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home : columns : ask the doctors June 24, 2018

4/19/2018 8:23:00 AM
Overseas travel plans could be hampered by measles outbreak

DEAR DOCTOR: There's apparently a serious measles outbreak going on in Europe right now. Does that mean that our family shouldn't go on our planned trip to Italy this spring?

DEAR READER: It's true that there has been a troubling surge in the number of cases of measles in Europe. After a record low of 5,273 reported cases in 2016, health officials say the number of people who contracted this extremely contagious disease quadrupled to more than 20,000 last year. There were 35 deaths from the measles throughout Europe last year, but due to the likelihood of incomplete reporting, health officials suspect that number is actually higher.

The measles virus is spread by coughing or sneezing. Because the live virus can remain in the air and on surfaces for up to two hours after being expelled by an infected individual, it is extremely contagious. Simply by walking through a room where, an hour or two before, someone with the measles either coughed or sneezed, you can contract the virus.

Symptoms include a high fever, runny nose, cough, red and watery eyes, and a signature rash of red spots. The rash typically begins at the head and then spreads to the rest of the body. Complications are common and include middle ear infections, diarrhea and dehydration, pneumonia, encephalitis, which is swelling of the brain, and even death.

At this time, 15 countries in Europe are experiencing large measles outbreaks. Italy had 5,006 reported cases of measles in 2017, which is second only to Romania, with 5,562 cases. Germany reported 927 cases, France had 520, the United Kingdom had 282, and Spain reported 152 cases. Switzerland had 105 cases.  

The spike in outbreaks has been attributed to multiple factors -- people deliberately not becoming vaccinated, a shortage in some regions of the MMR vaccine, and the lack of access to medical care by some marginalized groups. As has been the case here in the United States, vocal groups of anti-vaccine activists have been lobbying against the practice of vaccination.

In terms of your upcoming trip, the Centers for Disease Control and Prevention issued a Watch Level 1 travel notice for Italy in January of this year. This means epidemiologists have evaluated the situation and made the following recommendations:

-- Travelers headed to Italy should be vaccinated against measles with the MMR (measles, mumps and rubella) vaccine prior to departure. This includes infants between 6 and 11 months of age, who should have one dose of the MMR vaccine.

-- Adults and children 1 year and older should have received two doses of the MMR vaccine, separated by at least 28 days.

If you or anyone in your family hasn't been fully vaccinated against measles, then they will be at risk of contracting the disease if they come into contact with someone who is ill -- whether in Italy or at the local grocery store. If you're not sure whether you've been vaccinated, another dose of the MMR vaccine won't hurt. Your primary care physician can also confirm immunity through blood work.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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