October 2018 ACIP Meeting - Adult & Child/Adolescent Immunization schedule
Adult Travelers Bypass MMR, Hep A Shots
Data indicate U.S. residents skip out on pre-travel vaccination.
By Sarah Wickline, MedPage Today
Medically Reviewed by Robert Jasmer, MD
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U.S. adults who traveled abroad generally skipped vaccinations for measles, mumps, and rubella (MMR) and hepatitis A, researchers reported here.
In one study, a hepatitis A outbreak at a handful of resorts in Tulum, Mexico, commonly known as the "Mayan Riviera," infected 29 U.S. residents who had not been vaccinated according to recommendations, stated Monique Aaron-Foster, MD, MPH, of the CDC in Atlanta, and colleagues.
In the second study, 18 percent of U.S. adult travelers who presented at travel clinics merited MMR vaccination, but fewer than half of them were vaccinated at the pre-travel consultation, according to Emily Hyle, MD, of Massachusetts General Hospital (MGH) in Boston, and colleagues.
Both studies were presented at IDWeek -- the joint meeting of the Infectious Diseases Society of America (IDSA), the HIV Medicine Association (HIVMA), the Society for Healthcare Epidemiology of America (SHEA), and the Pediatric Infectious Diseases Society (PIDS).
Hepatitis A Shots
"The most common risk factor for hepatitis A is travel, and previous studies have shown that only 13 percent of travelers have completed their [hepatitis A] vaccination prior to departure," Aaron-Foster said.
Her group conducted their study after receiving reports from multiple state health departments about acute hepatitis A presenting in patients who had recently traveled to Tulum.
A total of 29 cases of acute hepatitis A were identified among patients, who were from 12 different states. All of the patients were infected from Jan. 5, 2015 through March 20, 2015, and 17 of the patients had traveled to one of nine resorts within a 6 km (about 3.7 miles) radius in Tulum.
The patients had a median age of 34 and 50 percent were female; all were non-Hispanic white. The onset of illness occurred from Feb. 12, 2015 to April 16, 2015, and lasted an average of 27 days (range 20-41) after departure from Mexico.
Among the travelers, 23 reported eating seafood, with 18 of those 23 reporting that they'd eaten ceviche, a raw seafood dish cured in lime juice. Ten of the cases said they'd eaten seafood at one of the restaurants associated with the resort, and three had eaten at nonresort restaurants.
None of the patients had been vaccinated against hepatitis A prior to travel.
"The CDC has recommended susceptible people get vaccinated since 1996," Foster said. "And recommend post-exposure prophylaxis of any household contacts to limit the further spread of the disease."
The authors concluded that "adherence to long-standing recommendations for hepatitis A vaccination of travelers to countries endemic for hepatitis A would have prevented this outbreak."
They also urged clinicians to remind patients that "the risk for infection is incurred through consumption of contaminated drinking water and uncooked foods, including condiments made with fresh ingredients, particularly raw fruits, vegetables, and shellfish."
Hyle's group looked at data from , which is a national network of travel clinics across the U.S., coordinated by MGH and supported by the CDC.
"More than 50 percent of measles outbreaks in the U.S. are from U.S. travelers who've been traveling outside the U.S.," Hyle pointed out.
RELATED: 10 Essential Facts About Measles
The authors were interested in pre-travel consultation data regarding itineraries and vaccination histories from 24 TravelEpiNet sites from 2009-2014.
A history of two rounds of MMR vaccinations, or self-reported measles illness, were defined as immunized, meaning a single dose was classified as "not protected."
Among the 40,817 adult travelers who were born in 1957 or after, 7,181 (18 percent) were not protected against measles, but only 44 percent chose to receive the vaccine prior to travel.
Among those who did not get the measles vaccine, 52 percent were linked to providers deeming the vaccination as "not indicated" for the travel location, or they referred the patient to their primary care provider. The other 48 percent of refusals were due to patients who said they were "not concerned about illness."
TravEpiNet data relied on self-report for vaccines, meaning the rates of vaccine protection could have been lower than reported.
"Many adults think of measles as a childhood illness, they don't think they're at risk, but the truth is that transmission continues to occur in a number of countries around the world, and I'm not just talking about under-resourced countries ... let's not forget [the measles outbreak in] California," commented Susan McLellan, MD, MPH, of Tulane University in New Orleans, who moderated the IDWeek panel where the studies were presented.
"The world of travel medicine, and the amount of expertise and knowledge that we have, is much greater than it was even 20 or 30 years ago, and not every doctor can keep up with that," McLellan toldMedPage Today, adding that it was worthwhile for all clinicians to refer patients who are venturing outside the U.S. to travel clinics.
Foster and co-authors disclosed no relevant relationships with industry.
Hyle and co-authors disclosed no relevant relationships with industry.
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