MMR Vaccination Before Travel Can Reduce Measles Importation Risk

Though costly on a large scale, administering the measles-mumps-rubella (MMR) vaccination at pretravel health encounters to individuals traveling abroad could lower the number of US measles cases, according to a new analysis.

To determine the clinical impact—as well as associated costs—of improving the measles vaccination rate among US travelers, the researchers designed a decision tree. Using this model, they measured the risk for measles exposure while traveling, as well as the average number of US-acquired cases and contacts due to a measles importation. 

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These measurements were projected for 2 strategies: one included a pretravel health encounter before traveling and one did not. At the pretravel health encounter, the individual would be assessed for baseline MMR vaccination status and, if eligible, vaccinated against MMR.

The researchers used data from Global TravEpiNet (2009 to 2014) as well as from the Centers for Disease Control and Prevention measles surveillance. In all, data on 10 million US international travelers were included. 

“The no-encounter strategy projected 22 imported and 66 US-acquired measles cases, costing $14.8 million per 10 million travelers,” the study authors wrote. “The pretravel health encounter strategy projected 15 imported and 35 US-acquired cases at $190.3 million per 10 million travelers.”

While the researchers determined that a pretravel health encounter strategy was not cost effective for all international travelers, the analysis showed that some individuals would gain more value from the strategy. 

“The best value is for travelers with a high likelihood of measles exposure, especially if the travelers are previously unvaccinated or will return to US communities with heterogeneous MMR coverage,” the researchers concluded.

—Colleen Murphy

Reference:

Hyle EP, Fields NF, Fiebelkorn AP, et al. The clinical impact and cost-effectiveness of measles-mumps-rubella vaccination to prevent measles importations among international travelers from the United States. Clin Infect Dis. 2019;69(2):306-315. doi:10.1093/cid/ciy861.