Lowering the age of measles immunization for travelers due to international outbreaks, the Centers for Disease Control and Prevention (CDC) “strongly recommends” that infants six months through 11 months receive one dose of measles, mumps, and rubella (MMR) vaccine before travel.

“Normally, we don’t recommend the measles vaccine begin in infants until 12 months of age,” Robert Redfield, MD, CDC director, said at a recent CDC press conference. “But because of the current situation globally, we recommend these infants get a dose of the MMR vaccine prior to travel.”

Children 12 months of age or older need two doses separated by at least 28 days, he added.

“People traveling internationally should try to be fully vaccinated at least two weeks before traveling,” he said.

“But even if your trip is less than two weeks away, you should still get a dose before you depart.”

Overall, 44 measles cases this year were from other countries.

“Among those cases, over 90% were in people who are unvaccinated or whose vaccination status was unknown,” said Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases.

The top three countries where importations are coming from are Ukraine, Israel, and the Philippines, she added.

“When measles is imported into a community with a highly vaccinated population, outbreaks either don’t happen or are small,” Messonnier said.

“However, once measles is in an undervaccinated community, it’s difficult to control the spread of disease.”

Two MMR vaccine doses are roughly 97% effective at preventing measles (one dose, 93% effective). But measles is resurging in recent years as parents decline to vaccinate their children.

There may be religious objections, unfounded fear that vaccines are linked to autism, or the perception that vaccination is unnecessary because measles is so rarely seen in the U.S.

There is even false nostalgia pushed by the national antivaccine movement, as evidenced in the recent controversy over an old TV show that portrayed measles as a comic rite of passage.

The issue spilled over into politics at the CDC press conference as reporters recalled President Trump linking vaccines to autism when he was a candidate in the presidential debates. (See Hospital Infection Control & Prevention, November 2015.)

He has changed his position on this, emphasized Alex Azar II, Secretary of the Department of Health and Human Services.

“The president was very firm last week that people need to get their shots, vaccinations are so important,” Azar said.

“The scientific community has generated new and definitive information that there’s no association between vaccines and autism.”

Azar cited a recent large study in Denmark of some 650,000 children that found no link to MMR vaccination and autism.

“MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination,” the authors concluded.¹

(Editor’s note: For IPs needing an educational resource, the Infectious Diseases Society of America has issued a myth-busting fact sheet on measles vaccine safety. It is available at: https://bit.ly/2PpaM2d.)

REFERENCE

1. Hviid A, Hansen JV, Frisch M, et al. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med 2019; DOI: 10.7326/M18-2101.