On This Page

Traveler Summary

Key Points

  • Measles, mumps, and rubella are viral infections acquired through respiratory droplets or through contact with saliva or contaminated surfaces.
  • Risk is high for travelers, especially in countries with low vaccination rates; risk for mumps is variable but remains high in many countries, including in many industrialized countries.
  • Symptoms for measles include cough, eye irritation, runny nose, spreading red rash, and white lesions in the mouth. Mumps presents with swelling of salivary glands on both sides of the face, and nonspecific symptoms. Rubella presents with a rash, generalized swollen glands, eye irritation, joint pain, and fever.
  • Consequences of measles include severe pneumonia and brain inflammation, leading to death. Mumps after puberty can cause painful swelling of the testicles. Rubella acquired during pregnancy can result in severe complications of the eyes, heart, ears, and nervous system in the baby.
  • Prevention includes practicing good handwashing and cough and sneeze etiquette.
  • All individuals 12 months and older, born in 1957 or later, without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days). All infants aged 6-11 months should receive 1 dose of MMR vaccine.
  • Vaccine side effects are most commonly fever, rash, and local reactions.
  • Duration of vaccine protection is lifelong; no booster is required.

Introduction

Measles (rubeola; red measles), mumps, and rubella (German measles) are contagious viral infections spread from person to person. Humans are the only known natural host for these viruses.

Risk Areas

Measles has been eliminated in the Americas, and the Western Pacific Region is approaching its measles elimination goal. However, large outbreaks continue to occur in Africa, Eastern Mediterranean Region, Europe (western and eastern), and Southeast Asia. In the U.S., about 50 cases are reported annually, most resulting from international travel.

Mumps occurs worldwide and remains a common disease in many parts of the world. Large outbreaks continue to occur in North America, Brazil, Australia, and New Zealand.

Rubella occurs worldwide; however, the Americas has eliminated indigenous rubella. In the U.S., rubella virus transmission in the local population has been eliminated, but imported cases occur.

Transmission

Measles, mumps, and rubella viruses are acquired through respiratory droplets or through contact with saliva or contaminated surfaces.

Risk Factors

Anyone who is not protected against measles, mumps, and rubella is at risk of infection, including travelers, regardless of destination. The risk of exposure to travelers outside the U.S. could be high, especially in countries with low vaccination rates. The risk of exposure to mumps among travelers is variable but remains high in many countries, including in many industrialized countries,

Symptoms

Measles presents with cough, eye irritation, runny nose, a red rash starting at the head and spreading to the trunk and limbs over 3 to 4 days, and white lesions in the mouth, which appear 1 to 2 days prior to the rash.

Mumps presents with swelling of salivary glands on both sides of the face that may be preceded by several days of fever, headache, weakness and fatigue, muscle aches, and loss of appetite. Mumps infection, which commonly occurs without symptoms in children (primarily school-age), can be very severe if contracted in adulthood.

Rubella usually manifests as rash, generalized swollen glands, eye irritation, joint pain, and slight fever.

Consequences of Infection

Measles can result in severe pneumonia, diarrhea, and brain inflammation, leading to death. Painful swelling of the testicles commonly occurs with mumps acquired after puberty. Rubella acquired before birth is associated with severe complications involving the eyes, heart, ears, nervous system, and blood, as well as growth disturbances.

Need for Medical Assistance

Susceptible persons who have been exposed to measles should seek medical attention. Measles, mumps, and rubella (MMR) vaccine or immune globulin may be given depending on the person’s age and the time since exposure. Treatment of measles is supportive.

Persons with symptoms of mumps or rubella should contact their medical provider. Supportive care should be given as needed. No specific treatment is available.

Prevention

Nonvaccine: Practice good handwashing and cough and sneeze etiquette.

Vaccine: MMR vaccination is the best available tool for preventing measles, mumps, and rubella and is typically started at age 12 months.

Duration of protection for measles and rubella is lifelong with 2 doses of MMR vaccine, whereas protection against mumps gradually declines.

Persons with underlying medical conditions or who have concerns about the vaccine should speak to their health care provider before vaccine administration.

Side Effects: Fever and rash are the most common side effects following MMR vaccination. Pain, redness, or rash at the injection site and swollen lymph nodes can occur. An increased risk of seizure (due to fever) exists 8 to 14 days after vaccination.

Timing: All individuals 12 months and older, born in 1957 or later (1970 or later in Canada and the U.K.; 1966 or later in Australia), without history of disease or of 2 countable doses of live vaccine at any time during their lives should complete a lifetime total of 2 doses of MMR vaccine (spaced by at least 28 days) prior to travel.

All infants aged 6-11 months should receive 1 dose of MMR vaccine prior to travel regardless of destination country or in outbreak situations. This is a noncountable dose, and the child will still need to receive 2 doses of MMR at the recommended ages at the normal times, given at least 28 days apart.

For routine childhood vaccination, the primary series consists of 2 doses, with the first dose usually given at age 12-15 months and the second dose at age 4-6 years. For international travel, the second dose may be given as early as 4 weeks after the first dose to ensure receipt of 2 doses before travel. This early second dose is countable and does not need to be repeated at age 4-6 years.

A booster dose is not recommended. In specific local mumps outbreak situations, public health authorities may recommend the administration of a booster (third) dose.