Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine. Measles is spread by airborne or droplet transmission. It is considered one of the most highly communicable infectious diseases.
Measles is found throughout the world and is still common in many developing countries, particularly in parts of Africa and Asia. In recent years there have been several outbreaks of measles in other countries out-with Africa and Asia including:
The recent outbreak of measles across many European countries serves as a reminder of measles risk in those individuals who are not vaccinated or not fully vaccinated. Countries affected include: Austria, Bulgaria, Czech Republic, France, Finland, Germany, Greece, Hungary, Ireland, Italy, Poland, Portugal, Romania, and the United Kingdom. In addition, the following neighbouring countries have also been affected: Albania, Belarus, Georgia, Russia, Serbia, Turkey and Ukraine.
During the summer months, the likelihood of individuals coming into contact with measles is potentially higher due to increasing numbers of individuals coming together in popular holiday destinations.
Measles is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.
Symptoms of measles include erythematous maculopapular rash with fever and cough/coryza or conjunctivitis. Measles infection can be severe. The most serious complications include blindness, encephalitis, severe diarrhoea and related dehydration, and severe respiratory infections such as pneumonia. Measles can be fatal.
Young children and adults aged 15 and over who missed out on the measles. Mumps and rubella (MMR) vaccine when they were young are at highest risk of measles and its complications. Any non-immune person (i.e. who has not been vaccinated with 2 doses of measles containing vaccine) can become infected.
The measles vaccine has been in use since the 1960s. It is safe, effective and inexpensive. WHO recommends immunisation for all susceptible children and adults for whom measles vaccination is not contraindicated. Measles has been included in the UK National schedule since 1968.
Travel may increase an individual’s risk of exposure to measles virus, and facilitate the spread of disease to unvaccinated and susceptible populations. Those at particular risk include children and those who will be living or working closely with the local population at their destination, in countries with high endemnicity or recent outbreaks.
The travel consultation provides healthcare practitioners with a valuable opportunity to ensure individuals are protected against the measles virus.
Further information for healthcare practitioners advising travellers can be found here
All travellers should seek advice from their healthcare provider in advance of travel and be aware of the risk of exposure to measles virus as well as transmission and symptoms of the disease.
Individuals travelling to countries where measles is common or where outbreaks are occurring are at risk of catching the disease if not fully protected. Two doses of MMR in a lifetime are needed for a person to be considered fully protected. Susceptible travellers may also risk exposing others to this highly infectious, serious illness either while travelling, or on return to the UK.
Transmission of infection may occur between passengers who are seated in the same area of an aircraft, usually as a result of a cough or sneeze or by touch. This is no different from being close to someone in any other form of transport such as a bus or train.
An airline has the right to refuse travel to any passenger who is unwell and they suspect may be contagious. In order to minimise the risk of passing infections in an aircraft, passengers who are actively unwell, especially if they have a fever, should delay travel until they have recovered. Where an individual has travelled on an airline whilst infectious with measles, contact tracing of passengers will be carried out by public health authorities.
Susceptible travellers who have returned from a country or area where measles is common should be alert for symptoms for three weeks after their last day of travel.
Susceptible travellers who are exposed to measles will usually develop symptoms about 10 days after they are exposed. However, it can take as few as seven and as many as 18 days for symptoms to develop.
Measles symptoms include:
Travellers who experience any of these symptoms, should not attend public places (such as work, school, healthcare services, shopping centres) or use public transport. They should seek medical attention. However, it is important to call ahead to the medical practice or emergency department to advise them of the symptoms, so that measures can be taken to limit their exposure to other people when they arrive.
Further travel health advice for the general public can be found on fitfortravel