A trip to The Magic Kingdom, otherwise known as the "Happiest Place on Earth," may get you more than you bargained for. A measles outbreak has been reported in recent weeks at Disneyland and Disney's California Adventure theme parks. The outbreak has expanded to at least 59 confirmed cases of the disease in patients ranging from seven months to 70 years of age. Of the 59 cases, 42 had visited one of the California Disney parks since mid-December to early January. Since Disney attracts visitors from far and wide, the disease has now spread to Utah, Washington, Colorado, Oregon, and Mexico.

California state officials have confirmed vaccination status for 34 of these cases: 28 had never been vaccinated, one was partially vaccinated, and five were fully vaccinated. Of the 28 unvaccinated, six were too young since the first dose of the MMR (measles, mumps, and rubella) vaccine begins at 12 to 15 months of age. The second dose is given between the ages of four and six.

Prior to 1991, only one dose was given, but it is believed the second dose provides increased immunity. Persons born before 1957 are considered immune since measles was so widespread before introduction of the vaccine, but the age distribution of these most recent cases appears to show otherwise. If you are uncertain of your vaccination status or if you plan on visiting public places like theme parks, airports, or international travel, getting immunized to protect your health is encouraged.

Measles is a completely preventable disease and it has been eliminated in the U.S. since 2000. The vaccine has been in use since 1963; however, measles still exists in other areas of the world, and travelers can still spread the disease.

Persons infected with the virus can be infectious for nine days. Symptoms typically include: high fever, cough, runny nose, red (pink) eyes and, within a few days, a rash appears on the neck and face and spreads to the rest of the body. Measles is airborne and highly infectious; it can spread by droplets from coughs and sneezes often before the person realizes they are sick. Viral particles in these droplets can remain viable in the air and on environmental surfaces for up to two hours.

In recent years, it has become popular in some pockets of the U.S. population, especially in California, to delay or avoid vaccinating children using the "personal belief exemption." The consequence of this is an increased risk of outbreaks. As a result, California instituted a new state law beginning in the 2014-2015 school season that required parents who opt out to meet with a care provider to discuss vaccines and preventable illness. Unvaccinated children are vulnerable to infection by highly communicable diseases, and they pose a threat to themselves and the greater population. As a result of the new state law, California opt out rates began to decline this year.

Measles is not a trivial illness. There can be serious and devastating health consequences, including pneumonia, encephalitis, and death. From 1989-1991, a measles outbreak ravaged California and other states in the U.S., resulting in 17,000 cases and 70 deaths. In addition, the disease has made a comeback in recent years due to a large increase in cases abroad. In 2014, there were over 600 cases of the disease in the U.S., mostly in pockets of unvaccinated children. The change in the vaccine opt out rate may be too late to make a difference this year, but it's hopeful the silver lining from this most recent outbreak may be an eye-opener to the benefits of vaccination.

by Kerry Pierce, MS, RM(NRCM)