On a recent trip to a popular theme park in Southern California with our two-year-old son and our then three-month-old daughter, the thought crossed my mind—with so many people at the park, should I be worried about her potentially being exposed to measles?
The reason I was concerned is because there has been a recent increase in measles cases in the United States. As of this week, the Centers for Disease Control and Prevention (CDC) reported that there have been 704 cases of measles in 22 states since the start of this year, the greatest number of cases reported in the United States since measles was eliminated from this country in 2000.
According to the CDC, the high number of cases in 2019 is “primarily the result of a few large outbreaks—one in Washington State and two in New York State that started in late 2018.” There have also been measles outbreaks (defined as three or more cases) reported in Rockland County, New York; New York City; Michigan; New Jersey; Georgia; Maryland; as well as in Butte County, Los Angeles County, and Sacramento County in California.
Measles cases have increased internationally as well. The World Health Organization recently reported that the number of measles cases has tripled worldwide this year compared with the first three months of 2018.
So, why these outbreaks now after the virus had been all but contained?
“In recent years, some parents have refused or delayed vaccinating their children out of fear or misinformation about the safety of the measles vaccine,” stated the American Academy of Pediatrics (AAP) on its HealthyChildren.org site, about the measles cases in the United States.
According to the AAP, families who choose not to vaccinate their children not only put their own children at risk of catching measles, but also expose other children to measles, including infants who are too young to be vaccinated and those who can’t be vaccinated because of other health conditions.
Indeed, at only three months old, our daughter Catalina had not yet received the measles vaccine. The first dose of the measles vaccine (typically administered together with the mumps and rubella vaccines, also known as the MMR vaccine) is routinely given to a child on or after his or her first birthday. According to the AAP, children can receive a measles vaccine at between six and 11 months of age if they will potentially be exposed to measles (they should then be revaccinated with two doses of the MMR vaccine, the first of which should be administered when the child is at least 12 months old).
Surely, other parents traveling at home and abroad with young children have felt some of the same concern that we did.
Precautions to take when traveling with infants
If your child is too young to be vaccinated, is there anything you can do to protect them when you’re traveling?
First, the decision as to whether you feel comfortable traveling with an infant child in light of the recent measles outbreaks should land squarely with each individual family. Here is some information that should help families decide what is right for them.
It’s worth noting that newborns do have some protection during the first few months of life to some infections from the antibodies they have received from their mothers, according to the AAP. But not having had the measles vaccine, infants remain at the highest risk of catching measles and of it potentially resulting in serious illness, hospitalization, or death.
If your child is too young to be vaccinated, the AAP advises that some of the ways you can help limit the risk of catching measles is to wash everyone in the family’s hands with soap and water; limit the baby’s exposure to crowds; disinfect objects and surfaces that the baby comes into contact with; and feed your baby breast milk, which has antibodies that help prevent and fight against infections.
The risk largely depends on the number of measles cases in the area you are traveling to. The domestic outbreaks are listed and updated by the CDC on a dedicated web page. And the WHO regularly updates its data on global measles outbreaks on this web page. As of April 2019, the countries with the greatest number of measles cases in the past year were Ukraine, Madagascar, India, Pakistan, the Philippines, Yemen, Brazil, Nigeria, Thailand, and the Democratic Republic of Congo.
If you are traveling with an infant under six months of age to a place with a significant number of reported measles cases, you might consider delaying the trip, the AAP advises.
Older children as well as adults born after 1957 who haven’t been vaccinated are also at risk of catching measles. The CDC recommends that individuals who haven’t been vaccinated get the MMR vaccine, which requires two doses at least 28 days apart.
How do you catch measles and what are the symptoms?
The measles virus is extremely contagious and is transferred through the air when an infected person sneezes or coughs. It can also be transmitted by coming into direct contact with fluids from the nose or mouth of an infected person.
The CDC reports that the most recognizable symptoms of measles are a high fever accompanied by a rash. Before the rash appears, children with measles typically develop standard cold-like symptoms, including cough, runny nose, fever, and red, watery eyes. Many children also get ear infections. The most serious outcomes result from complications associated with measles, such as pneumonia and encephalitis, a brain infection.
Nearly one out of every three children under the age of five who catches measles ends up in the hospital, the AAP reported. And in the United States, between one and two out of every 1,000 children who get measles ends up dying from it. A similar number of children suffer from encephalitis due to measles.
So, yes, the risks are out there and they are serious. In our case, we decided not to stay at home with Catalina. But I would be lying if I said we didn’t take some extra precautions and scurry away whenever we heard or saw someone coughing or sneezing.
The CDC said that stopping these measles outbreaks has become a priority for the agency, and it is committed to countering misinformation about the safety of the MMR vaccine. Noted the agency, “Some organizations are deliberately targeting these communities with inaccurate and misleading information about vaccines. CDC continues to encourage parents to speak to their family’s healthcare provider about the importance of vaccination.”