The role of travel in measles outbreaks in Australia – An enhanced surveillance study

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The role of travel in measles outbreaks in Australia – An enhanced surveillance study

• C.R. MacIntyre  
• S. Karki 
• M. Sheikh 
• N. Zwar 
• A.E. Heywood

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doi:10.1016/j.vaccine.2016.07.023

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  Open Access

Highlights

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Importation of measles is a continuing threat to disease control in Australia.

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The most frequent age group notified with measles were older children and teenagers.

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Over half of all measles cases occurred in Migrants and VFR travellers.

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Cases of measles occurred in children of vaccine objectors.

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Young adults and migrants should be a high priority for preventive strategies.

Abstract

Many developed countries like Australia maintain a high population level immunity against measles however there remains a risk of acquisition of measles in non-immune travellers and subsequent importation into Australia leading to localised outbreaks. In this study we estimate the incidence of measles and describe characteristics including immunisation and pre-travel health seeking behaviour of notified cases of measles in New South Wales and Victoria Australia between February 2013 and January 2014. Cases were followed up by telephone interview using a questionnaire to collect information of demographic and travel characteristics. In NSW the incidence was highest in age group 0–9 years (20/million population) whereas in Victoria the highest incidence was observed in 10–19 (23/million population) years group. Out of 44 cases interviewed 25 (56.8%) had history of travel outside of Australia during or immediately prior to the onset of measles. Holiday (60%) was the main reason for travel with 44% (11/25) reporting visiting friends and relatives (VFR) during the trip. The major reason described for not seeking prior medical advice before travel were “no perceived risk of diseases” (41%) and “previous overseas travel without any problem” (41%). Of the 25 measles cases with recent overseas travel during the incubation period one reported a measles vaccine prior to their recent trip. Four cases were children of parents who refused vaccination. Twenty out of 25 (80.0%) had attended mass gathering events. Young adults and VFR travellers should be a high priority for preventive strategies in order to maintain measles elimination status.