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One More Source of Air-Travel Stress: Catching the Measles

It’s pretty much a given at this point that no one enjoys air travel. The indignity of the security line. The battle for an overhead bin. The anxiety of recognizing you’re in a middle seat, and the agony of wondering whether that wailing toddler headed down the aisle is going to end up next to you.

To that long list of stressors, add another: You might catch measles. And you don’t even have to enter the tight quarters of an airplane cabin to be vulnerable. For the second time in two years, the Centers for Disease Control and Prevention has confirmed that someone caught the measles by walking past an infected person in an airport.

Last week, in its bulletin the Morbidity and Mortality Weekly Report (really, it’s called that; great title, no?), the CDC said that a toddler traveling from India gave a Minneapolis man the disease when the two passed each other in a Chicago airport gate in April. The man was getting off a flight; the toddler and family were waiting to board the same aircraft after it was emptied and cleaned. There was no direct contact between the two, but there didn’t have to be: virus-laden droplets of moisture breathed out by a measles victim can hang in the air for up to two hours, long after the infected person has gone somewhere else.

The child who had been in India (the CDC isn’t explicit—probably to avoid identifying the family—whether the child was from the country or just visiting) had had only one of the two recommended doses of measles vaccine, and broke out in the characteristic rash, plus a fever, during the long India-Chicago leg of the family’s trip. With the help of the airlines and several state health departments, the CDC tracked down all the other passengers on both flights, and found no other cases. Everyone was fully vaccinated, and thus protected against the disease.

Except the man at the gate. He apparently was not vaccinated, and he developed a rash and fever two weeks later while on a business trip to  Massachusetts. The health department there put him into hospital isolation, and helped the CDC confirm that the molecular signature of the virus from both the man and the child were identical. In that brief moment of walking through the gate, the toddler had infected him.

It seems like a random coincidence—but this isn’t the first time it has happened. In January 2014, four people were infected with measles by passing through an airport gate in California. In that case, the cluster’s “patient zero” was never found. But the timing of the cases, plus molecular analysis, confirmed that all four of the known victims were infected at the same time, and did not pass the disease to each other. In that case, the virus came from the Philippines, and just as in the new episode, the people who caught the disease in California went on to carry it to other states: this time, New York, Wisconsin and Texas.

There are several things in these episodes worth unpacking. The first is how very contagious measles is; we tend to think of disease transmission as something that requires close proximity or bodily contact, but not being on the other side of a room. The second is how quickly a disease can be transported cross-country, and how rapidly chains of transmission get very complicated. From the CDC’s analysis of the 2014 episode:

…all four patients were linked to the same terminal gate during a 4-hour period on January 17, 2014. Patient 1, an unvaccinated man aged 21 years with rash onset February 1, traveled on two domestic flights on January 17 and 18 that connected at the international airport. Patient 2, an unvaccinated man aged 49 years with rash onset February 1, traveled from the airport on January 17. Patient 3, an unvaccinated man aged 19 years with rash onset January 30, traveled domestically with at least a 4-hour layover at the airport on January 17. Patient 4, an unvaccinated man aged 63 years with rash onset February 5, traveled on a flight to the airport on January 17.

Patients 1 and 2 traveled on the same flight from the airport and were seated one row apart; both spent time at the departure gate before the flight. Patient 3, whose flight departed after the flight of patients 1 and 2, also reported spending time at this gate area during the time that patients 1 and 2 were present. Patient 4 passed through the same domestic gate around the time the other three patients were waiting to depart.

The third is that we can be vulnerable to disease when we least expect it. Measles still flourishes in some developing countries, as well as in some parts of Europe; if you plan on international travel, you might expect that hazard. We mostly don’t think of random disease transmission as a risk within the US, but we should: The people in both these episodes were infected at domestic airport gates, not international ones. (The 111 adults and children infected with measles at Disneyland last year probably didn’t expect to run that risk either.)

And the final thing, of course, is that this is why we get vaccinated: not just to guard against the risks we can anticipate, but also to protect us against the ones we can’t. All the people infected in these accidental encounters either declined measles vaccination themselves, or had that decision made for them by family members. Because they forewent that safe, routine, long-established protection, they contracted a potentially perilous disease, and they put others—who were so far from the original case they had no idea of the danger—at risk.

3 thoughts on “One More Source of Air-Travel Stress: Catching the Measles

  1. Measles and other vaccine-preventable infectious diseases can be devastating. For those who think that measles is fine to get “naturally”, ask the parent of a child who has developed debilitating, deadly effects. Anyone thinking they shouldn’t get their own child vaccinated should look up http://www.ninds.nih.gov/disorders/subacute_panencephalitis/subacute_panencephalitis.htm Measles pneumonia can be fatal, and is too often a cause of death, especially in countries where children have poor nutrition.
    The right of individuals not be be vaccinated should not trump the right of other parents to have their children protected from vacccine-preventable diseases and death.
    It is time for our theme parks and resorts to come together and establish policies requiring visitors to at least verbally confirm that they, and their children, unless medically exempted – e.g. due to documented allergic reactions – are vaccinated against measles, mumps and rubella (MMR) before being eligible to purchase tickets, enter and interact with other patrons.
    Before anyone lets visitors into the hospital room of a child the visitors should be required to attest that they have been vaccinated against MMR, lest they endanger the child, and others throughout the hospital.
    We, as a society, should have the routine expectation, and even require that, when holding a birthday party for a child, that every visitor, and child attending is vaccinated.
    Is this potentially harsh?
    Consider how harsh the impact of measles causing severe, lifelong, progressive debilitation, or death of a child, a child who is dying because of the intentional decision of an adult not to have their own child vaccinated.
    Thank you Ms. McKenna for another fine article.
    NavyDoc gxv6remote@yahoo.com

    MM: Thanks very much for the insight from the medical front lines!

  2. I agree with NavyDoc that proof of vaccination for both children and adults should be required in public places, except if it is medically dangerous. If I had a young child, I would require their birthday party guests, play date friends, etc. to be vaccinated.
    I think that the reason many people still cling to the idea that the MMR causes autism, in the face of scientific evidence to the contrary, is that autism is so overwhelming. The feeling of helplessness it causes leads parents to grasp at any straw they can to explain their child’s autism or to prevent it in their other children. Perhaps educational programs that help parents understand the consequences of not vaccinating could also provide support as well as constructive means of addressing the problem.

    MM: I appreciate your compassion for the parents of autistic kids, who must indeed be hungry for explanations.

  3. One element left out of the vaccination debate is the issue of how soon and how often infants are required to be vaccinated. It’s not just the vaccinations themselves that might cause problems but challenging brand new bodies who are already working hard to thrive outside the womb, with infections of their immune systems is problematic. Quote: ” Between 1970 and 1974, 37 infant death occurred after DPT vaccination in Japan; because of this the doctors in one prefecture boycotted vaccination (Iwasa et al. 1985 and Noble et al. 1987). Consequently, the Japanese Government first stopped DPT vaccination for 2 months in 1975, and, when vaccination was resumed, the vaccination age was lifted to 2 years. Interestingly, not only the entity of sudden death disappeared from vaccine injury compensation claims (only 2 deaths were subject of vaccine injury compensation claims in the 2-year olds compared with 37 in younger children), but the the overall infant mortality has improved: Japan zoomed from 17th to first place in infant mortality in the world. This means that Japan moved from a very high bracket to the lowest infant mortality rate in the world (Jenny Scott 1991)….The same thing happened in England after 1 July 1975 when thanks to the first media reports of brain damage linked to vaccination, parents stopped vaccinating: the compliance fell down to 30% or even 10% in some areas. As unwittingly documented by McFarlane (1982), the overall infant mortality rate plummeted.” http://www.whale.to/vaccines/scheibner1.html I’d like to see this issue discussed in the debates. There’s more to it than to vaccinate or not. I know anecdotally with my own son.

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