Cases of measles continue to be reported around the world as outbreaks spread quickly. According to the World Health Organization (WHO), in the first six months of 2019, reported measles cases are the highest they’ve been since 2006, with close to 90,000 cases in the WHO European region. To date, there have been almost three times as many cases reported in 2019 as there were at this same time last year. The United States recorded 10 new measles cases the week of August 5, taking the total cases for the year to 1,182 — and the highest count in 25 years.
Because of some of its unique properties, it’s impossible to know if you’ve been exposed, says Kevin Sullivan, SVP Operations of Patronus Medical. Measles spreads very easily and lives in the nasal and throat secretions of an infected person. These contaminated droplets can enter the environment when that person talks, coughs, or sneezes, the MedAire medical team says. If a healthy person inhales them, they can get sick.
When these droplets are deposited on objects and surfaces, they can live there and in the air for several hours after the infected person leaves. If you touch a contaminated surface and then your eyes/nose/mouth, you can introduce the virus into your body. Ninety percent of unvaccinated people who come into contact with an infected person will become infected themselves, and it’s contagious for four days before a person begins showing any symptoms, and for four to six days after they disappear. Less than three percent of vaccinated people will be infected after contact and their infections will be shorter and less severe.
Although many associate the virus with a characteristic rash, the rash is a late-stage development that not everyone gets, Sullivan says. It is characterized by a high fever, malaise, cough, sinus swelling/pressure, and conjunctivitis. Measles can also cause swelling in the ear canals, pneumonia, bronchitis, and swelling of the vocal cords, and diarrhea. One out of 1,000 people will develop acute encephalitis (swelling in the brain) that results in permanent brain damage, and three in 1,000 will die from neurologic and/or respiratory complications.
Before visiting areas with reported outbreaks, the MedAire medical team suggests you make sure you’re fully vaccinated or otherwise protected against measles. It can be effectively prevented by vaccination, which many countries routinely administer during childhood, and two doses will provide most people with life-long immunity (97 percent prevention). The vaccination also protects against other highly contagious viruses, like the chickenpox. For adults who only received a single dose, a doctor can test whether or not you are still immune with a simple blood test, Sullivan says. And if the results show no or low immunity, you can get vaccinated again and it’s perfectly safe. They noted that people who have had measles are immune and don’t need a vaccination.
To stay vigilant against measles, wash your hands often, and when soap and water isn’t available, use hand sanitizer that contains at least 60 percent alcohol. Although you should avoid touching your face, if you need to, make sure your hands are clean and cover your mouth and nose with a tissue or your sleeve when coughing or sneezing. Try to avoid close contact with people who are sick, such as kissing, hugging, or sharing eating utensils or cups.
For those responsible for crew health, the MedAire medical team recommends distributing measles awareness materials (example here), offering vaccinations, and developing a response plan should a case of measles be identified amongst the crew.
Patronus recommends for crewmembers to utilize occupational health standards, which call for everyone to be vaccinated, and if someone is not vaccinated or can’t produce vaccination records, have them tested for immunity or get them vaccinated/revaccinated. For guests, they recommend offering them the opportunity to fill out a medical profile that includes vaccination history and use it as a risk-screening tool. Dr. Rob Darling of Patronus often reviews the medical profiles with the crew’s lead medical person and consults about outbreak locations and other places to avoid given the medical profiles of the guests.
The most important thing for a captain to keep in mind is that he or she should ensure that the crew is protected and will be able to care for the vessel and guests in the event of an outbreak. If the crew is vaccinated, then the outbreak will be limited to the guests only.
While there is no particular treatment, symptoms can be managed with over-the-counter preparations, good nutrition, and adequate fluid intake. Antibiotics are required if there are bacterial complications, and sick people should be isolated from non-immune people and shouldn’t go out in public until at least four days after their rash disappears.
If you’re unsure about your immunity and may have been exposed or develop symptoms, seek medical attention. But be sure to call before visiting in person so the staff can protect themselves and other patients from the contagious virus. The MedAire medical team advises keeping young children and other not immune people away from outbreak areas. With a decline in vaccinations over the last 10 years, spreading has increased, but no matter the destination, Sullivan’s advice remains the same: Get vaccinated!
Photo: World Health Organization
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