Measles in the 21st Century, a Continuing Preventable Risk to Travelers: Data From the GeoSentinel Global Network

Sotir, Mark J.; Esposito, Douglas H.; Barnett, Elizabeth D.; Leder, Karin; Kozarsky, Phyllis E.; Lim, Poh Lian; Gkrania‐Klotsas, Effrossyni; Hamer, Davidson H.; Kuhn, Susan; Connor, Bradley A.; Pradhan, Rashila; Caumes, Éric

doi:10.1093/cid/civ839

Cited by 24 publications

(11 citation statements)

References 8 publications

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“…2–5 Recently, travel-associated outbreaks of measles have also significantly increased. 6–8 Consultation with a health care provider prior to travel can help reduce the risk of travel-related illness and mitigate the spread of infectious diseases.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and preparation of the last-minute traveler: analysis of vaccine usage in the Global TravEpiNet Consortium

Rao

et al. 2019

Journal of Travel Medicine

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Background: Last-minute travellers (LMTs) present challenges for health care providers because they may have insufficient time for recommended vaccinations or pre-travel preparation. Our objective was to obtain a better understanding of LMTs in order to help travel medicine providers develop improved strategies to decrease the number of LMTs and potentially reduce travel-related morbidity. Methods:We defined LMTs as travellers with a departure date of 7 days or fewer from the medical encounter. We analysed the characteristics and health preparation of 12 494 LMTs who presented to a network of US clinical practices Results: LMTs comprised 16% of all travellers. More LMTs than non-LMTs travelled for business or to visit friends and relatives (VFR) (26% vs 16% and 15% vs 8%, respectively; P< 0.0001). More LMTs also travelled for longer than 1 month (27% vs 21%; P<0.0001) and visited only urban areas (40% vs 29%; P<0.0001). At least one travel vaccine was deferred by 18% of LMTs because of insufficient time before departure. Vaccines that required multiple vaccinations, For Permissions, please journals.permissions@oup.com such as Japanese encephalitis and rabies, were the most likely to be deferred because of time constraints. Conclusion:Interventions to improve the timing of pre-travel health consultations should be developed, particularly for business and VFR travellers. Recently endorsed accelerated vaccine schedules for Japanese encephalitis and rabies may help some LMTs receive protection against these infections despite late presentation for pre-travel health care.

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Section: Introductionmentioning

confidence: 99%

Characteristics and preparation of the last-minute traveler: analysis of vaccine usage in the Global TravEpiNet Consortium

Rao

et al. 2019

Journal of Travel Medicine

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“…GeoSentinel is a global sentinel surveillance of infectious diseases in returning travelers [36]. Measles remains a risk for travellers, with 94 measles diagnoses reported to the GeoSentinel network from 2000 to 2014, two-thirds since 2010 [37], with Asia being the most common exposure region, followed by Africa and Europe. The years 2018 and 2019, however, saw a further increase of measles in travellers seen at GeoSentinel sites [38].…”

Section: Discussionmentioning

confidence: 99%

Measles Resurgence in Europe: Migrants and Travellers are not the Main Drivers

Leong¹,

Wilder-Smith²

2019

JEGH

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Measles is a highly transmissible viral infection that may lead to serious illness, lifelong complications, and death. As there is no animal reservoir for measles, measles resurgence is due to human movement of viremic persons. Therefore, some have blamed the enormous migration into Europe in the past 5 years for the measles resurgence in this region. We set out to determine the main driver for measles resurgence in Europe by assessing vaccine coverage rates and economic status in European countries, number of migrants, and travel volumes. Data on measles vaccine coverage rates with two vaccine doses of measles, mumps and rubella (MMR) [Measles Containing Vaccine (MCV)2] and total number of measles cases in 2017 for Europe, including Eastern European countries, were obtained, in addition to Gross Domestic Product (GDP), and number of migrants and tourist arrivals. The outcome measured, incidence of measles per 100,000, was log transformed and subsequently analyzed using multiple linear regression, along with predictor variables: number of international migrants, GDP per capita, tourist arrivals, and vaccine coverage. The final model was interpreted by exponentiating the regression coefficients. Incidence of measles was highest in Romania (46.1/100,000), followed by Ukraine (10.8/100,000) and Greece (8.7/100,000). MCV2 coverage in these countries is less than 84%, with lowest coverage rate (75%) reported in Romania. Only vaccine coverage appears to be the significant predictor in the model (p < 0.001) for incidence of measles even after adjusting for international migrants, international tourist arrivals, and GDP per capita. With one unit increase in vaccination coverage, the incidence of measles decreased by 18% [95% confidence interval (CI): 10-25]. Our results showed that number of migrants and international tourist arrivals into any of the European countries were not the drivers for increased measles cases. Countries with high vaccine coverage rates regardless of economic status did not experience a resurgence of measles, even if the number of migrants or incoming travellers was high. The statistically significant sole driver was vaccine coverage rates. These analyses reemphasize the importance of strategies to improve national measles vaccination to achieve coverage greater than 95%.

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“…The importance of travel medicine in updating generally recommended vaccinations such as measles has also been highlighted in a few international studies [25,26]. Updating of generally recommended vaccinations during travel consultations is an important chance to catch people who would normally not consult their GP only for missing vaccination shots, especially in countries, such as Switzerland,…”

Section: Discussionmentioning

confidence: 99%