The measles are back: Four cases just confirmed Thursday for a total of seven in Hawaii in recent days.

The latest four cases resulted from exposure to three infected young adults who should have been vaccinated years ago.

Should we be worried? Absolutely, according to Dr. Sarah Park, our state epidemiologist. It’s only a matter of time before a larger outbreak occurs.

Measles had not been in Hawaii since 2010. That year, one case from a traveling infant led to three more cases here in the islands.

But for the next four years, no more measles, until last February. An 11-month old child who was not properly vaccinated got sick while traveling to the Philippines and was taken to her doctor after returning to Oahu.

Honolulu Int'l Airport

We need to ensure that international travelers are not infected with contagious diseases.

Flickr.com

Unfortunately, another child who was in the office waiting room was infected — as 90 percent of all unimmunized contacts would be, just by breathing the same air nearby.

Both children were treated at Wahiawa General Hospital and an alert went out to people who might have been in the area where the children were treated to be alert about possible symptoms and to check on their immunity status.

At least three of the new cases are “more concerning,” says Park, “ because they involve young adults, not children, who travelled to the Philippines, Indonesia or Malaysia. This is not a cluster from one infection, but three unrelated people who have all simultaneously been diagnosed with this highly contagious disease.”

Travel guidelines from the U.S. Centers for Disease Control and Infection suggest getting the measles, mumps, rubella (or MMR) shot for any infant over 6 months prior to traveling to an endemic area.

According to the World Health Organization, the Philippines has had an outbreak of almost 50,000 cases this year alone, with almost 100 people dying. The only country with a higher rate, at almost 100,000 suspected cases, is China.

The measles used to be a common infection before the introduction of the vaccine in 1963. Before that, the only way to become immune was to get sick. But these days, we have a shot to protect children, and thus the rest of the population, from contracting the disease and spreading it — and we shouldn’t wait until we are planning to travel to be vaccinated.

measles-2

A blowup of a cell carrying the measles infection.

CDC

The latest version, given since 2005, includes measles, mumps, rubella and varicella, or chicken pox. After two shots, the efficacy rate is over 99 percent. You can’t get much better than that with immunizations.

It’s given at 12 months and again at 18 months of age for most people, earlier if traveling. A simple blood test can tell if immunity has decreased over time and a booster is given to adults. It’s recommended that anyone who plans to leave the country should receive a booster shot, but it’s not enforced.

Why worry about measles?

Well, it is estimated that 20 million people worldwide get the disease and 122,000 die each year from it. One in five will get an ear infection or pneumonia, one in 1,000 will get brain inflammation. Some will die.

Park herself recalls a case where a set of twins were exposed, and one is permanently disabled the infection.

Early symptoms include a fever, cough, and pink eye, leading to a characteristic rash that most doctors these days have never seen, and therefore may not readily diagnose.

As a frequent traveler, and a physician, I know how important it is to be protected when abroad. Not just for my sake, but for every patient I see when I come back.

We require immigrants to prove immunity so that they don’t bring contagious diseases to our shores. Why don’t we have requirements of our own citizens to get travel clearance before going abroad as well?

We need passports, but there are no requirements for any immunizations.

It doesn’t make sense to require more of immigrants than our own citizens coming back to this country.

So far in 2014, there have been 597 confirmed cases of measles in the United States. In 98 percent of those cases, unvaccinated people were exposed to someone who had measles. Hawaii now has had five cases, and all could have been prevented.

Rather than waiting until we have more, it’s time to look at our current screening procedures for travelers, and require more than just a passport to re-enter our borders.

In the meantime, for anyone traveling abroad, the CDC has excellent resources to let people know what vaccines are recommended: www.cdc.gov.

Primary care doctors and travel clinics are also able to help for people who want to be safe on their next journey.

Just because proof of immunity is not yet required doesn’t mean we can’t start now to keep everyone safe.

So far in 2014, there have been 601 confirmed cases of measles in the United States. In 98 percent of those cases, unvaccinated people were exposed to someone who had measles.

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