- Measles is an airborne disease that is very transmissible and may spread easily and rapidly on a plane, bus, or train.
- The United States and some other countries have recently seen a rise in measles cases and outbreaks.
- The Centers for Disease Control and Prevention has urged people traveling internationally to ensure they are vaccinated against measles.
- Some travelers may need boosters if they received inactivated forms of the measles vaccine or only one dose.
Measles cases have been on the rise in recent months, and infection poses serious health risks, yet discussion about how to protect more vulnerable groups has been lacking.
As a highly contagious viral disease, measles poses a particular risk to children, older adults, people who are unvaccinated, and immunocompromised individuals. However, another group that is at high risk is travelers.
Because of the closed space and recycled air breathing, travelers can be at heightened risk of contracting viruses, such as in the case of measles.
The Centers for Disease Control and Prevention (CDC) recently issued updated advice to people traveling internationally, urging everyone to get fully vaccinated and monitor their health to prevent further spread of the virus.
Medical News Today spoke to two experts — Monica Gandhi, MD, MPH, an infectious disease specialist with the University of California, SF, and David Cutler, MD, a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, to learn more about how measles spreads and what measures travelers can take to stay safe and minimize their risk of measles infection.
Much like COVID-19, measles spreads via respiratory droplets expelled when a person with a measles infection coughs or sneezes. It can also spread via touch, with a person touching their mouth, nose, or eyes after having touched surfaces contaminated with these droplets.
The virus that causes measles can also remain active and contagious in the air or on surfaces for up to
“Measles is one of the most infectious viruses known. After being exposed, 90% of susceptible people become infected. However, since infection offers lifelong protection, and immunization is 93–97% effective, there has always been the hope that this disease could be eradicated,” Cutler said.
But how does one determine how much at risk they are for measles?
“The risk of an individual acquiring measles depends on their susceptibility, the presence of active measles cases, and gaining proximity to someone with measles,” Cutler explained.
What may help travelers to determine their individual risk is considering their vaccination status, health conditions, as well as knowing current global hotspots for measles outbreaks.
Considering how measles is transmitted, we asked our experts how much of a risk traveling via bus, train, or plane constitutes.
Gandhi told MNT that, since the measles virus is airborne, it can remain in the air for a substantial amount of time “after the person infected with measles has left.”
“Therefore, traveling during an outbreak can constitute a risk since these modes of transportation are most often sealed off without ventilation,” she pointed out.
Out of all classic modes of transport, planes may be associated with the highest risk of infection due to the fact that travelers have to remain in close quarters to each other for prolonged periods of time.
“Traveling by bus, train, plane, or automobile could expose you to measles if you are in close proximity to someone who is infected. Keeping distant from other people, avoiding those who might be infected, and staying away from communities with known measles outbreaks may reduce the risk of infection,” Cutler explained.
Both experts agreed on one measure that is scientifically proven to protect people against infection with measles: getting vaccinated.
“The best way to protect yourself from measles is to be vaccinated,” Gandhi said.
The MMR vaccine has been proven to offer lifelong protection against measles with two doses, and breakthrough cases are rare and milder.
Travelers should aim to carry evidence of their vaccination status, especially if they are traveling to a high-risk area. In terms of timing, they should aim to get vaccinated at least two weeks before their travel.
1. MMR vaccine: When to get vaccinated against measles
Infants ages 6–11 months should receive an early dose of the vaccine before they travel, and then follow the routine vaccination schedule. Children older than 12 months should receive their first dose now, and the second dose at least 28 days later.
Teenagers or adults without immunity against measles should get two doses of the MMR vaccine, 28 days apart.
2. Face masks and personal hygiene
Cutler said that as measles is spread by airborne transmission, one way people can protect themselves is by wearing an N95 mask, especially indoors or in places of outbreaks.
Practicing good hygiene such as washing hands thoroughly, avoiding touching one’s face, and using hand sanitizer can also minimize the risk of infection.
Gandhi also touched on the importance of proper ventilation and personal safety measures such as masking, as additional layers of protection after getting vaccinated.
“Since measles is airborne, ventilation is very protective so sitting next to open window on a bus or train is also [somewhat] protective. For those who are vulnerable, a tight-fitting and filtering mask, such as an N95 or K95 mask, can protect from measles,” she said.
People with measles typically experience high fever, cough, runny nose, red eyes, and a distinctive rash that starts to develop about three to five days after the initial symptoms appear. The incubation period for measles is generally between seven and 14 days from exposure, though this can go up to 21 days.
Experts recommend that people who have been in contact with someone with measles should get in touch healthcare providers as soon as possible and isolate themselves to prevent the disease from spreading further.
Researching local health clinics and learning a few basic phrases to describe symptoms may help travelers feel more at ease if they start feeling unwell.
“People with measles should isolate themselves, wear a strong fit and filtered mask and present to a medical facility so that supportive care can be provided if needed and contact tracing initiated to trace the origin of the infection (and to ensure that others who were exposed to measles do not get infected or are treated),” said Gandhi.
As measles can lead to various health complications such as pneumonia, encephalitis (inflammation of the brain), ear infections and, in severe cases, long-term neurological issues or even death if left untreated, experts advise people to seek immediate medical attention.
Cutler explained for MNT that:
“Once infected with measles there is no effective cure. Treatment for someone with measles is simply supportive: maintaining adequate hydration, good nutrition and control of fever. There is about a 1 [in] 1,000 risk of dying if infected with measles. So, while hospitalization may not be necessary, it is a good idea to seek medical attention if you might have measles to confirm the diagnosis, eliminate the possibility of an infection which might mimic measles, and to assure that anyone you have exposed has the opportunity to gain appropriate protection,”
Vitamin A, when administered by healthcare professionals, can help lessen the severity of disease. However, experts agree that it is not a substitute for vaccination.
For people who are unvaccinated, the first 72 hours may also be crucial in terms of disease progression. To that extent, Cutler talked about two strategies that may help reduce risk.
“For individuals who are not protected by vaccination or prior infection, infection after exposure can best be prevented by administering the vaccine within three days of exposure,” Cutler said.
“Intramuscular or intravenous immune globulin is another option. This is generally reserved for infants under 6 months of age, pregnant women, and those who are 3–6 days after exposure. For these people, vaccination to prevent infection is not recommended,” he added.
People should also monitor their health for three weeks after they return home from their travels, and watch out for symptoms such as a rash, fever, confusion, and breathing problems.
