Preparing for the global measles outbreak

Measles is making a comeback worldwide with reports of 112,163 outbreak cases as of 15 April 2019. A report by the World Health Organization (WHO) shows that the number of measles cases has increased by 300 percent in the first quarter of this year. This outbreak has alarmed public and especially travellers as measles is a serious and potentially fatal disease.

Measles outbreak is a risk to travellers

Measles is a disease that is easily infectious just like the flu virus. It is highly contagious and can live up to two hours in the airspace where an infected person breathed, coughed or sneezed. The measles virus remains suspended in air like light dust particles allowing pathogen to linger and float and may likely spread between 9 to 19 people who are not immunized.

Travellers are at risk as the early symptoms of the virus may not be obvious and may look like many other common respiratory illnesses. Measles can spread to other people four days before a rash appears, and up to four days after, making it possible for an infected person to spread the disease when they do not appear ill.

Additionally, travellers are easily exposed to the virus as the air travel that carries at least one person with the measles disease is able to infect others in the flight. Furthermore, the lower the temperature, the higher the survival rate of the airborne virus making it easier to spread, especially to unvaccinated travellers.

Sources of measles exposure also include destinations popular among domestic and international travellers. Mass gathering events such as Christmas parties, New Year’s Eve celebrations, funerals, night clubs, weddings, group prayers, community markets, music festivals and theme parks can also contribute to measles outbreaks.

Persistence of the outbreak

Imported cases

A number of causes have been associated with the measles outbreak. A cause that is often cited is the introduction of a foreign virus having strained into the country through people who were infected outside the continent.  For example, recent outbreaks in New Jersey and New York in the United States were linked to unvaccinated travellers who came back from Israel and Ukraine where there are large outbreaks of the disease.

Vaccination rates

Such outbreaks became more frequent and bigger in numbers as they were boosted by populations who refused to get vaccinated for medical or non-medical reasons. An underlying problem of the anti-vaccination movement has caused the declining vaccination rates that made outbreaks more commonplace. An unvaccinated person coming back from Eastern Europe, for instance, may carry a strain of virus and spread it to unvaccinated communities. The community then spreads the virus when they visit public places and may pose risk to others, especially pregnant women and babies.

Low risk-perception

Many travellers may not know that they are under-immunised and therefore do not consider the measles virus when getting their travel vaccines. Additionally, seasoned travellers may feel that they have not encountered such outbreaks due to previous overseas travel and may choose not to seek pre-travel health advice from health professionals.

Travellers only consider getting vaccination when going on, for instance, an African safari, but often ignore the risks when travelling to places such as France, Israel, Greece, England or the Philippines. The pockets of transmission in the countries are rising around the world not only in the countries mentioned. Therefore, it is better for travellers to check their vaccination history before travelling abroad.

The leading countries reporting measles epidemic are as follows:

Preventing measles virus

The best protection is to get vaccinated with MMR (measles, mumps and rubella) six weeks before travelling abroad. Travellers can determine if they are fully protected against measles by visiting general practitioners. Health professionals can interpret age and vaccine history to determine the vaccines that the body needs, and this can be categorised as follows:

  • Travellers born before 1970 who are not immune to measles should get one dose of the MMR vaccine
  • Those who are born in or after 1970 and not immune to measles should get one dose of the MMR vaccine

Besides vaccination, travellers are advised to:

  • Keep hygiene habits and cleanliness by washing hands frequently especially after touching public installations and before touching your nose, eyes and mouth.
  • Cover the nose and mouth with a surgical mask when having respiratory symptoms.
  • Regularly disinfect surfaces that are touched frequently.
  • Check and get your MMR vaccine before travelling as vaccination protects you and those who are not vaccinated.

Measles symptoms

Measles usually begins with a high fever, runny nose, cough and sore red eyes, followed by uncomfortable rash starting behind the ears and spreading to the body. The rash makes itself known about three to five days after infection. Some may experience the symptoms after one or two weeks after coming into contact with the virus. Loss of appetite and malaise are common symptoms as well.

One in three people may develop complications such as ear infections, pneumonia, diarrhea or in rare cases inflammation of the brain. These complications mostly arise in people whose immune systems are already weakened due to age, pre-existing diseases or malnutrition.

Ezza Omar
GWS Analyst
Security risk analyst based in Kuala Lumpur
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