Your family no longer has to travel overseas to come home with one souvenir you didn’t bargain for, a vaccine-preventable disease. Such “souvenirs” may be coming to visit you. Currently, measles is the prime example.
1. Measles, which had become a rarity in this country, is popping up all over. As of mid-April 2019, cases have been reported in 19 states. Virtually all originate overseas. They are brought here by American travelers who became infected overseas and by infected foreigners coming to the US as tourists and students. The virus then spreads, mostly to people who were not or were incompletely vaccinated against measles.
2. Measles was once a common childhood disease, an expected part of growing up. Most children recovered completely. However, one or two in a thousand died, usually from measles complications such as pneumonia or encephalitis, and some others were left with serious permanent disabilities. An average of 450 deaths occurred annually, mostly in previously healthy children.
3. Measles is one of the most infectious diseases. The virus is transmitted through the air: an infected person coughs or sneezes and someone in close proximity then inhales the droplets. Transmission also occurs by touching objects and surfaces contaminated with infected nose or mouth fluids. The virus can remain infectious for up to two hours. Brief exposures suffice to become infected.
4. Aspects of measles help delay diagnosis and subsequent isolation of patients, abetting the spread. Infected individuals begin exhaling the virus about three days prior to showing symptoms of being ill. The earliest symptoms, fever and cough, are not specific to having the disease. Even the eventual rash is not necessarily diagnostic; it resembles other rashes. Moreover, the vast majority of American healthcare providers have never seen a case, further delaying diagnosis. Tell providers about your recent trips if they do not ask you.
5. In the US, since 2000, the percentage of children under two years of age not optimally vaccinated has quadrupled. While this percentage remains small, the trend is troublesome, especially for infants less than six months of age. Measles vaccines are not very effective under this age while many infants are susceptible and tend to experience complications. The best way to protect young infants is to make sure all individuals in contact with them are vaccinated.
6. There are many reasons why parents refuse to vaccinate their children. Ironically, one reason is the success of vaccination programs. Most parents have never seen cases of vaccine-preventable diseases and erroneously conclude that vaccines are no longer important. Some parents believe vaccines cause the diseases that the vaccines are designed to prevent, or cause other adverse reactions. (In fact, the achiness following some vaccines is due to the immune system “revving up” to boost protection.) Other parents believe that vaccines cause autism although there is no evidence to support this. Still others refuse vaccines for ethical or religious reasons.
7. Don’t ask healthcare providers to alter accepted vaccination schedules. Parents ask providers to delay starting vaccinations until children are older, to increase the interval between doses, to dilute doses, or to give one vaccine at a time rather than many. Some providers acquiesce, reasoning that some protection is better than none. This is not a good idea. Accepted schedules are prepared by recognized experts, are based on the latest data, and change from time to time. Altering schedules results in confusion: unknown immunization status, ultimately more doses to correct the situation, and turmoil in record keeping.
8. The risk of acquiring vaccine-preventable diseases increases substantially when traveling outside the US. Most countries have less comprehensive vaccination programs than the US. Some governments cannot afford the costs, vaccination protocols are haphazard with poor record keeping, and children are immunized against fewer diseases. The result: diseases remain common, even in developed countries. Moreover, traveling with children likely increases your family’s odds of interacting with local children, the primary source of such diseases.
9. Consult your healthcare provider if a family member may have been exposed to measles. The time between exposure and the appearance of symptoms varies between seven and fourteen days. A dose of measles vaccine given within three days of exposure will usually prevent or ameliorate the disease. A dose of gamma globulin may help to ameliorate the disease after the three-day period. When making the appointment, notify providers of a possible measles exposure. They may want to see you when there are no other patients in the office.
10. Inform healthcare providers of upcoming foreign travel as soon as you finalize your plans. Family members may require additional vaccines (and preventive medications), especially when visiting developing countries. Some destinations require vaccines that require multiple doses over a period of a several months. Attending large gatherings and staying at the homes of friends and relatives are common ways people are exposed to infection.
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