In 2000, the United States declared measles to be eliminated in the nation—which is defined as the absence of continuous disease transmission for 12 months or more. However, a few large outbreaks in populations with lower vaccination rates are leading to a resurgence of the contagious disease. As of 10 June 2019, there have been 1,022 confirmed individual cases of measles in the United States, a dramatic increase from the 372 cases in all of 2018.
According to data from the U.S. Centers for Disease Control and Prevention (CDC), measles is primarily brought back into the United States from other countries, such as Israel, where a large outbreak is occurring. In 2018, at least 82 people brought measles to the United States, resulting in 17 outbreaks. Recent outbreaks have also been spread within communities with pockets of unvaccinated people.
Measles is a highly contagious viral disease, with symptoms appearing 10–12 days after infection. While global measles deaths have decreased by 84 percent in recent years (89,780 deaths in 2016, compared to 550,100 in 2000), according to the World Health Organization, the disease is still common in many developing countries, especially in parts of Africa and Asia.
“Measles has always been a problem internationally,” says Gary Brunette, MD, chief of the Travelers’ Health Branch of the CDC. “Even in Western Europe, there have been outbreaks going on for the past decades. They don’t have as high an immunization rate as we do.” In order for measles outbreaks to remain contained, vaccination rates need to be near 90 percent, Brunette says.
“The best protection against measles is vaccination,” he adds. He urges people to refrain from traveling while sick. “Don’t get on a plane. That’s a quick way of spreading whatever you’ve got.”
While business travelers primarily face the same risks as tourists or other travelers in general, they do incur some unique challenges that make safety and security a challenge to grapple with, says Brunette.
First, organizations often have a broad spectrum of business travelers and therefore a broad spectrum of risk—executives visiting large metropolises and staying in international brand hotels have a lower level of health risk compared to travelers sent to work in industrial settings in developing countries or those on mining or oil exploration projects in remote locations with limited access to medical care, Brunette says. In light of these varied risk levels, he recommends that organizations build protocols and plans for before, during, and after travel.
Before business travel, employees should be up to date on routine immunizations (measles, annual flu shot) and any travel-related immunizations specific to the destination (rabies, yellow fever, polio). Travelers should be seen by a healthcare provider or in-organization travel specialist for a consultation. The provider should assess risk based on the traveler’s past medical history and the destination, provide immunizations and medications for conditions like malaria or high-altitude sickness, and give guidance on how to stay safe, Brunette says.
Another unique factor to business travel is it is often last-minute, he adds. Pre-travel consultations should ideally be four to six weeks ahead of travel to leave enough time to schedule vaccinations or collect medication, but having a consultation even days before departure could be valuable, if only to give the traveler accurate information about the risks in the destination.
Employees could get preemptive consults, however. If they are assigned to a new territory in South America and know that late-notice site visits are likely, employees could have an advance travel health consultation and get any typical vaccinations early, Brunette says.
Besides risks of disease and illness, organizations should also consider warning travelers about potential workplace and environmental risks, says Brunette. If the traveler is inspecting a factory in China, for example, he or she should know that the exposure to risk or chemical hazards will be different from those in a U.S. facility, where workplace safety regulation is more stringent.
In addition, travelers should remain alert for more common risks that are often overlooked in travel security plans and training. “Understand that perhaps the most common injuries—both minor and serious—that occur when people travel overseas are motor vehicle accidents,” says Paul Auerbach, MD, Redlich Family Professor Emeritus at the Department of Emergency Medicine at Stanford University School of Medicine. “So be very careful driving abroad. Wear your seatbelts. If you see people getting transportation by standing in the back of pickup trucks, for instance—don’t do it. The same rules that apply to safety in the United States in terms of motor vehicle accidents apply triply so when you’re overseas.”
Another good practice is for organizations to know where travelers are at any given time, even if the traveler is taking some personal time in the midst of business travel, in case of an emergency or evacuation.
During travel, employees should be regularly monitoring their health for signs of illness, such as keeping alert for fevers when in a malaria-prone region and seeking medical attention quickly. Employees’ travel plans should include identifying a trusted local healthcare provider that speaks their language; Brunette recommends contacting the local embassy for advice. Organizations or individual travelers may also want to invest in travel medical insurance and evacuation insurance—especially for remote areas or countries where they would not want to have surgery or a major medical treatment.
Auerbach adds that in addition to packing a first aid kit, accurate medical history, medications, and prescriptions, travelers should also bring healthcare reference material with them that describes the signs of illnesses common to the destination country, as well as how to avoid them. If traveling to Haiti, for example, he recommends bringing a short guide of cholera symptoms so the traveler can recognize early signs of infection and seek medical care promptly. Travelers should be able to recognize symptoms of measles in themselves and others both abroad and at home and get an extra booster shot within a few days of exposure if needed, he adds.
After travel, employees should continue to monitor their health status for signs of emerging illnesses such as measles or malaria, which can take weeks to detect.
Organizations can also apply health safety protocols to their domestic facilities. At Eldorado Resorts’ THE ROW—a group of three casinos and resorts in Reno, Nevada—close ties with the local Washoe County Health District enable resort authorities to take action to address potential pandemics or health concerns. If there is a severe flu outbreak, for example, the health department would give THE ROW advance warning about emerging cases in the area, which would trigger a response initiation, says Darrell Clifton, CPP, CSP (Certified Safety Professional), executive director of security for Eldorado Resorts, Inc. That response would involve hotter dishwashing or different soaps, cleaning surfaces more frequently, and putting out hand sanitizer stations in heavily trafficked areas.
The warning would also trigger different protocols for employees, Clifton adds. Food and beverage service standards might change—for example, setting tables only when diners arrive in order to minimize potential germ exposure. Employees would be monitored for signs of sickness when they arrive for work, and supervisors would be on the lookout for employees who may be ill. To curb employees’ temptation to power through illness and clock in as usual during an outbreak, the resorts may adjust their timecard policy so sick employees are not docked for missing work during a serious flu season.
Clifton is also partnering with the health district to make THE ROW a Point of Dispensing (POD) for the county. This POD program designates the resorts as a key location that is used to distribute medications, vaccines, or medical supplies during a public health emergency such as a disease outbreak or bioterrorism attack.
“In hospitality, we touch a lot more people than the health department would usually, so if there’s a pandemic-type outbreak, they love having us involved because we don’t only touch 4,000 employees and their families, but we can also touch anybody who’s in town,” says Clifton. “People know how to get here, we have parking, so as a hospitality venue, it’s the perfect place to serve a good portion of the city or county.” In addition, THE ROW employees and their families would jump to the front of the line to get medicine during an emergency, which brings value back to the organization. While the system has not been activated yet, Clifton participates in regular tabletop exercises and drills with the health district to prepare.
“The program is good for our brand reputation in town, and it’s good for the community,” Clifton says. “We take up a big chunk of the community, so it’s our duty to give back in that regard.”