Most recent measles virus cases in the US have been caused by travellers importing the virus, with subsequent domestic spread. The authors were interested in whether increasing the uptake of measles-mumps-rubella (MMR) vaccination among departing US travellers could reduce this clinical impact and cost of measles in the US. They developed a decision tree to evaluate MMR vaccination at a pre-travel health encounter and compared this with no encounter. “Riskexposure” to measles while traveling was quantified, together with the average number of US-acquired cases and contacts due to an imported measles case. The authors found that the no encounter strategy could lead to 22 importations and 66 subsequent US-acquired measles cases, costing $14.8 million per 10 million international travellers. The pre-travel encounter strategy would lead to 15 importations and 35 US-acquired cases but cost $190.3 million per 10 million international travellers. Therefore the pre-travel encounter is not cost-effective for all international travellers (ICER $4.6 million/measles case averted) but may be better value (ICER <$100,000/measles case averted) or be cost-saving for travellers to “hotspots,” particularly if they were unvaccinated or returning to US communities with heterogeneous MMR coverage. Therefore a pre-travel health encounter that improves MMR vaccination among US international travellers could reduce measles cases but is costly.
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