Although most people think of measles as a pimply plague of the past, U.S. families traveling or living abroad should take extra precautions because of increasing cases among residents returning from Europe, Africa and Asia.
U.S. infants and toddlers spending time overseas should be vaccinated earlier than those living in this country, the federal Centers for Disease Control and Prevention recommended Friday as part of a report on cases imported by tiny travelers. Young children are more vulnerable to severe measles infections and at greater risk of death or encephalitis, a dangerous brain inflammation.
Before heading overseas, U.S. children aged 6 to 11 months should receive one dose of the measles, mumps and rubella (MMR) vaccine, while those at least 1 year old should receive two doses spaced at least 28 days apart. That compares with the general recommendation to give the first dose at 12-15 months, and a second before starting kindergarten. The CDC since 1989 has advised accelerating measles vaccinations for youngsters headed to regions with known outbreaks, although it's unclear how many parents have heeded the guidance.
The latest public health warning about "imported cases" might surprise parents and some doctors, as measles largely has fallen off the U.S. radar screen since 2000, when it was declared eliminated within our borders.
More worrisome to U.S. moms and dads might be news that measles has been on the upswing in such developed countries as Great Britain, Switzerland, France and Spain. According to the CDC, 39 percent of U.S. measles imports in 2005-2008 originated in Europe.
"Despite the fact that it's been in the news in Europe, we believe that people in the United States are largely unaware that there is measles in Europe," Dr. Gregory L. Armstrong, a medical epidemiologist with the CDC in Atlanta, said in an interview Friday.
In 1994, health officials pronounced measles gone from the United Kingdom, only to declare it endemic again in 2008 because of falling immunization levels, he said. Cases have been increasing in France, Switzerland, and lately in Spain.
"By and large, these cases are occurring in people who are born in those countries and who are philosophically opposed to vaccination," Armstrong said.
Armstrong and colleagues from the CDC and state health departments analyzed 13 cases in which U.S. residents who recently returned from traveling or living abroad developed measles during the first two months of 2011. Seven of the patients were unvaccinated children younger than 2 years from Massachusetts, Texas, New York, Pennsylvania, Washington and California.
All seven ultimately recovered, although four were hospitalized with diarrhea, dehydration, fever or pneumonia, according to the CDC Morbidity and Mortality Weekly Report released last week. In three youngsters, diagnosis was delayed because doctors didn't recognize measles as a possible source of the children's rashes.
Most of the sick children's families "were not philosophically opposed to vaccination," Armstrong said. "They were unaware they could have been vaccinated at a younger age, or they had had an opportunity to get their child vaccinated but missed that opportunity for some reason. A lot of these children were a little bit delayed in their immunizations."