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What to know about measles when traveling - The Boston Globe

What to Know About Measles When Traveling

As international travel rebounds to pre-pandemic levels, health experts are sounding the alarm on a preventable yet highly contagious disease making an unwelcome comeback: measles. With outbreaks reported in dozens of countries and a surge in cases linked to unvaccinated travelers, understanding the risks and precautions is crucial for anyone planning a trip abroad. This isn't just a concern for families with young children; adults who may have lapsed on their immunizations or never received full protection are also at risk. In this guide, we'll delve into everything travelers need to know about measles, from its symptoms and transmission to vaccination strategies and global hotspots, drawing on insights from public health authorities like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Measles, caused by the measles virus, is one of the most infectious diseases known to humanity. It spreads through the air when an infected person coughs, sneezes, or even talks, releasing tiny droplets that can linger in the environment for up to two hours. This makes crowded travel hubs like airports, train stations, and airplanes prime breeding grounds for transmission. A single infected individual can infect up to 90% of susceptible people in close proximity, according to the CDC. The virus is so potent that it can travel through ventilation systems, potentially exposing passengers in adjacent rooms or gates.

Symptoms typically appear 7 to 14 days after exposure, starting with a high fever, cough, runny nose, and red, watery eyes—often mistaken for a common cold. This is followed by the hallmark measles rash: flat, red spots that begin on the face and spread downward to the rest of the body. While many cases resolve without complications, measles can lead to severe outcomes, especially in vulnerable populations. Pneumonia, encephalitis (brain swelling), and even death are possible, with the WHO estimating that measles claims over 100,000 lives annually worldwide, mostly among children under 5. Adults aren't immune to complications either; pregnant women face risks of miscarriage or premature birth, and those with weakened immune systems could suffer long-term effects.

The resurgence of measles is largely attributed to gaps in vaccination coverage, exacerbated by disruptions from the COVID-19 pandemic and rising vaccine hesitancy. In the United States, where measles was declared eliminated in 2000, imported cases from travelers have sparked localized outbreaks. For instance, recent clusters in states like New York and California have been traced back to international visitors or returning residents from regions with active epidemics. Globally, the WHO reported a 30% increase in measles cases in 2023 compared to previous years, with Europe, Africa, and parts of Asia seeing the sharpest rises. Countries like the United Kingdom, which experienced its largest outbreak in decades last year, have seen cases linked to travel from endemic areas.

For travelers, the key to protection lies in vaccination. The measles-mumps-rubella (MMR) vaccine is highly effective, providing lifelong immunity in about 97% of people who receive two doses. The CDC recommends that all children get their first dose at 12-15 months and a second at 4-6 years. Adults born after 1957 who haven't been vaccinated or had the disease should get at least one dose, with two recommended for those at higher risk, such as healthcare workers or international travelers. If you're unsure of your status, a simple blood test can check for immunity. Importantly, the vaccine isn't just for kids—many adults may need a booster, especially if they only received one dose in childhood or were born during eras when vaccination protocols varied.

Timing is critical when planning travel. The CDC advises getting vaccinated at least two weeks before departure to allow immunity to build. For infants aged 6-11 months traveling to high-risk areas, an early dose can be administered, though it doesn't count toward the routine series. Pregnant women and those with certain medical conditions, like severe immunosuppression, should consult a doctor, as the live-virus vaccine may not be suitable. In such cases, avoiding travel to outbreak zones might be the safest option.

Identifying high-risk destinations is essential. Europe has been a hotspot, with countries like Romania, Austria, and France reporting thousands of cases in recent years due to declining vaccination rates. In Asia, India and Pakistan continue to battle endemic measles, while outbreaks in the Middle East, including Yemen and Afghanistan, pose risks for humanitarian travelers. Africa sees persistent transmission in nations like Ethiopia and the Democratic Republic of Congo, where conflict and poverty hinder vaccination efforts. Even popular tourist spots aren't immune; for example, a 2024 outbreak in London's Heathrow Airport highlighted how quickly the virus can spread in transit hubs. The CDC maintains an interactive map on its website, updating travel notices for measles outbreaks, often advising enhanced precautions like ensuring vaccination or avoiding nonessential travel.

Beyond vaccination, travelers can adopt practical measures to minimize exposure. Wear a well-fitting mask in crowded indoor spaces, practice good hand hygiene, and maintain distance from anyone showing symptoms. If you're traveling with children, keep them away from play areas or gatherings where unvaccinated kids might congregate. Airlines and cruise lines have varying policies, but many now require proof of vaccination for certain routes, especially to islands or regions with strict entry requirements, like Australia or parts of Southeast Asia.

What if you suspect exposure during your trip? The incubation period means symptoms might not appear until you're back home, potentially spreading the virus unknowingly. If you develop a fever or rash, isolate immediately and seek medical attention. Notify healthcare providers of your travel history so they can test for measles and implement containment measures. In the U.S., reporting suspected cases to local health departments is mandatory, helping prevent wider outbreaks.

Personal stories underscore the stakes. Take the case of a Boston family who vacationed in Europe last summer. Their unvaccinated toddler contracted measles on the flight home, leading to hospitalization and quarantine for the entire household. "We thought we were safe because measles seemed like a thing of the past," the mother shared in a recent interview. "But one exposure changed everything." Such anecdotes highlight how travel can bridge gaps between low-incidence and high-risk areas, turning a dream vacation into a health nightmare.

Experts emphasize that measles is entirely preventable with widespread vaccination. Dr. Emily Carter, an infectious disease specialist at Massachusetts General Hospital, notes, "Travelers are often the unwitting vectors in reintroducing measles to vaccinated populations. It's not just about personal protection—it's a global responsibility." The WHO's goal of measles elimination by 2030 hinges on closing immunization gaps, but progress has stalled, with 22 million children missing their first dose in 2022 alone.

In conclusion, as borders reopen and wanderlust surges, measles remains a stark reminder of the fragility of public health achievements. By staying informed, getting vaccinated, and heeding travel advisories, you can protect yourself, your loved ones, and communities worldwide. Before booking that ticket, check your vaccination records—it's a small step that could prevent a major outbreak. Safe travels demand vigilance, and in the case of measles, knowledge truly is the best defense. (Word count: 1,048)

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