What Travelers Need to Know About Measles

More than a hundred people across 14 states have come down with the measles, many of them sickened as a result of an outbreak in December at Disneyland in Anaheim, Calif.

But the only travelers who have reason for trepidation are those who have had neither measles nor the vaccine that prevents it.

No one is quite sure how the Disneyland outbreak began, but Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control, said that it probably came from an infected person returning from overseas. In 2014, when there were more than 600 cases of measles, the source was travelers returning from the Philippines, where there had been an outbreak of more than 50,000 cases.

Because the vaccine for measles (given as the MMR vaccine, in combination with the vaccines for mumps and rubella) is so effective, measles had been virtually eliminated in the United States by 2000. From then until the 2014 outbreaks, there were only about 60 cases a year nationwide.

The World Health Organization reports that by 2013, 84 percent of the world’s children were receiving a dose of the vaccine before their first birthday, and there was a 75 percent drop in measles deaths between 2000 and 2013. The W.H.O. estimates that vaccination prevented 15.6 million deaths over those years, leading the agency to call it “one of the best buys in public health.”

But still there were 145,700 deaths from measles globally in 2013 — that is, 400 people a day, mostly children, died from a completely preventable disease.

Generally, travelers who are immunized will not have problems in crowded places like cruise ships. Cruise lines do not investigate the immune status of their passengers, but they do check to make sure no one who is obviously ill will board a ship.

“Cruise lines continue their health screenings prior to embarkation as they have done for many years,” said Elinore Boeke, director of public affairs for Cruise Lines International Association, an industry trade group. “As health issues arise on land, this health screening is re-evaluated and modified as appropriate.”

Does this mean it would be safe to take an unvaccinated child on a cruise? No, said Dr. Deborah Ann Mulligan, a clinical professor of pediatrics at Nova Southeastern University.

“The best course of action,” she said, “is to make sure your vaccinations are up to date. To do otherwise is playing Russian roulette. There’s no reason to voluntarily put a child at risk without the protection of the vaccinations.”

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Disneyland Resort declined to comment except to say that they are referring guests to the California Department of Public Health website, which has tips for travelers.

The W.H.O. names Africa and southern Asia as high-risk areas, but measles still occurs in Europe and the Pacific as well, and worldwide the virus infects about 20 million people a year. It is one of the most infectious diseases known — just being in a room that a measles patient has left an hour before can lead to infection, and a person who has no symptoms and feels perfectly fine can still be infectious. For travelers, this presents a problem, but it is easily solved: get vaccinated.

Measles has become so rare that many people have forgotten how nasty it can be. “Kids look miserable,” said Dr. Marguerite Mayers, an infectious disease specialist at Children’s Hospital at Montefiore Medical Center in the Bronx. “They’re covered with spots, they have a high fever, coughing, runny nose, drippy eyes, a head-to-toe rash. The virus invades the eyes and the kids can’t stand light, and they insist on being in a dark room. And there is no treatment.”

Usually, babies get their first dose of the MMR vaccine at 12 to 15 months and then a second when they are 4 to 6 years old. But children can get the second dose as early as 28 days after the first one. The first shot is about 95 percent effective, and the second one seals the deal — it provides virtually 100 percent protection. Until they are 6 months old, babies are protected from the disease by their mother’s antibodies — provided, of course, that the mother is immune.

As of Jan. 21, of the 34 California cases in which vaccine status has been documented, 28 were unvaccinated. Failure to get vaccinated is the main reason for outbreaks, Dr. Mayers said, but those at fault are not only the people who believe the scientifically discredited idea that the vaccine causes autism. For example, she said, “You know you have an appointment to get the vaccine but you have a cold that day, so you don’t go out. Or your insurance lapsed, so you skip it. Or you just forget.”

The C.D.C. says that anyone over 6 months old who leaves the country should have a measles vaccination.

“There are no other precautions you can take,” Dr. Mayers said. “If you’re not already immune, the only protection is vaccination.”

There are some people who cannot get the vaccine — people who are undergoing treatment for cancer or organ transplant, for example, or are immunocompromised for other reasons. But almost everyone else can get it safely. The most common side effect is swelling or stinging at the injection site.

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If you have had measles — and you are very likely to have had it if you were born before 1957 — you do not need the vaccine, although there is no harm done if you get the vaccine anyway. If you’re planning a trip, Dr. Mayers said, you can get one shot and then another in four weeks. Once you are immune — that is, you have had either the disease or the shots — you are immune for life. Immunity to measles never wears off.

What about traveling with an unvaccinated infant under 6 months old? “Obviously if there’s a known epidemic in a given location, I advise them not to go,” Dr. Mayers said. “But there are occasional outbreaks even in Europe, and I’m certainly not telling people to avoid going to Switzerland. Children under 6 months are generally immune. As for the others, I vaccinate them and say ‘bon voyage.’ ”

Is Disneyland to be avoided? “Absolutely not,” Dr. Mayers said. “Disneyland is fun! I would happily take my grandchildren there — all six of them — because they’ve all been vaccinated!”