After the Disneyland outbreak, concern about measles transmission in crowded places, such as theme parks and cruise ships, rises. But immunized travelers generally will not have problems.
More than 120 people in 17 states have come down with the measles, many of them sickened as a result of an outbreak in December at Disneyland in California.
But the only travelers who have reason for trepidation are those who have had neither measles nor the vaccine that prevents it.
No one is quite sure how the Disneyland outbreak began, but Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, said that it probably came from an infected person returning from overseas. In 2014, when there were more than 600 cases of measles, the source was travelers returning from the Philippines, where there had been an outbreak of more than 50,000 cases.
Because the vaccine for measles (given as the MMR vaccine, in combination with the vaccines for the mumps and rubella) is so effective, measles had been virtually eliminated in the United States by 2000. From then until the 2014 outbreaks, there were only about 60 cases a year nationwide.
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The World Health Organization reports that by 2013, 84 percent of the world’s children were receiving a dose of the vaccine before their first birthday, and that there was a 75 percent drop in deaths from measles between 2000 and 2013. The organization estimates that vaccination prevented 15.6 million deaths over those years, leading the agency to call it “one of the best buys in public health.”
Still, there were 145,700 deaths from measles globally in 2013 — that is, almost 400 people a day, mostly children, died from a preventable disease.
Generally, travelers who are immunized will not have problems in crowded places like cruise ships. Cruise lines do not investigate the immune status of their passengers, but they do check to make sure that no one who is obviously ill boards a ship.
“Cruise lines continue their health screenings prior to embarkation as they have done for many years,” said Elinore Boeke, the director of public affairs for the Cruise Lines International Association, an industry trade group. “As health issues arise on land, this health screening is re-evaluated and modified as appropriate.”
Does this mean it’s safe to take an unvaccinated child on a cruise? No, said Dr. Deborah Ann Mulligan, a clinical professor of pediatrics at Nova Southeastern University.
“The best course of action,” she said, “is to make sure your vaccinations are up-to-date. To do otherwise is playing Russian roulette. There’s no reason to voluntarily put a child at risk without the protection of the vaccinations.”
The World Health Organization names Africa and southern Asia as high-risk areas, but measles still occurs in Europe and the Pacific, as well. And worldwide the virus infects about 20 million people a year. It is one of the most infectious diseases known; just being in a room that a measles patient has left an hour before can lead to infection, and a person who has no symptoms and feels perfectly fine can still be infectious. For travelers, this presents a problem, but it is easily solved: vaccination.
Measles has become so rare that many people have forgotten how nasty it can be. “Kids look miserable,” said Dr. Marguerite Mayers, an infectious-disease specialist at Children’s Hospital at Montefiore Medical Center in the Bronx. “They’re covered with spots, they have a high fever, coughing, runny nose, drippy eyes, a head-to-toe rash. The virus invades the eyes, and the kids can’t stand light, and they insist on being in a dark room. And there is no treatment.”