Be aware of measles in children returning from international travel

Physicians should maintain a high level of suspicion for measles in children with febrile rash illness who have returned recently from foreign travel, advises the Centers for Disease Control and Prevention (CDC).

In a recent issue of Morbidity and Mortality Weekly Report, the CDC reported on 7 cases of measles in the first 2 months of 2011 among unvaccinated children aged 6 to 23 months returning to the United States from travel abroad. Four children required hospitalization (2 with diarrhea and dehydration, 1 with persistent fever, and 1 with pneumonia). Hospitalization duration ranged from 0 to 7 days (median, 3.5 days).

The diagnosis of measles was delayed in 3 of the 7 children because measles is not often considered in the differential diagnosis of children returning from international travel with rash illness, according to the CDC. One of the children was hospitalized for 3 days; the diagnosis was made retrospectively only after a sibling developed measles. Another child visited a pediatrician 3 times before a diagnosis was made in the emergency department, and in the third child, measles was not suspected until 8 days after its onset. All children recovered.

These 7 cases are comparable to the number of imported cases reported for children aged 6 to 23 months each year from 2001 to 2010, the CDC notes. From 2001 to 2010, there were 47 (range, 3-8 cases per year) imported cases of measles in this age group, 3 of whom had been vaccinated before travel.

The 7 patients had traveled to at least 6 different countries. None of the children had received any doses of the measles, mumps, and rubella (MMR) vaccine, even though all were eligible before travel.

The CDC reminds physicians that children 12 months or older who travel internationally should receive 2 doses of MMR vaccine at least 28 days apart. Children 6 to 11 months of age should receive 1 dose of MMR vaccine, with revaccination recommended on or after the first birthday (1 dose followed by a second dose at least 28 days later).

Centers for Disease Control and Prevention (CDC). Measles imported by returning U.S. travelers aged 6-23 months, 2001-2011. MMWR Morb Mortal Wkly Rep. 2011;60(13):397-400.