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Friday Jun 06, 2014

Measles and Mumps and MERS, Oh my…

It's not hard for me to remember that it's that time of the year again because my daughters are frequently singing Olaf's song from the Disney movie "Frozen." "When life gets rough, I like to hold on to my dream, of relaxing in the summer sun, just lettin' off steam … in summer."

My family is heading to Hawaii for our summer vacation, and we won't be alone. After a harsh winter in many parts of the country, a busy summer travel season is expected. The American Automobile Association (AAA) estimated that nearly 32 million Americans traveled at least 50 miles by automobile during the Memorial Day holiday alone, and another 2.6 million traveled by plane. It marked the second-highest travel volume for the holiday in more than a decade.


Airlines for America, an industry lobbying organization, projects summer air travel will rise to its highest level in six years. Roughly 210 million passengers are expected to fly U.S.-based airlines from June through August, including a record 30 million passengers traveling internationally on U.S. carriers.

With that summer fun comes some potential risks. Measles remains common in many parts of the world, including areas of Europe, Africa, Asia and the Pacific. For example, the Philippines had more than 31,000 suspected cases of the disease (and 70 deaths) through May 20 of this year.

In an average year, only about 60 cases of measles are reported in the United States. Unfortunately, international travelers are bringing home more than just souvenir T-shirts. This year, the United States has had more than 300 cases of measles -- including 15 outbreaks covering 18 states -- reported since Jan. 1. That's the highest total since public health officials declared the disease eliminated here in 2000. According to the CDC, the vast majority of reported cases (97 percent) have been associated with either foreign visitors or U.S. travelers returning home from international trips.

Meanwhile, the CDC also reports that from Jan. 1 to May 2, 464 cases of mumps have been reported. That total already is higher than all the mumps cases reported last year.

Although nearly half of the measles importations have been linked to the Philippines, other cases imported into the United States have been associated with travel to other countries in Southeast Asia, Europe and what the World Health Organization refers to as the Western Pacific region and the Eastern Mediterranean region.

Measles isn't the only health issue for travelers and their physicians to think about. With new reports of infection caused by the novel Middle East respiratory syndrome coronavirus (MERS-CoV), many of my patients are now concerned about what they otherwise would have thought of as simply a mild cough or seasonal allergies. I, too, have found myself being more diligent in asking about travel history when confronted with patients who present with fever or upper respiratory symptoms.

Although few of us may remember seeing -- much less treating -- measles, even fewer have experience managing suspected cases of MERS-CoV infection. I remember the hypervigilance of our health care community in 2003 after the World Health Organization issued a global alert regarding the severe acute respiratory syndrome (SARS) outbreak, how we masked every patient who presented with cough, how there was a run on local pharmacy supplies of N-95 masks, and how every traveler returning from Asia was screened via infrared cameras on their entry into the United States.

The general public may be lulled into a false sense of security when infectious diseases such as measles, smallpox or polio are eliminated domestically or when a particular outbreak "dies out," as SARS did. It is our responsibility as trusted physicians to remain vigilant about global trends in communicable diseases and outbreaks. It is our role as patient advocates to ensure that our patients are protected from preventable illnesses in this global community. And it is our role as public health defenders to convince those who are reluctant to get vaccinated that it really is in their own best interests -- and the best interests of those around them -- to do so.

But one of the most difficult challenges in my daily practice is to know what advice to give when patients travel to locales unfamiliar to me. So when I ask my patients' their about summer travel plans, I breathe a sigh of relief if they mention some place like Japan or Cancun. But how about a honeymoon trip to Tahiti, the annual Hajj pilgrimage to Mecca, or a medical mission to Haiti?

Well, I recommend a quick search on the CDC's Travelers' Health Web page, which provides the latest information and advisories about communicable disease outbreaks around the world. It also has information -- searchable by country -- for both clinicians and lay travelers about vaccination requirements and other recommendations. You also can find travel tips for patients heading abroad (including the fact that they should be vaccinated at least six weeks before leaving home) on FamilyDoctor.org

Armed with these invaluable resources, I can confidently advise my patients and protect my community from the latest outbreak of polio in Syria, dengue in Brazil and Ebola in Liberia.

So, when you see your patients this summer, don't forget to ask them about their travel plans.

Jack Chou, M.D., is a member of the AAFP Board of Directors.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.