Disease Information:
Measles

Source: Health Canada

Know before you go!
Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness.

The risk is yours
Your risk of acquiring a disease depends on several factors. They include: your age, gender, immunization status and current state of health; your itinerary, duration and style of travel (e.g., first class, adventure) and anticipated travel activities (e.g., animal contact, exposure to fresh water, sexual contact); as well as the local disease situation.

Risk assessment consultation
Health Canada strongly recommends that your travel plans include contacting a travel medicine clinic or physician six to eight weeks before departure. Based on your individual risk assessment, a health care professional can determine your need for immunizations and/or preventive medication (prophylaxis) and advise you on precautions to avoid disease. We can help you locate a travel medicine clinic closest to your home.

Some facts from the experts
The information below has been developed and is updated in consultation with Health Canada's Committee to Advise on Tropical Medicine and Travel (CATMAT). The recommendations are intended as general advice about the prevention of measles for Canadians travelling internationally.

Disease profile
Measles is a highly contagious and acute infectious disease caused by a virus of the genus Morbillivirus in the family Paramyxoviridae. It is one of the best known and deadliest of all childhood rash and febrile illnesses. In severe cases, complications such as pneumonia, diarrhea, middle ear infection and encephalitis may occur. Measles mainly affects young children, but can strike older children and adults as well.

Transmission
The measles virus is spread by airborne droplets or direct contact with nasal or throat secretions of infected persons. It is less commonly spread through contact with articles, such as tissue paper that has been freshly soiled with nose or throat secretions.

Geographic distribution and incidence trends
Measles remains a common disease in many countries of the world, including some developed countries in Europe and Asia. In temperate climates, measles occurs primarily in late winter and early spring. In tropical climates, measles occurs primarily in the dry season.

Before measles vaccine became available, virtually all children contracted measles, an estimated 135 million cases with about 7 to 8 million deaths globally each year. The World Health Organization's (WHO) Expanded Program on Immunization (EPI) has enabled a dramatic increase in vaccine coverage that has reduced both measles cases and deaths. In 1998, approximately 82% of the world's children under one year of age were reported to have received measles vaccine, and it was estimated that around 2 million deaths were prevented. Nevertheless, it is estimated that 700,000 deaths due to measles occur annually in developing countries.

With effective childhood immunization programs, measles cases in the US, Canada and other western countries have dropped by 99%.

In Canada
In 1999, a provisional total of 28 confirmed measles cases were reported as of December 10. The ages ranged from 10 months to 26 years, with a median of 8 years. None of the cases had a documented history of measles vaccination. Eight of the 28 cases in 1999 had exposure to measles outside Canada (India, Indonesia, Japan, the Netherlands, Pakistan and the Philippines). All the remaining cases were linked to an imported case.

Symptoms
The incubation period for measles is approximately 10 days, varying from 8 to 13 days from exposure to onset of fever, and about 14 days before a rash appears. An individual is contagious usually from four days before to 4 days after the appearance of a rash. Measles symptoms generally appear in two stages. The first signs are the onset of fever, red eyes (i.e., conjunctivitis), runny nose, cough and white spots on the inside lining of the mouth. In the second stage, a characteristic red blotchy rash appears on the third to seventh day, beginning on the face and becoming generalized. Generally, the disease is more severe in infants and adults than in children. One attack of measles usually gives lifetime immunity, but a measles attack does not extend immunity to German measles (or, rubella), which is somewhat similar to measles.

Treatment
There is no specific treatment for measles. Bed rest is recommended.

Vaccine
There is no cure for measles, but it can be prevented with vaccination.

Measles vaccine contains live attenuated measles virus. It is available alone or in combination with live rubella vaccine (MR) or with mumps and rubella vaccines (MMR).

Canada has a high standard of childhood immunization programs, and measles vaccination is included in our national childhood immunization schedule. Routine immunization includes two doses, the first dose given usually to infants after their first birthday. The second dose should be given at least one month after the first dose and before school entry. Measles-containing vaccine can be given concurrently with other childhood vaccines such as combined diptheria, pertussis, tetanus, polio or Haemophilus influenzae type B vaccines. Measles or MMR vaccine may be given to adults if they were not immunized as children.

Two doses of measles vaccine are recommended for all unimmunized travellers over one year of age who were born after 1970 and who are en route to an area where measles occurs (i.e., is endemic), unless there is serologic proof of immunity or physician documentation of prior measles.

Prevention and personal precautions
As there is no cure for measles, prevention is key.

Recommendations
Health Canada strongly recommends that Canadian international travellers contact a physician or travel medicine clinic prior to departure for an individual risk assessment. Based on travellers' current health status, previous immunization history and anticipated travel itinerary, their need for measles vaccination can be assessed.

For Canadians travelling to countries where measles is epidemic or endemic, primary immunization (two doses) of children and, if indicated, primary immunization of adults or a single booster dose for adults, are recommended in accordance with the recommendations of the National Advisory Committee on Immunization.

Some things to think about...
International travel can expose Canadians to infectious diseases, like measles, that may not be frequently seen in North America. Our high standard of sanitation and childhood immunization programs may lead many adult Canadians to become complacent about keeping their routine immunizations up to date. Travellers are reminded to ensure that their routine childhood immunizations are up to date prior to travelling. All travellers are advised to review their immunization history with a physician well in advance of departure to confirm whether they have been properly immunized against measles.

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