The Travel Health and Vaccine Specialists

Health Alert


LEVEL 1 - PRACTICE USUAL PRECAUTIONS

Measles: Global Update

Updated April 20, 2015

Travel Health Notice

MeaslesExternal link is a highly contagious viral disease. It is one of the leading causes of death in children worldwide. Measles cases occur around the world. Within the last 10 years, the number of measles cases reported globally has decreased significantly; however, there have been a number of large outbreaks, mostly in Africa and Europe. The Americas, including Canada, have experienced outbreaks of measles, when the virus has been imported from other regions.

Travellers who are not immune to measles (those who have not been fully vaccinated or have not been previously infected with the disease) have an increased risk of infection. For example, travel through international airports, including those in Canada, may increase your chance of exposure to the disease.

The Public Health Agency of Canada reminds travellers to make sure their measles vaccination is up-to-date.

Where is measles a concern?

Measles remains a common disease worldwide. A map of reported measles cases worldwideExternal link is available on the World Health Organization (WHO) website.

  • In the Region of the Americas (North, Central and South America and the Caribbean), measles has been eliminated; however, outbreaks continue to occur when the virus is imported into this region from other countries.
    • The United States is currently experiencing a multi-state measles outbreakExternal link, which started in California in December 2014. Related cases have since been reported in Mexico and Canada.
    • Brazil is currently experiencing an outbreak. The majority of cases have been reported in the northern states of Ceará and Pernambuco.
  • In many countries in other regions of the world (Africa, Asia, Europe, Oceania), measles is present (endemic) and periodic large outbreaks occur. Travellers who are not immune are at risk.
    • Europe: In 2014 and 2015, over 23,000 cases of measles have been reported across several countries. Bosnia and Herzegovina, Croatia, Georgia, Germany, Italy, Kazakhstan, Kyrgyzstan, Russia and Serbia continue to report cases.
    • India: Since 2010, nine cases of measles have been reported in travellers who arrived in Canada from India, with the most recent case reported in January 2015.
    • Philippines: There have been reported cases of measles in unimmunized travellers who arrived in Canada from the Philippines, where there is an ongoing outbreak.
    • Vietnam is currently experiencing an outbreak; there have been a high number of measles cases reported throughout the country since the beginning of 2014.
    • China: In 2014, health authorities reported a significant increase in the number of cases as compared to those reported in 2013. Cases of measles have been reported in travellers who arrived in Canada from China.

Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

  1. Get vaccinated
    Canadians are reminded to keep all vaccinations up-to-date. See the recommended routine vaccine schedule for further information.

    Travellers should be up-to-date on measles immunization regardless of their travel destination.

    • Infants and Children:
      • Two doses of a measles-containing vaccine are recommended for children.
      • The first dose should be given at 12-15 months of age and the second dose should be given at 18 months of age or any time thereafter, typically before school entry.
      • During outbreaks or for travel to regions where measles is a concern, the vaccine may be given as early as six months of age. Under these circumstances, the routine two dose series must be then restarted on or after the first birthday, for a total of three doses.
    • Adolescents and Adults:
      • Adults born in or after 1970 should make sure that they have received two doses of measles-containing vaccine.
      • Travellers born before 1970 should receive one dose of measles containing vaccine if they do not have one of the following:
        • documented evidence of receiving measles-containing vaccine on or after their first birthday;
        • laboratory evidence of immunity (e.g. through blood testing); or
        • a history of laboratory confirmed measles disease.
  2. Wash your hands frequently
    • Wash your hands with soap under warm running water for at least 20 seconds, as often as possible.
    • Use alcohol-based hand sanitizer if soap and water are not available. It’s a good idea to always keep some with you when you travel.
  3. Practise proper cough and sneeze etiquette
    • Cover your mouth and nose with your arm to reduce the spread of germs.
    • If you use a tissue, dispose of it as soon as possible and wash your hands afterwards.
  4. Monitor your health
    • If you develop symptoms similar to measles when travelling or after your return to Canada, you should see a health care provider:
      • Describe your symptoms to the health care provider before your appointment, so that he/she can arrange to see you without exposing others to measles. It is best to avoid close contact with other people for four days after the rash first appears to reduce the spread to others who may not be vaccinated.
      • Remember to tell the health care provider which countries you have travelled to.
    • If you are still ill upon arrival into Canada, please tell the flight attendant before you land or the border services officer as you exit the flight.