While a trip abroad can be a great experience for kids, whether you are just site seeing or you are visiting family, don’t forget to take some simple precautions so that your family comes back safe and healthy.
Get a Vaccine Checkup Before You Travel
It is important to remember that just because your kids are up-to-date on their routine childhood immunizations, that doesn’t mean that they are ready to travel out of the country.
It might surprise some folks to know that there are many vaccines that kids in the United States don’t routinely get, like vaccines that protect against cholera, yellow fever, typhoid, and Japanese encephalitis, etc. These are considered to be travel vaccines and may be recommended or required depending on where you are going.
How do you know which vaccines your kids need?
The CDC Traveler’s Health website is the best place to figure it out. With a list of 245 destinations, in addition to offering advice on how to avoid vaccine-preventable diseases, you get recommendations on avoiding others too, like Zika and malaria.
Don’t wait until the last minute before checking on these vaccine recommendations though. These are not vaccines that most pediatricians have in their office, so call or visit your pediatrician a few months in advance to plan out how you will get them. As a last resort, if your pediatrician can’t order them, can’t help you get them from an area pharmacy, and they aren’t available at your local health department, you might look to see if there is a “travel clinic” nearby.
Don’t Forget the Early MMR Recommendations
It’s also important to remember to make sure your child’s routine vaccines are up-to-date too. Confusing things a little, that can mean getting their MMR vaccines early.
Many parents, and some pediatricians, often forget that before traveling out of the United States:
Infants 6 months through 11 months of age should receive one dose of MMR vaccine. While this early dose should provide protection while traveling, it doesn’t provide full protection, doesn’t count as the 12 to 15 month routine dose, and will need to be repeated.
Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days. So even if your child is less than 4-years, he or she needs two doses of MMR before traveling out of the country. This second early dose won’t have to be repeated when they do turn 4.
Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days. While some adults are considered fully vaccinated with one dose of MMR, that isn’t true if they are traveling out of the country. Travelers need two doses!
Continuing outbreaks of measles linked to unvaccinated and partially vaccinated travelers highlight the need to spread the word about these recommendations.
Traveling is fun. Be sure to bring back some great memories and a few souvenirs. Don’t bring home measles or other diseases that you can then spread to others in your community or on the plane ride home.
In the early 1960s, the American Character Doll Company produced a series of Whimsie dolls, including:
Annie the Astronut
Fanny the Flapper
Hilda the Hillbilly
Lena the Cleaner (baseball)
Samson the Strongman
Simon the Degree
Wheeler the Dealer (casino dealer)
Zero the Hero
Hardly politically correct for our times, the stereotyped dolls do provide a look at the history of their time.
One other doll, Hedda Get Bedda, is especially helpful in that sense.
Made in 1961, this Whimsie doll could change her face, letting you know how she was feeling when you turned the knob on her head. She could go from having a sleeping face, to a sick face (perhaps having chicken pox or measles), to a happy face (once you made her better).
Does the fact that she also came with a hospital bed mean anything?
Just like some anti-vaccine folks like to think that the simple fact that they made a doll that had measles or chicken pox could possibly mean that they looked at them as mild diseases, you could just as easily say that including the hospital bed means ‘they’ understand they were life-threatening diseases that could put land you in the hospital.
We are talking about the pre-vaccine era after all, and in 1961, and when the Hedda Get Bedda doll came out, there were about 503,282 cases of measles in the United States and 432 measles deaths.
Like the Brady Bunch measles episode, the Hedda Get Bedda doll is sometimes used to push the myth that vaccine-preventable diseases aren’t that serious, helping folks justify their decisions to intentionally skip or delay vaccines and leaving their kids unprotected.
“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”
Walter Orenstein, MD
For example, if you believed that measles, chicken pox, or Hib were mild diseases, then you might feel better about not getting your child the MMR, chicken pox, or Hib vaccines.
Sure, many people get measles and do get better without any complications. On their way to getting better though, even they have high, hard to control fever for 5 to 7 days, with coughing and extreme irritability.
But while most get better, we shouldn’t forget that some people don’t survive measles without complications. Natural immunity sometimes comes with a price, from vision problems and permanent hearing loss to brain damage.
And tragically, some people don’t get to survive measles.
Breaking News – We already have reports of measles cases in 23 people from 8 states (California, Colorado, Florida, New Jersey, New York, Pennsylvania, Utah, and Washington) in 2017. (see below)
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
In the pre-vaccine era, measles was a very common childhood disease.
As it is now, it was also a deadly disease.
In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).
In 1962, there were 469,924 cases of measles in the United States and 432 deaths.
Post-Vaccine Era Measles Outbreaks
The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.
In 1970, there were only 47,351 cases and 89 deaths.
Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.
Post-Elimination Era Measles Outbreaks
Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.
We have seen more than a few records in the post-elimination era, including:
the year with the historic low number of measles cases – 37 cases in 2004
the year with the largest number of cases since 1994 – 667 cases in 2014
the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014
In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.
2017 Measles Outbreaks
While we are still watching the outbreaks in Denver and LA county, the first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person did expose others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.
The second case of 2017 was related to the LA county outbreak – a resident of Ventura County.
And it goes on already, with other measles cases in 2017 including:
at least 23 cases (as of late February)
cases in 8 states, including California, Colorado, Florida, New Jersey, New York, Pennsylvania, Utah, and Washington
an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
How many cases will we end up with this year? It is certainly getting off to a quick start, which could mean a big year for measles, although it is certainly hard to predict what will happen.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
a large outbreak in Arizona, 23 cases, linked to a private detention center
a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department
As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.
International Measles Outbreaks
The endemic spread of measles was stopped or eliminated in 2000. Since then, most of the measles outbreaks in the United States begin when someone travels out of the country, gets sick, and exposes others. Or less commonly, when an international traveler brings measles into the country.
That makes it easy to understand that large outbreaks of measles in other parts of the world could increase the risk that we have more outbreaks here. And that’s what happened in 2014 when there was an epidemic of measles in the Philippines and we ended up with the most cases since 1994, many linked to travel to and from the Philippines.
This year, the world is seeing large outbreaks of measles in:
European Union – Austria, Belgium, Germany, Italy (Florence), Romania, and Spain. The largest outbreak is in Romania, where there have been 3,071 cases and 16 deaths in the past 13 months.
Italy – cases have tripled already in 2017, which means that the country should look forward to many more cases than they had in 2016 (844).
Switzerland – the Swiss Sentinel Surveillance Network already reports 42 measles cases in 2017, compared to 36 in 2015 and 71 in 2016. Many of the cases are in young adults, aged 20-24 years.
Guinea – a measles epidemic has been declared in the country, with at least 1,527 cases and 2 deaths this year
Republican of South Sudan
These outbreaks are a great reminder to review the special vaccine travel requirements, including that adults who “plan to travel internationally should receive 2 doses of MMR at least 28 days apart,” that infants traveling abroad can get their first dose of MMR as early as age 6 to 11 months, with a repeat dose at age 12 months, and that “children aged who are greater than or equal to 12 months need 2 doses of MMR vaccine before traveling overseas,” even if they aren’t four to six years old yet.