Should adults be concerned about measles when traveling?

Should adults be concerned about getting the measles, especially when traveling to states that have outbreaks?

“As an adult primary care physician, this is the main question my patients are asking me about the measles, and they also want to know if they need to be vaccinated or re-vaccinated,” said Daniel Golovko, MD, a primary care physician at North Falmouth Primary Care, and a Falmouth Hospital hospitalist.

The good news is that most of the adult population is immune for the following reasons, according to Dr. Golovko.

• The Centers for Disease Control and Prevention (CDC) has stated that anyone born before 1957 is considered automatically immune, because regardless of where they were born, they were likely infected with measles, mumps and rubella when they were children and most everyone got the measles.
• In the adult population, essentially everybody has been vaccinated. If you got the MMR (measles, mumps and rubella) vaccines when you were young, there is basically no risk of contracting the measles.

There Are a Couple of Exceptions

“I have seen many patients who were born between 1957 and 1970, before the measles and measles, mumps and rubella (MMR) vaccines were available,” Dr. Golovko said. “The measles vaccine developed in the 1960s didn’t work as well as the MMR that was released in 1971.”

Dr. Golovko has a discussion with each patient to check if they have vaccination records to indicate their vaccination status. If they don’t have a record or are unsure of their status, he offers them the option of getting vaccinated with an MMR or having blood drawn to find out if they are immune.

For adults with unknown vaccination history who choose to be vaccinated, the CDC recommends two doses of MMR vaccine, if they don't have evidence of immunity. The doses should be separated by at least 28 days. The current recommendation for a second MMR dose in childhood only started in 1989, so it may make sense to receive a second MMR dose, he said.

Dr. Golovko also recommends healthcare workers who were born before 1957 have a titer (a test for the presence of measles immunity) done at least once in their life so they have formal documentation that they are immune to the measles.

In February this year, the Massachusetts Department of Public Health confirmed that two residents had been diagnosed with the measles. The first case was a school-aged child who was exposed out-of-state and remained out-of-state during the infectious period.

The second was an adult with an uncertain vaccination history who had traveled internationally to several locations where they were likely exposed to measles. State and local public health officials worked with the locations to identify and notify others who had potential exposure.

How Contagious is It?

“The measles virus is very infectious and contagious,” Dr. Golovko said. “It is spread through respiratory droplets that can linger for hours in a space where an infected person has been and remain highly infectious. Symptoms include fever, conjunctivitis, runny nose and a rash that lasts one to two weeks. You are contagious five days before the rash appears and four days after it appears.”

The complications are most concerning because patients can develop secondary infections, including respiratory and serious neurological problems. One of the more serious complications is encephalitis that can have long-term effects or be fatal, said Dr. Golovko.