2008. PL/CMO/2008/5. [Accessed 25 April 2012]. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersand
7. Health Protection Agency. Confirmed measles cases in England and Wales: update to end-March 2012. Health Protection Report. Vol 6, 13 April 2012. [Accessed 25 April 2012]. Available at: http://www.hpa.org.uk/hpr/archives/2012/news1512.htm#msls
8. Health Protection Agency. Measles on Merseyside – latest. 26 March 2012. [Accessed 25 April 2012]. Available at: http://www.hpa.org.uk/ProductsServices/LocalServices/
- Health Protection Agency: Measles
- NaTHNaC Health Information Sheet: measles
- NaTHNaC UEFA European Football Championship 2012 – Information for health professionals advising travellers
- National Institute for Clinical Excellence: Reducing differences in the uptake of immunisations.
- World Health Organization Position Paper: measles