Measles: All things old are new again

By Dr Jennifer Sisson*

Measles. It just won’t go away.
Despite having been effectively wiped out in Australia through our national immunisation program, cases doggedly persist here due to international travel.
In fact, cases are increasing each year. Australia has recorded 70 confirmed infections in the first three months of 2016, putting us well on track to pass last year’s total of 104.
Virtually all of these cases involve Australian travellers or foreign visitors infected overseas. Just last week, NSW Health issued a public warning after separate incidents in which foreign tourists – two young children from India and two backpackers from Europe – arrived in Australia infected with the highly contagious virus.
Those at risk of developing measles in coming days and weeks not only include other passengers who shared international and domestic flights with the four, but fellow hostel guests, and the staff and patients of hospital and medical facilities where they sought treatment.

Measles is extremely contagious

Still fresh in the minds NSW health authorities is 2013 when 170 people in the state were infected when a young Australian traveller contracted measles during a holiday in Thailand.
Each time there’s a measles importation, tens of thousands of dollars in precious health resources must be spent tracking down and warning those who had close contact with the infected person or people.
The symptoms of measles – a fever, a runny nose, red and watery eyes, a cough, and an all-of-body rash – begin 7 to 21 days after exposure. But, measles is also contagious from around 4 days before the rash appears and for 4 days after.
While measles is typically transmitted when the infected person sneezes or coughs fine virus-containing droplets into the air, they don’t have to be sneezing or coughing. It's possible to catch measles just by being in the same aircraft cabin or room.
Infection is still possible hours after they’ve left.
In fact, measles is so contagious that 9-in-every-10 people who aren't immune will get the disease if they are close to an infected person.

It takes just one infected passenger…

As with influenza, it’s easy to get measles on a plane, train, bus or cruise ship – in fact, in any confined space.
Certainly, those passengers at highest risk are usually those seated within a two seats of an infected person. But, anyone walking by can breathe in virus-laden droplets and become infected, too.
And, just like flu, the measles virus can also live for up to 2 hours on hard surfaces like fold-down tables, arm rests and toilet fixtures. You can literally pick it up by touching the infected surface and then touch your mouth, nose, or eyes.
Along with unvaccinated travellers, pregnant women, infants under 6 months, and anyone with a chronic illness or a weakened immune system are at highest risk of potentially severe illness from measles.
Each year about 20 million people get measles worldwide and 164,000 die – 100,000 of them children. Around 1-in-20 children with measles will get pneumonia, while 1-in-1000 will get encephalitis, an inflammation of the brain. (Measles can also result in Subacute Sclerosing Panencephalitis, a rare but severe degenerative disease of the central nervous system disease that occurs 7-10 years after the initial measles infection.)

Measles vaccine safe and effective

If you’re travelling overseas, there’s a very effective way to avoid this nasty holiday memento. Simply, confirm that you have had:
- Measles infection in the past, or
- Two documented doses of live-virus measles-containing vaccine, such as an MMR (measles, mumps, rubella), in the past.
Australian’s immunisation guidelines advise that people born during or since 1966 who have not received 2 doses of MMR vaccine should receive at least one dose before departure and a second on their return to complete the course.
If you are in any doubt about your vaccination status, have the MMR vaccine: It’s safe, effective, and provides long-term protection against all three diseases.
Protection against rubella is particularly important for women of child-bearing age as infection just before conception or during early pregnancy could result in miscarriage, foetal death, or congenital defects known as congenital rubella syndrome.

Six weeks is ideal for pre-travel consultation

Contrary to some misguided claims you might read, many studies have now proven that measles vaccine (MMR) does not cause autism. It can also be given to children and adults who are allergic to eggs.
If you’re travelling abroad this year, check your immunisation status for measles as well as other childhood diseases such as diphtheria, whooping cough, mumps, and polio.
If required, these routine immunisations can be boosted at the same time as you receive any vaccines that are recommended or required for your trip.
Six weeks before departure is the ideal time to have your pre-travel medical consultation to ensure you are fully protected against any vaccine-preventable diseases you may encounter while away – or on the flight home.

* Dr Sisson is the Acting Medical Director of Travelvax Australia.

Call Travelvax Australia’s telephone advisory service on 1300 360 164 (toll-free from landlines) for no-obligation, country-specific travel health and immunisation advice. We can also make an appointment at your nearest Travelvax clinic to obtain vaccinations, medication to prevent or treat illness, and accessories for your journey.