Susan Kuhn from the Calgary GeoSentinel® site reports a travel related measles case in a 12-month old Canadian child who had spent the prior 9 months visiting friends and relatives in India. The previously-healthy 12-month-old Canadian-born girl travelled to Kolkata, India to stay with relatives for 9 months. She departed Canada in April at 3 months of age, having had her first set of routine vaccines (DTaP-IPV-Hib, pneumococcal conjugate [Pneu-C13], and rotavirus). She was seen at a local travel clinic where they discussed malaria risk and noted that she was too young for any travel vaccines. In India she received vaccines at 4 and 6 months, including hepatitis B (which is not routinely given until age 10 years in Alberta). She did not receive the measles vaccine or MMR at 9 months. She returned to Canada on January 10th via London, England. On January 21st she became ill with fever, fatigue, then cough, coryza and conjunctivitis followed by a generalized maculopapular rash on the 22nd. She was seen by her family physician who suspected measles and sent the child to the emergency department for testing on Jan 25th. The NPA was found to be positive for the virus on NAT, and serology demonstrated measles IgM positive and IgG negative. She was seen by ID on Jan 27th when the results were confirmed and the child started on vitamin A. None of her close contacts in India, principally family members, were ill prior to her departure or subsequently after she left. There have been no reported cases for many months in Calgary, so local exposure is extremely unlikely. Exposure during travel home or transit in London (about 12 – 14 days before presenting) is therefore suspected. The case underlines the importance of using the pre-travel consultation to check the status of routine vaccines. It also illustrates a pre-travel dilemma and a lack of evidence base with regard to vaccinating very young children prior to prolonged VFR travel. Some vaccination schedules allow for MMR vaccination for younger infants (aged 6 months and older) however, the infant here was just 3 months old when presenting at the pre-travel consultation.
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Susan Kuhn from the Calgary GeoSentinel® site reports a travel related measles case in a 12-month old Canadian child who had spent the prior 9 months visiting friends and relatives in India. The previously-healthy 12-month-old Canadian-born girl travelled to Kolkata, India to stay with relatives for 9 months. She departed Canada in April at 3 months of age, having had her first set of routine vaccines (DTaP-IPV-Hib, pneumococcal conjugate [Pneu-C13], and rotavirus). She was seen at a local travel clinic where they discussed malaria risk and noted that she was too young for any travel vaccines. In India she received vaccines at 4 and 6 months, including hepatitis B (which is not routinely given until age 10 years in Alberta). She did not receive the measles vaccine or MMR at 9 months. She returned to Canada on January 10th via London, England. On January 21st she became ill with fever, fatigue, then cough, coryza and conjunctivitis followed by a generalized maculopapular rash on the 22nd. She was seen by her family physician who suspected measles and sent the child to the emergency department for testing on Jan 25th. The NPA was found to be positive for the virus on NAT, and serology demonstrated measles IgM positive and IgG negative. She was seen by ID on Jan 27th when the results were confirmed and the child started on vitamin A. None of her close contacts in India, principally family members, were ill prior to her departure or subsequently after she left. There have been no reported cases for many months in Calgary, so local exposure is extremely unlikely. Exposure during travel home or transit in London (about 12 – 14 days before presenting) is therefore suspected. The case underlines the importance of using the pre-travel consultation to check the status of routine vaccines. It also illustrates a pre-travel dilemma and a lack of evidence base with regard to vaccinating very young children prior to prolonged VFR travel. Some vaccination schedules allow for MMR vaccination for younger infants (aged 6 months and older) however, the infant here was just 3 months old when presenting at the pre-travel consultation.