INSIDE WVSMA
Editor’ s Letter
Measles and Holiday Travel
Linda S. Nield, MD
Many equate September and the beginning of fall with the start of the holiday season, which means more travel. A frequent issue raised by patients this year has been the possibility of being exposed to measles during travel. As of mid- 2025, the Centers for Disease Control and Prevention( CDC) reported more than 1,200 confirmed measles cases in the United States( US) in 37 jurisdictions with 12 % resulting in hospitalization. 1 At this year’ s midpoint, there were three confirmed deaths due to this vaccine-preventable disease. As of the June 24, 2025, report, there were no confirmed cases of measles in West Virginia. Lay media is reporting that the measles virus, which is highly contagious, is likely being spread at airports and large events like concerts and shopping excursions in several states. 2
Clinicians can advise travelers about the risks of measles during holiday travel on a case-by-case basis by assessing the likelihood of potential exposures based upon mode and location of travel venues, travel activities, and travel destinations. For traveling internationally and nationally to measles outbreak areas, eligible adults should have received in their lifetime two doses of the measles / mumps / rubella( MMR) vaccine given at least four weeks apart and completed at least two weeks before departure. Parents of children whose ages are less than the recommended age of routine MMR administration may have heightened fears about traveling with their young ones; eligible infants ages 6 to 12 months should receive one dose of the MMR vaccine, which would then need to be repeated at the age of 12 to 15 months and 4 to 6 years. 3
The concluding line of the CDC’ s February 15, 2002, Morbidity and Mortality Weekly Report about US measles rates in the year 2000 included this premonitory warning that we must heed today,“ Sustaining high levels of vaccination is important in limiting indigenous spread of measles from imported cases and preventing measles from becoming re-established as an endemic disease in the US.” 4 It is disconcerting that we have to forewarn travelers about encountering potential measles exposures in our country in 2025, when measles was declared eliminated in the US in 2000.
Here is a reminder about how measles will present: The symptoms of measles, also known as hard measles, 7-day measles, and rubeola, classically include the three Cs of cough, coryza, and conjunctivitis; buccal mucosal lesions( Koplik spots); fever; and rash. Ambulatory clinicians commonly care for patients with these types of symptoms, sans the Koplik spots, and must have measles on their differential diagnosis list when caring for such patients. Prompt recognition of measles is imperative for optimal management of the infected individual and optimal protection of the public. Potential complications associated with measles range from the less severe( otitis media and diarrhea) to the most severe( pneumonia, encephalitis, and death). Although treatment is supportive, the World Health Organization advocates for all children and adults with measles to receive vitamin A supplementation, even in well-nourished individuals to potentially decrease the number of deaths. Readers can hear more of a brief re-fresher about measles presentation, treatment, and prevention in my upcoming British Medical Journal Best Practice podcast.
REFERENCES
1. Centers for Disease Control and Prevention. Measles Cases and Outbreaks. Available at https:// www. cdc. gov / measles / data-research / index. html. Accessed on June 25, 2025.
2. CNN Health. More measles exposures are happening at airports and tourist destination. Here’ s what travelers need to know. Available at https:// www. cnn. com / 2025 / 06 / 05 / health / measles-exposures-travelerswellness. Accessed on June 25, 2025.
3. Centers for Disease Control and Prevention. Measles( Rubeola) Plan for Travel. Available at https:// www. cdc. gov / measles / travel / index. html. Accessed on June 25, 2025.
4. Centers for Disease Control and Prevention. Measles---United States, 2000. MMWR. February 15, 2022; 51( 06): 120-3.
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