Hey Gen X and Millennial Travelers: You May Need Another Measles Vaccine

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Lisa Winston is an epidemiologist at San Francisco General Hospital. She has a shelf of stuffed microbes in her office - she holds the stuffed measles virus. (April Dembosky/KQED)

Destination: Bulgaria. A tiny country in Eastern Europe typically overlooked by American tourists. But my husband’s father grew up in Bulgaria, so it’s long been on our travel list.

It’s also on the list of countries with measles outbreaks. Bulgaria has had almost 800 cases this year, according to the World Health Organization.

In California, four of the five outbreaks that occurred in the state this year were linked to international travel. Most travelers were infected in the Philippines or Ukraine, which are experiencing severe outbreaks, and 37% of cases were imported from Europe overall. New measles infections continue to be reported, with California now at 65 cases as of Aug. 14.

More on measles

Measles is highly contagious. If someone who’s sick visits a popular tourist site and coughs, or rides the subway and sneezes, the virus can live in the air for two hours after they leave. If people who are unvaccinated pass through the same place, 90% of them will get sick.

That’s why my travel nurse wanted to check on my vaccination status before I left for Bulgaria. This is routine for Gen Xers and Millennials born in the '70s and '80s because when the measles, mumps, rubella vaccine (MMR) was first introduced in 1971, scientists recommended just one dose. But over the years, they noticed some kids still got measles. It wasn’t until 1989 that they changed the guidelines to two doses.

But a lot of people, like me, who are now in their 30s and 40s, aren’t sure if they ever got the second dose.

So my travel nurse recommended I go to the lab to get a blood test to check my immunity. It’s a basic test that looks for antibodies to measles and should come back positive or negative, yes or no.

But my results came back “borderline.” In other words, maybe I’m immune, maybe I’m not.

“The blood test is imperfect,” said Dr. Art Reingold, a professor of epidemiology at UC Berkeley. “If you have antibodies, then we're pretty certain you're immune. But if you don't have antibodies you may still be immune, but your antibodies are not detectable by the test.”

So it’s possible I got a false negative. But there’s no way to know for sure.

“I know a lot of people who would say that's a good reason not to do testing,” Reingold said with a laugh. “Because you get these results, you don’t know how to interpret them, people worry.”

So now what? My doctor suggested getting another dose of measles vaccine. It’s safe. But when I look into it, it turns out, there are some side effects in adults that don’t occur in babies: 25% of women and teenage girls get acute arthritis one to three weeks after getting the vaccine.

That would be right in the middle of my trip, right when my husband and I are due to arrive at Bulgaria’s Black Sea Coast.

I imagined lying on the beach, meditating on the rolling waves — wracked with joint pain.

“That would suck,” I said to my husband, when we talked it through.

“Yeah,” he replied. “But wouldn’t it be more of a bummer to get measles?”

So I went back to the experts. This time I spoke with Dr. Lisa Winston, an epidemiologist at San Francisco General Hospital.

“I can fully appreciate getting measles is not something you want,” she said.

She tells me not to worry about the acute arthritis, which really means sudden onset and short lived. And she says the joint pain is typically mild, nothing a couple ibuprofen wouldn’t take care of.

On top of that, the side effect is caused by the rubella part of the measles, mumps, rubella vaccine, and rarely occurs in women who have had one dose of MMR already.

“I would say that if the choice is between ‘I'm a little worried that I may get this arthritis or some joint pain,’ versus ‘I'm going someplace where I'm really going to be at risk for measles,’ the balance would swing towards being vaccinated for sure,” Winston said.

But before I went through the trouble of another medical visit, I wanted to make sure I really needed it. My mom was a nurse, and she kept my pediatric vaccine records. Squeezed in the margin, scrawled in black pen, it says that I got a second dose of the vaccine when I was 11. But the handwriting is hard to read and it looks so ... unofficial. This is why I got the blood test.

Winston tells me, in general, medical records are more reliable than the blood test.

“For somebody who knows that they have been vaccinated, who has their history, you would actually be considered immune regardless of what your blood test shows,” she said.

Bottom line, if you’re not sure what your vaccination status is and you’re traveling to a country with a known measles outbreak, there’s no harm getting a second dose of vaccine. But if you know you’ve had two doses, there’s no benefit to getting a third.

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