Travel the world.


A STAMARIL Center
John D. Wilson, M.D.
1200 Hilyard St., Ste. 560
Eugene, Oregon 97401 USA
541.343.6028
fax 541.485.7702
www.TravelClinicOregon.com


MEASLES

 

Measles is readily transmitted during international travel. Assuring immunity to measles is easy.

Persons born before 1957 are likely (99%) to have had measles disease and possess measles immunity. I have seen 5 people born 1956 or before whose antibody test was negative, and they each needed 2 doses of MMR (measles-mumps-rubella) vaccine. Two were born in the 1940s. This is particularly important if traveling to Asia or Africa; each continent has about 200,000 cases of measles per year. Even Europe has thousands of cases per year in the aftermath of the Wakefield fraud. Keep in mind that measles is very communicable (Disneyland 2015). If we are presuming that an older person has not had measles disease and that "a shot will take care of it" rather than doing a blood test, you are into a 2 dose series, and there are potential conflicts with other live virus vaccines. Lab tests are less expensive than vaccines, and insurances will generally cover labs better than MMR vaccine, especially for those over age 65. If conditions are right (high pretest probability of measles disease if born before 1957), the most effective management in this group is to do a lab test.

My general rule for all leaving the US borders is to "assure measles immunity". This generally means a written record of measles disease, a written record of 2 doses of measles-containing vaccine or a blood test (measles or rubeola IgG or total antibody). If it shows immunity, the information is good for lifetime. Unfortunately, a remembered history of measles may be fallible. Unfortunately, physician records rarely exist decades after the event. There are at least 6 childhood diseases with rash and fever, and 2 of them are called measles. It seems to me that there is no recalled information which could improve upon 99% likelihood.

If born 1957 to 1975 or so, and there is no measles disease history, some may not have received the now recommended series of 2 vaccine doses (this recommendation was made about 1990 or so). A lab test in this situation often shows a detectable but inadequate amount of antibody, prompting what is probably the second vaccine dose. Sometimes in this age group one may ask the questions: "Did you receive all of your kid shots?" and "Did your parents have objections to vaccines?". If the answers are “yes” and "no" respectively, one could assume that a dose of measles-containing vaccine would have been given at the age of 12-15 months starting in the mid-1960s. Measles vaccines given in the 1960s were not as effective as they are now. If conditions are right, the most effective management in this group is to give what is presumed to be the final dose of vaccine and not do a blood test.

If born after 1975 or so, it is likely the traveler will have documentation of their vaccine doses. Some will need a second dose of MMR. Children of vaccine resisters may need 2 doses of MMR, and possibly other vaccines.
 
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  John D. Wilson, M.D. 1999-2016; Last Update 4/15/2016