18 Feb 2015

Measles: worldwide

A measles reminder for health professionals and travellers
  • Measles is one of the most communicable infectious diseases with the potential for serious and life threatening complications.
  • Travel remains an important factor in the international spread of measles.
  • All UK travellers should ensure they are up-to-date with theMeasles, Mumps and Rubella (MMR) vaccination, according to current UK recommendations.
  • MMR can be given from six months of age in some circumstances, e.g. before travel to an endemic country and/or where an outbreak is occurring.

Measles global update

As of 9 February 2015, The Pan American Health Organization/ World Health Organization reported several ongoing outbreaks in the region of the Americas [1]:

  • Brazil: between 2013 and 2015, a total of 971 confirmed measles cases were reported, the majority (718) from Ceará state.
  • USA: From 1 January to 13 February 2015, 141 people from 17 states and Washington DC were reported to have measles; 113 of these cases were linked to an outbreak connected to an amusement park in California [2].
  • Canada: two separate measles outbreaks are being investigated; one in Quebec, suspected to be connected to the ongoing outbreak in California, and another in Ontario province [1].

In Europe, of the 3,840 cases reported between December 2013 and November 2014, 76% were unvaccinated.  Italy reported the highest number of cases (1,921) followed by, followed by Germany (348), France (269) and the Netherlands (250) [3].

In other parts of the world, including China, the Philippines, Viet Nam, the Solomon Islands and Papua New Guinea, large outbreaks of measles were reported during 2014 [4, 5].

Some verified outbreak reports for measles, mumps and rubella worldwide are available on  Outbreaks Surveillance.

About measles

Measles is a highly infectious viral illness spread by airborne or droplet transmission. Initial symptoms can include fever, runny nose, conjunctivitis and cough. A rash usually appears a few days later that starts at the head and spreads to the trunk and limbs over three to four days. Individuals are infectious from the time when the first symptom appears to four days after the appearance of the rash. The incubation period is about ten days (ranging between seven and 18 days) [6].

Complications of measles infection can occur and in the UK, death occurs in approximately one in 5,000 cases. The risk of death from measles infection is age-related; it is high in children under one year of age, lower in children aged one to nine years and rises again in teenagers and adults [6].

Countries experiencing or recovering from a conflict or natural disaster are particularly prone to outbreaks of measles. Damage to health infrastructure and health services can interrupt routine immunisation schedules and overcrowding in residential camps greatly increases the risk of infection [7].

Advice for travellers

You should ensure you are up-to-date with all vaccines, according to current UK recommendations.

If you have never had measles infection or you are unvaccinated or incompletely vaccinated, you may be at risk from measles when visiting countries reporting cases, especially if staying with friends or family and mixing with the local population.

Measles vaccine can be given from six months of age in some circumstances, e.g. before travel to an endemic country and/or where an outbreak is occurring.

Advice for health professionals

Guidance on measles vaccination is available in Immunisation against infectious disease Chapter 21.

Advice on immunisation against measles is also available for those whose immunisation status is uncertain.

In the UK, measles is a notifiable disease. Any case of suspected measles should be notified to the local Health Protection Team.

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