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by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Measles and the International Traveller – latest from TravelSafe Immunization Clinic

Measles and the International Traveller - latest from TravelSafe Immunization ClinicMeasles and the International Traveller

Measles is a highly contagious disease spread by a virus easily transmitted through the air. It was once a common disease in Canada during childhood. Before the introduction of the measles vaccine the disease caused an estimated 2.6 million deaths worldwide, and was a significant cause of disability.

Measles is still common in many developing countries, especially in Africa and Asia. Outbreaks continue to occur worldwide. Current outbreaks include Mauritius, Mali, Uganda, Russia, Spain, New Zealand, Colombia, Czech Republic, Taiwan, Japan, Belarus, Liberia, Kosovo, Syria, Italy, Brazil, Ireland, Philippines, United Kingdom, and France to name a few. You don’t need to be traveling to a developing country to be at risk for measles!

Symptoms of measles begin 7-21 days after being exposed and can include high fever, rash, cold-like symptoms and red, inflamed eyes. Complications of measles can include diarrhea, ear infection, pneumonia, and encephalitis (swelling of the brain that can lead to seizures, deafness, or permanent brain damage). There is no cure for measles; treatment is only supportive. About 1 in 3000 people with measles will die from complications.

 

The efforts toward the elimination of measles in Canada

A single dose of the measles vaccine has been recommended in Canada for infants at 12 months of age since 1970. Between 1996-1998 a 2-dose vaccine program was implemented, and a second dose was then given to children and adolescents previously vaccinated under the 1-dose program. Receiving two doses of the measles vaccine is more than 99% effective to protect against measles, compared to 93% after one dose. However, some people missed out on this second dose of measles vaccine and as a result could still be susceptible to measles. In BC children currently receive their first dose of the measles, mumps, rubella (MMR) vaccine at 12 months of age, and a second dose between 4-6 years of age.

In 1992 Canada set a goal to eliminate measles by 2005. Although elimination usually implies a total absence of cases, this is not possible as importations can still occur from countries with less control over measles. Elimination of measles in Canada was therefore defined as the interruption of endemic measles transmission for at least 1 year, and failure to reestablish endemic transmission after importation (endemic refers to a disease that is regularly found among a particular population or certain area). The goal of measles elimination was achieved in Canada in 1998.

Despite Canada’s efforts to maintain elimination, there continues to be outbreaks of measles throughout the country. The 2011 outbreak of 725 reported cases in Quebec was the highest number of cases since 1995. There was also a large outbreak in 2014 in B.C.’s Fraser Valley with 433 reported cases. There have also been other outbreaks in various regions in Canada.

 

So why are there still measles outbreaks after it was eliminated in 1998?

There continues to be measles outbreaks in Canada mainly due to cases imported from international travellers who acquire the disease abroad which can then be spread to unvaccinated or partially vaccinated individuals. In recent years Canada has experienced falling vaccination rates due to a number of reasons including anti-vaccine views and incompletely immunized individuals. The vaccine coverage rate in Canada is close to 90% but it needs 93-95% to protect the population against measles.

 

International travel and the MMR vaccine

The measles vaccine is available only in combination with mumps and rubella (MMR vaccine). The best way to prevent the spread of measles and importing it to Canada is to ensure you are properly immunized before international travel, even to industrialized countries. Travellers should receive the vaccine according to the following guidelines:

  • Infants between the ages of 6-11 months should receive 1 dose of MMR. Infants who received the vaccine before 12 months of age must be revaccinated according to the routine schedule (dose #1 at 12 months of age; dose #2 at 4-6 years of age).
  • Children 12 months of age and older should receive 2 doses of MMR separated by at least 28 days.
  • Adults born after 1970 (1957 for health care workers) should receive 2 doses of MMR separated by at least 28 days (individuals born prior to 1957 are assumed immune to measles from natural infection). Those born between 1957 and 1970 are generally assumed to have acquired immunity from natural infection, however those without documentation of 2 doses of measles vaccine, or those who do not self-identify as having had the disease may be susceptible and should receive 1 dose of MMR.

 

Vaccine Safety

Common reactions to the MMR vaccine include redness, tenderness and swelling at the injection site. A mild fever, rash, or swelling of the glands in the cheeks or neck can occur about 7-12 days after receiving the vaccine. Temporary joint pain may also occur in teenage and adult women.

A published report linking the MMR vaccine to autism has never been replicated by any other study. The report has been widely discredited and has been retracted by the journal.

There are some people who should not get the MMR vaccine including individuals who:

  • Have had a severe allergic reaction to a previous dose of the MMR vaccine or any vaccine component
  • Are severely immunosupressed
  • Are pregnant or planning pregnancy (women should avoid pregnancy for 1 month after receiving the MMR vaccine)
  • Have had a blood transfusion or received other blood products in the last 12 months
  • Have had a drop in platelets after a previous dose of MMR

There is no need to delay the MMR vaccine if you have a cold or another mild illness.

 

Getting ready to travel?

There is an estimated 20 million people infected globally each year with measles, so travellers may be exposed to the virus in almost any country they visit. As an international traveler it is important to ensure your MMR vaccines are up to date. Protect yourself against measles and ensure you do not become an importer of the disease!

Don’t delay! If you are traveling soon make your appointment today!

 

 

by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Traveling With Children

Holiday Flight Entertainment

Does planning a trip with your young children feel daunting? While there may be new worries that never crossed your mind in your child free travel days, traveling with children doesn’t need to be scary! Here are some factors to consider in your planning as well as tips for keeping your child healthy on your travels. Preparation is key!

Traveling With Children – Ensure immunizations are up to date

Make sure your child’s routine immunizations are up to date. Visit a travel clinic 6-8 weeks before your departure for health advice and travel vaccines. The vaccines recommended will depend on your destination, length of travel, type of travel, and your child’s age. If you are traveling to an area with risk of measles, the measles, mumps, rubella (MMR) vaccine can be given as early as 6 months of age, and then repeated with routine vaccines at 1 year of age. Some possibilities for travel vaccines that are not included in the routine vaccines include:

Hepatitis A

Typhoid

Traveler’s diarrhea and cholera

Yellow Fever

Japanese Encephalitis

Rabies

Meningococcal meningitis

Traveling With Children

Preventing and treating traveler’s diarrhea

The most common travel related illnesses affecting children include diarrhea and other gastrointestinal illnesses. Diarrhea can cause infants and children to become dehydrated more quickly than adults. Some things you can do to reduce your child’s risk of traveler’s diarrhea:

  • Breast is best! Breastfeeding is the best way to prevent illnesses spread through contaminated food and water. If your infant is formula fed consider bringing formula from home as those available abroad may not be the same.
  • Drinking water (as well as water for brushing teeth and preparing infant formula) should be bottled water or treated by boiling or another method of purification. Methods to purify water can be found here.  Avoid ice, fountain drinks, and anything that could be mixed with untreated water.
  • Food should be cooked fresh and hot. Avoid salads, and any raw fruits and vegetables that are not peeled by the caregiver. Cooked vegetables are safest as are fruits that peeled immediately before giving to your child.
  • Avoid dairy products as they may be diluted with untreated water or may not be pasteurized.
  • Take care to ensure proper hand washing and cleaning bottles, pacifiers, teething rings and toys that fall to the floor or are handled by other people. Use bottled or treated water to clean these items. Wash hands well after diaper changes. Bring an alcohol-based hand sanitizer to use when soap and water is not available but keep in mind that it is not effective against all germs so wash with soap and water as soon as possible.

 

Treating traveler’s diarrhea:

The biggest concern for an infant or child with diarrhea or vomiting is dehydration. Oral rehydration salts (ORS) packets are available at pharmacies and should be brought from home to add to clean water to give to the child. Continue breast or formula feeding in addition to ORS. Older infants and children should continue to eat solid foods in addition to ORS.

Seek medical attention if your infant or young child has

  • signs of moderate to severe dehydration
  • bloody diarrhea
  • temperature >38.6º C
  • Persistent vomiting or diarrhea (unable to keep down ORS)

Do not give children bismuth subsalicylate (i.e. Pepto-Bismol) to children younger than 12 years of age. Breastfeeding mothers should also avoid this.

Parents may want to carry an antibiotic from home (azithromycin) for treatment of more moderate to severe diarrhea. Medical attention should be sought if children do not improve with antibiotic treatment.

 

Malaria

Malaria is a disease caused by the bite of an infected mosquito. Children are at an increased risk of severe complications of malaria. If possible avoid taking young children to areas where malaria is present. Otherwise, the best way to avoid malaria is to avoid being bitten by mosquitoes!

  • Sleep in rooms with air conditioning or screened windows or bed nets
  • Use mosquito netting over infant carriers
  • Dress children in long sleeve, light coloured clothing and avoid strongly scented products
  • Apply Icaridin 20% or DEET 10% to exposed non sensitive areas of the body to children 6 months of age and older
  • Give your child an antimalarial medication. The type and dose depends on your child’s age, weight, as well as your travel destination. Your health care provider will best advise regarding choice of antimalarial medication for your child.

 

Infections from soil

Children are more likely to have contact with soil and sand where various infections and parasites can be transmitted. Be mindful:

  • That your child wears protective footwear and plays on a sheet or towel rather than directly on the ground
  • Clothing should not be dried on the ground.

Traveling With Children

Air Travel

Pressure in the middle ear when the plane is descending can cause pain for infants and children. Swallowing or chewing can help to equalize the pressure and decrease the pain. Here are a few ways to help with this:

  • Infants can breast feed or suck on a bottle
  • Older children can try chewing gum
  • Antihistamines or decongestants have not been shown to be of any benefit

 

Injury Prevention

  • Children weighing 40lbs should be restrained in age-appropriate car seats or booster seats when traveling in vehicles, which must often be brought from home. Transportation should be arranged in vehicles with seat belts and other safety features.
  • Ensure close supervision of children around water and ensure protective foot wear is worn.

 

Sun

  • Children age > 6 months should wear sunscreen with at least SPF 30 which should be reapplied as needed and after sweating and water exposure
  • Infants < 6 months should be kept in the shade and wear clothing that covers the entire body.
  • Consider sun-blocking clothing as well as hats and sunglasses
  • More tips about sun safety can be found here! Always Practice Safe Sun

Thinksport KIDS Safe Sunscreen SPF 50+ (3oz)

 

Travel Kit

Here are some suggestions of items to bring in your travel kit:

  • Insect repellent containing DEET 10% or Icaridin 20%
  • Oral rehydration salts
  • Water purification device (i.e. chlorine tabs, filter, UV light, etc.)
  • Medication recommended by your health care provider for fever or traveler’s diarrhea
  • A waterproof sunscreen with at least SPF 30
  • A thermometer
  • Basic first aid kit for minor injuries (gauze pads, bandages, alcohol swabs)
  • Mosquito net (depending on your itinerary)
  • Hand sanitizer

While a few of the above topics may cause some worry, this blog was not meant to scare you, but prepare you! Awareness and preparation is key to a safe and healthy trip with your children!

Before you travel, protect your health.

Travel Safely with TravelSafe Immunization Clinic

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