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With Measles Outbreaks on the Rise, a Concern Over the Connection to Air Travel



Measles is not just in titles these days;

An infectious adult of the disease flew from Asia to San Francisco in February, infecting two others – an adult and a child – during the flight, California health departments said this month.

It is a grim development in a year that has already seen 228 cases of serious and potentially lethal diseases in 12 states, including six outbreaks of at least three people. All outbreaks in 2019 were linked to travelers who carried measles from countries with lower vaccination rates, according to the Centers for Disease Control and Prevention and sick people in areas of the United States where residents were not vaccinated .

Last year 82 of the 349 people diagnosed with measles brought them to this country from elsewhere, the highest number of cases imported since the virus was declared eliminated by the United States in 2000, the CDC Said .

With 17 countries under a C.D.C. Travel clock due to their high rate of measles, including popular destinations like England, France and Italy, stopping the spread of measles by travelers does not seem likely at any time.

A record 81 flights were examined in 2011 for having transported at least one person contagious of the disease, from 15 investigations in 2017 and 10 in 2016, according to the CDC Of the 106 aircraft, 66 were on domestic routes and the rest was in arrival from foreign airports.

Since the United States has a fairly high general vaccination rate against measles, the general population is largely protected by herd immunity. But there are states and pockets in states, with much less compliance, and the concern is that infected flyers carry measles in these vulnerable areas.

"Suddenly the only introduction of a case can have disruptive consequences," said Martin Cetron, director of the Global Migration and Quarantine Division at the CDC

Measles is considered among the most common viruses contagious to the world. Unlike the flu pathogens, which spread when a person sneezes or coughs but then falls, the measles virus remains suspended in the air "like really light dust particles," said Dr. Cetron, allowing pathogens to linger and float for up to two hours.

The flu is spread by an exponent of two, which means that every person who gets it is able to infect two others in a context in which people have not been immunized, said. Measles is likely to spread to nine and 19 people who are not immunized, depending on the herd setting and immunity of neighboring ones, he said.

In 2014, a 19-year-old boy who connects to a flight from India passed measles to a man at a Chicago airport, even though they didn't fly on the same plane. The man had arrived from Minnesota and landed at the same gate where the child was waiting to board the return flight.

"Although the transmission could have taken place anywhere in the airport where the child and adult airspace were most likely occurred in the gate area," the CDC wrote in the his accident report. Did not identify the airport.

The child had received a measles vaccination at 12 months, but not the recommended booster. The history of the immunization of man was unknown. No notification system is set up to alert travelers at risk of potential measles exposure at airports.

On airplanes, however, the law requires that the C.D.C. be contacted when health officials identify someone with measles as infectious on board. In these cases, health officials use the flight manifest to contact those seated within two rows of the infected passenger. They also notify anyone on the plane of a child on their lap, on the premise that they are more likely to roam the plane, the C.D.C.

If an unvaccinated person can be informed quickly, within 72 hours of exposure, they may receive a dose of the MMR vaccine, which may prevent them from contracting the disease or reducing its severity. If the notification arrives within six days, or if the person is not fit to receive the vaccine and is informed by this deadline, then he can receive a dose of immunoglobulin, which are pre-made antibodies.

"Protection from both of these is absolutely not 100 percent, so none of these is as good as being vaccinated in advance," he said Dr. Matthew Zahn, medical director for the epidemiology of the Health Care Agency of Orange County in California.

On an airplane carrying a contagious traveler, the other most vulnerable people are those who are too young to be vaccinated, who have given up getting a vaccine for personal reasons and 3% -5% of the population that has a system Immune compromised due to cancer, advanced treatments against rheumatoid arthritis and other causes, said Dr. Zahn. They may not be eligible to receive the MMR vaccine, a live vaccine that protects against measles, mumps and rubella.

"There is potential for exposure in your community, this is the reality we live in," Dr. Zahn said. "Air travel in general is one of those cases where this risk becomes a bit higher. People should be aware of it."

Most travelers can take steps to ensure they are protecting themselves and those around them:

  • Travelers taking domestic trips should follow the CDC Recommendations: children should receive a first dose of MMR vaccine at 12-15 months of age, with a second dose of 4 to 6 years of age. The agency also recommends that adolescents and adults who are not pregnant and do not have written documentation to have received the MMR vaccine, get two doses separated by at least 28 days.

  • For those traveling with children on international journeys, the CDC recommends an accelerated vaccination program, advising that children receive a dose of vaccine at 6 months up to 11 months of age, another dose from 12 to 15 months and a third dose later. All vaccinations should be separated by at least 28 days.

  • For anyone who is eligible for a vaccine that has passed the first birthday and is traveling internationally, the C.D.C. recommends two doses of vaccine, separated by at least 28 days.

  • Those who are not eligible to receive the MMR vaccine should familiarize themselves with C.D.C. travel alerts for measles, and talk to their health care provider about the risks.

  • Exceptions to the above include those who have written documentation of adequate vaccination, have had a confirmed case of measles, have laboratory tests of immunity and those born before 1957, which are considered to be exposed to the disease in their youth .

Furthermore, between 1963 and 1967, between 1963 and 1967, about 600,000 to 900,000 people received a different type of measles vaccination and did not develop an immunity. These individuals should be revaccinated.


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