Measles risk for international travellers

Publication Date: 12 July 2019

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 outwith Africa and Asia including:

  • Japan
  • Taiwan
  • Philippines
  • New Zealand
  • Thailand
  • Syria
  • USA
  • many European countries – see below

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
  • United Kingdom

In addition, the following neighbouring countries have also been affected:

  • Albania
  • Belarus
  • Georgia
  • Russia
  • Serbia
  • Turkey
  • 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 two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four 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 – meaning someone who has not been vaccinated with two 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.

Advice for Healthcare Professionals to prevent the international spread of measles

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.

  • All travellers should check their vaccination status is up-to-date. In the absence of a history of prior measles infection, travellers should ensure they have received two doses of a measles containing vaccine.
  • Travellers who are uncertain of their measles vaccination status should receive at least one dose of measles vaccine. Ideally, travellers should be vaccinated against measles at least 15 days prior to travel.
  • In the UK, MMR is usually given to infants at around 12 months of age, with a second dose given before school, to ensure best protection. In some cases, MMR can be offered to babies from six months of age – for example, for travel to countries where measles is common, or to an area where there is a current outbreak. As the response to MMR in infants is sub-optimal where the vaccine has been given before one year of age, immunisation with two further doses of MMR should be given at the recommended ages.
    • Measles vaccines are not recommended for pregnant women.
  • Measles vaccine can be co-administered with other vaccines recommended for travellers. Where yellow fever vaccine and MMR are both required, ideally they should not be given on the same day but given at least four weeks apart. Where protection is required rapidly, then the vaccines may be given at any interval
  • Children who are travelling to measles endemic areas or to an area where there is a current outbreak, and have received one dose of MMR at the routine age should have the second dose brought forward to at least one month after the first. If the child is under 18 months of age and the second dose is given within three months of the first dose, then the routine pre-school dose (a third dose) should be given in order to ensure full protection.

Further information for healthcare practitioners advising travellers can be found on TRAVAX.

Advice for Travellers

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:

  • fever
  • cough, runny nose, and sore red eyes
  • general tiredness and feeling unwell
  • a spotty, non-itchy rash that starts on your head and neck and spreads to the rest of your body

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.