Traveling Internationally This Summer? Be Sure to Get the MMR Vaccine

Summer is a popular time to travel, but it is especially important to remind patients about measles outbreaks and prevention strategies. Measles is a highly contagious disease that spreads through the air from coughing or sneezing. In fact, about 9 out of 10 individuals with close contact to a measles patient will develop the disease.¹ Symptoms include fever, cough, conjunctivitis, and a characteristic rash consisting of tiny red spots. The rash generally appears approximately 2 weeks after exposure. Additionally, the virus can live for up to 2 hours in the air or on surfaces. Individuals at high risk of severe illness and complications from measles include infants and children less than 5 years of age, adults over 20 years of age, pregnant women, and immunocompromised patients.

Measles can be prevented with the measles, mumps, and rubella vaccine (MMR).

The Centers for Disease Control and Prevention (CDC) recommends children receive 2 doses of the MMR vaccine with the first dose at 12-15 months of age, and the second dose at 4-6 years of age.² One dose is approximately 93% effective at preventing measles, and 2 doses are about 97% effective.² Teens and adults should also be up-to-date on the MMR.

Most measles cases in the United States result from international travel.

More than 14,000 cases of measles have been reported in 15 European countries since January 2016, resulting in 35 deaths.¹ The CDC has issued travel health notices for the following 5 countries with measles outbreaks since November 2016: France, Belgium, Germany, Italy, and Romania.¹ Educate patients to see a health care provider at least 4-6 weeks prior to any international travel. Pharmacists should check with their state laws to determine whether they are authorized to administer the MMR vaccine and to which age groups.

Vaccination prior to international travel is crucial.

Educate patients regarding the following CDC recommendations for infants, teens, and adults prior to international travel:³

• Infants 6 months-11 months of age should receive one dose of the MMR vaccine.
• Children 12 months of age and older should receive 2 doses of the MMR vaccine separated by at least 28 days.
• Teenagers and adults who do not have evidence of immunity against measles should receive 2 doses of the MMR vaccine separated by at least 28 days.

Educate patients that evidence of immunity against measles includes at least one of the following: written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the United States before 1957.³

Counsel parents that infants who receive one dose of the MMR vaccine before their first birthday should get 2 more doses (one dose at 12-15 months of age and the next at least 28 days later). Remind parents that the MMR vaccine does not cause autism, as numerous studies have disproven this theory.

Educate patients about the following additional prevention strategies to include in combination with vaccination:

• Wash hands often with soap and water.
• Use hand sanitizer containing at least 60% alcohol when soap and water are not available.
• Avoid touching your face.
• Sneeze and cough into a tissue or sleeve.
• Avoid close contact or sharing utensils with individuals who are sick.

Pharmacists can play an important role by providing travel health education to prevent measles outbreaks.

References

• CDC reminds travelers to Europe: protect against measles. CDC website. https://www.cdc.gov/media/releases/2017/p0719-europe-measles.html. Accessed July 19, 2017.
• Measles vaccination. CDC website. https://www.cdc.gov/measles/vaccination.html. Accessed July 19, 2017.
• Measles for travelers. CDC website. https://www.cdc.gov/measles/travelers.html. Accessed July 19, 2017.