The safest way to protect yourself against measles while traveling is to get vaccinated.
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The United States is experiencing the worst resurgence of measles in decades. Recent outbreaks in several states and exposures in places like bars, sports stadiums and on public transportation have some people wondering about travel safety or how they should prepare for upcoming projects.
The Centers for Disease Control and Prevention lists more than 3,600 confirmed cases of measles in the United States as of September 24 – and two deaths as of September 28. Almost all of these cases involve unvaccinated people.
The CDC notes that the number of deaths is subject to change as more information becomes available and after more testing is performed. It is important to note that the Pennsylvania Department of Health has counted four deaths associated with measles so far. The CDC has disputed whether measles actually caused these deaths.
Over the past two weeks, Pennsylvania, Ohio and New York have recorded the highest number of cases, according to the Johns Hopkins Bloomberg School of Public Health’s U.S. Measles Tracking System.
The actual number of cases across the country is likely higher, according to Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania.
“I think we are rather underestimating how many people are actually exposed, how many people are infected and how many people are hospitalized and dying,” he said.
He says this is because many children, parents or adults may not seek medical attention if they become infected.
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Dr. Kalyani McCullough, who directs the Vaccine Preventable Disease Epidemiology and Control Section of the California Department of Public Health’s Immunization Branch, said it’s important for people to know that measles is not “just a fever and a rash.”
“It can affect many different parts of the body, and it can also have long-term effects,” she said. “Both have immune amnesia, which means the measles virus can actually reduce immunity to other infections after being infected with measles.”
“So I think it’s important for people to realize that getting measles can have pretty serious consequences,” McCullough said.
How to protect yourself against measles?
People who have received two doses of the MMR vaccine are considered protected against measles.
The disease is very contagious. It is spread through the air when an infected person coughs, sneezes or breathes. And you don’t need to come into direct contact with someone with measles to become infected; you just need to be in their airspace within two hours of their arrival.
Offit said one person with measles can infect about 15 to 18 other people, if they are susceptible. Offit says “susceptible,” in this case, refers to people who have never had measles or are not vaccinated.
For people in this category, up to 9 out of 10 exposed people will contract measles.
What does it mean if there have been measles exposures in my state?
Some states that are not currently experiencing significant measles outbreaks have notified their residents of possible exposures.
While an outbreak is a cluster of cases in an area over a certain period of time, an exposure occurs when a person comes into contact with someone who has measles, according to Amira Roess, an epidemiologist at the George Mason University College of Public Health.
The California Department of Public Health notified people of potential exposures after an infected, unvaccinated train and bus passenger traveled across the United States and several California counties.
The St. Louis City Department of Health also encouraged residents to monitor for symptoms after a person visiting local bars and a sports stadium tested positive for measles.
Measles can be difficult for epidemiologists to track because symptoms — like fever, cough and rash — typically begin seven to 14 days after a person’s exposure or up to 21 days later.
Once a person is confirmed to have measles, epidemiologists interview them and try to determine the places they visited and people they saw while they were contagious. In the case of measles, this usually happens four days before the telltale rash appears and four days afterward, according to McCullough. Epidemiologists consider this eight-day window to be the infectious period.
“So it’s a very labor-intensive process,” she said.
She added that anyone exposed to measles is generally advised to seek medical attention and self-isolate if they develop symptoms within three weeks of exposure. Unvaccinated people may be asked to quarantine and may be monitored by public health officials to see if they become ill.
What should I do if I travel soon?
All the experts who spoke to NPR said the first and most effective step to protecting yourself against measles is to make sure you’re fully vaccinated.
This means having received two doses of the MMR vaccine – which is commonly given during childhood. You can check with your healthcare professional if you are unsure of your vaccination status. They may recommend a booster based on your records and recent health status.
Offit said this recommendation also applies to travelers arriving in the United States from other countries.
“I think anyone traveling from another country to the United States should make sure they are up to date on their vaccinations, because it is dangerous to be in the United States now if you are not fully immunized against measles,” he said.
Offit noted that many people who are immunocompromised cannot be vaccinated if they haven’t already been vaccinated. These people can count on herd immunity – protection against a disease when a certain percentage of people in a community are vaccinated. For measles, this threshold is 95%. Last school year, kindergarten vaccination coverage dropped to 92.4%, according to the CDC.
Children usually receive their first dose of the MMR vaccine around 12 months of age. But McCullough says if parents plan to travel internationally with infants or babies ages 6 to 11 months, the CDC’s recommendation is to get an early dose of the vaccine.
But the experts we spoke with said if you have your vaccines, you don’t have to worry.
“If you’re in relatively good health and your vaccinations are up to date and your doctor visits are up to date, you’ll be fine,” Roess said. “I’m not worried about these individuals.”
Roess also said people can wear masks in busy areas if they are…
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