Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations

Abstract

Background Measles outbreaks continue to occur in the United States and are mostly due to infections in returning travelers. Objective We described how providers assessed the measles immunity status of departing U.S. adult travelers seeking pretravel consultation and assessed reasons given for nonvaccination among those considered eligible to receive the measles-mumps-rubella (MMR) vaccine. Design Observational study in U.S. pretravel clinics. Setting 24 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention-funded consortium. Patients Adults (born in or after 1957) attending pre-travel consultations at GTEN sites (2009-2014). Measurements Structured questionnaire completed by traveler and provider during pretravel consultation. Results We included 40,810 adult travelers; providers considered 6,612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3,477 (53%) were not vaccinated at the visit; of these, 1,689 (48%) were not vaccinated due to traveler refusal, 966 (28%) due to provider decision, and 822 (24%) due to health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2,262 travelers, 65%) or at nonacademic centers (1,777 travelers, 51%). Nonvaccination due to traveler refusal was most frequent in the South (1,432 travelers, 63%) or at nonacademic centers (1,178 travelers, 66%). Limitations Our estimates could underrepresent the opportunities for MMR vaccination, as providers accepted verbal histories of disease and vaccination as evidence of immunity. Conclusions Sixteen percent of U.S. adult travelers who presented for pretravel consultation at GTEN sites met criteria for MMR vaccination according to the provider's assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of measles importations and transmissions.

Life-course immunization as a gateway to health

“…Currently, many opportunities for vaccination are being missed at scheduled medical visits and during in-patient encounters [131][132][133]. A missed vaccination opportunity is defined as a medical visit where a patient eligible for vaccination remained unvaccinated.…”

Epidemics, Air Travel, and Elimination in a Globalized World: The Case of Measles

“…For the United States and other governments concerned with importation of diseases like measles, this work highlights two important priorities. First, reducing the risk contributed by resident travelers is essential, accomplished through increased risk awareness 55 and vaccination coverage 56 among travelers (particularly high-risk travelers and those from communities with heterogeneous vaccination coverage 57 ). Second, this work stresses the tremendous value of information to both domestic biosecurity and global disease control.…”

Spread of Measles in Europe and Implications for US Travelers

“…Similar to in other countries that have eliminated measles, measles cases in the United States are directly or indirectly the result of international travel 33 ; as long as measles remains endemic in other countries, the United States will be challenged by measles importations. The record case counts throughout the WHO 17 In the same study, 399 travelers to Europe were eligible for the MMR vaccine; 131 (33%) were not vaccinated at the visit. 17 The high frequency of missed vaccination and vaccine refusal is surprising because travelers who attend a pretravel health consultation with a health care provider are typically concerned about receiving protection for health risks they may encounter while traveling.…”

“…The record case counts throughout the WHO 17 In the same study, 399 travelers to Europe were eligible for the MMR vaccine; 131 (33%) were not vaccinated at the visit. 17 The high frequency of missed vaccination and vaccine refusal is surprising because travelers who attend a pretravel health consultation with a health care provider are typically concerned about receiving protection for health risks they may encounter while traveling. The reason one-third of travelers to Europe missed an opportunity for measles vaccination remains unclear; it may represent a lack of concern or awareness on the part of travelers 34 and the health care providers about acquiring measles in Europe.…”