Unvaccinated adult, travel, and measles outbreak
November 9, 2019 11:11 AM   Subscribe

My 38-year-old partner's mum has just revealed they never vaccinated my partner against measles and whooping cough as a child. This is ahead of a holiday - with the mum- somewhere with a measles outbreak. I have a ton of questions, which include how to discuss this with their mum and where/whether to travel at all.

Partner's mum just sent an email sharing that my partner and their sibling never got vaccinated against measles and whooping cough. We had no idea my partner was not vaccinated and we both feel angry at this news. I believe that it's not morally okay to choose not to have your child vaccinated because that inaction - not getting the vaccine - risks harming other individuals. I don't want to have a discussion on the ethics of vaccination - please accept my premise and help me understand my choices within the constraint of said premise.

We may or may not manage to get vaccinated two weeks before we're meant to join the in-laws (said mum) in New Zealand.

Question One: This seems enough time given the medical advice I've come across. Is it? Or is the risk too high given the outbreak? (Yes, we're speaking with a doctor and following their advice.)

Partner might not manage to get vaccinated before the journey. To make things worse, there are people in our community including young children who are not vaccinated. In that case, it's clear to me we do NOT travel to New Zealand at all. Risking infecting other people in NZ and back here by being a vector is wrong, even if somehow the personal risk was acceptable (I don't think it is).

Question Two: Is it okay to travel somewhere else that's not having a measles outbreak?

I'm leaning towards no but I'm afraid my judgement is clouded because we work somewhere very isolated, very small and often toxic. Our break was to offer some much-needed decompression time. We both try to be the best human beings we can be under often stressful and challenging circumstances. And it's tough to stay positive if you can't get away once in a while and we won't be able to get away for another half year if we don't manage to get away during this window. But to knowingly risk harming other people is not okay. So it'd be useful to have calm, measured responses to help us make a moral choice here. I'm not asking you to give me permission to go somewhere else. I'm asking for qualified opinions on whether or not travelling somewhere else is morally permissible at all.

Question Three: How do we discuss this with partner's mum?

My approach would be to explain the facts as we know them - as neutrally as possible - and ensure that partner's sibling is aware (she has a young child too!). I think it's important to be clear on the facts and not accept any suggestion that it's okay not to vaccinate your children and that she was making a good choice, but we want to do this kindly. My partner's mum is a loving, affectionate person who thought she was being a responsible parent. It seems that she hadn't given this much thought until a recent medical check-up when her doctor informed her of the current measles outbreak in New Zealand. They're *really* looking forward to catching up with us. At the same time, I'm so angry at my in-laws - the mum for this wrapped thinking and (in)actions and for failing to inform my partner sooner - way sooner! - and the dad for enabling this. I'm livid. I don't want to vent my anger at her but I'm feeling very tired, frustrated and disappointed at this time. This was our holiday too and I'm concerned about my resilience if we don't get to go away for a few weeks. I also feel that mum can often be indulged too much but there is a cultural clash here - I'm far blunter than partner's family who value non-conflict and cohesion above all.
posted by anonymous to Travel & Transportation (29 answers total)
I’d see a doctor, and not accept crowd sourced answers. Depending on where your partner is from, she may have gotten vaccinated at school. She’s my age, and I was only given one vaccine, so they revaccinated everyone at my high school. As well, during my pregnancy my titers were checked to ensure immunity. If your partner’s sister was pregnant, she may have gotten a booster.
posted by Valancy Rachel at 11:16 AM on November 9, 2019 [9 favorites]

Mod note: Quick note, OP doesn't specify partner's gender or their own, so better to avoid making assumptions. Thanks.
posted by LobsterMitten (staff) at 11:22 AM on November 9, 2019 [4 favorites]

The New Zealand Ministry of Health advises not traveling if you have early symptoms of measles (fever, cough, runny nose, sore eyes and/or a rash).
Travelling to New Zealand

People intending to travel to New Zealand should be fully immunised for measles. If you need additional vaccination, it should be administered at least two weeks before arriving in New Zealand.

Remember, people who aren’t immune and have early symptoms of measles (fever, cough, runny nose, sore eyes and/or a rash) shouldn’t travel.
I understand that you're upset with your mother-in-law, but I worry that you're jumping to conclusions about risk that's not commensurate with facts. (I say this as an absolutely pro-vaccine person.) Definitely talk to a medical professional, and your partner should definitely do everything possible to get vaccinated as soon as possible, but I'm not sure you need to avoid all travel if your partner's not actually sick.
posted by lazuli at 11:25 AM on November 9, 2019 [14 favorites]

Here is what the CDC has to say about measles. Specifically "You should plan to be fully vaccinated at least 2 weeks before you depart." but they say 2-3 weeks is the range. Do you live somewhere the vaccine is hard to get? Around here you can walk-in get it at a drug store.

Realistically a fully vaccinated person still has a 3% chance of contracting measles, so I wouldn't make them stay home from a trip to a place without a measles outbreak especially. And I am a roll-the-dice person and would go to NZ anyhow. I realize you are having a lot of anxiety about this, is it possible some of that is because of the toxic environment you are in, needing a break, and possibly stress about travel?

How do we discuss this with partner's mum?

Don't. Talk to your partner's sibling to ensure they have good information but even though this was somewhat shocking news to you, there's not really a thing you can change about what happened in the past. Especially if your partner is someone who values non-conflict and cohesion, it would be clear that bringing this up just to be mad about it would not be a good Team Us experience. Sometimes you have to let things go if there's nothing that can be done about them in the present.
posted by jessamyn at 11:28 AM on November 9, 2019 [26 favorites]

Do not discuss this with the parent. It will not help. Those choices are water so far under the bridge.

Measles vaccine wears off for many adults. I know, because I WAS fully vaccinated as a child and had my titers checked last year. I got a two part vaccine as a result. Any adult should check their vaccine status before traveling to a place with an outbreak. Your partners status could have been the same even if they had received the vaccine as a child.

Measles vaccine is a 2 dose protocol here in the US, which means both doses must be completed to be considered vaccinated. The doses are given a month apart.

I am not qualified to address the moral concerns that you have about travel. Please each get the shots as soon as possible, for your own peace of mind.
posted by bilabial at 11:58 AM on November 9, 2019 [3 favorites]

My partner's family had a whooping cough outbreak at a family reunion several years ago, because they have such a high percentage of anti-vaxxers. A bunch of the kids got it, with few lasting ill effects, but also my sister-in-law, around age 50, got a very severe case. It took months for the severe symptoms to abate, and she still has aftereffects about 10 years later.

Sister-in-law had all her vaccinations as a child but protection does wear off with time, and that is how she became infected.

Then recently my partner was baby sitting for a family we know, and one of their kids came down with whooping cough. And my wife had spent hours wiping their noses etc just during the infectious period. So we all ran down to the doctor & got any/all vaccinations needed. *Luckily* my wife had an incident that required a tetanus shot a few months ago, and they thought to do Tdap (tetanus, diptheria, and pertussis/whooping cough) at that time instead of just Td. So she had a practically ideal immunization situation for pertussis, and the result was no whooping cough this time.

A few points:

- In both cases I was mad as a hornet at our family/friends for endangering us and their other friends/relatives by not getting vaccinated. Particularly at risk for these infectious diseases are infants, older people, and anyone not in robust health. So basically their selfish and idiotic choices had endangered the most vulnerable among all of their friends and relatives (was my thinking).

Anti-vaxxers are straining at a gnat by worrying about some bad effect that may or may not affect a very, very small proportion of the vaccinated population, or mild, transient side effects that definitely to occur.

But they're swallowing like 10 million camels by forgetting that these diseases literally killed vast percentages of the population not that many decades ago. Just in my own family history is an example of a mother who lost three children in two weeks to whooping cough. And she is far from unique in losing one or more children every time an epidemic came around.

That disease--and measles, too--are literally deadly serious matters.

My point is, I was mad as anything at the people who caused this situation and I totally understand your anger. They are threatening your family and loved ones with painful, debilitating, and even fatal illness. So you feel threatened and angry; perfectly natural.

The question, though, is what do you do now.

- After our recent whooping cough scare, we ran down literally the next day after finding this out and got all needed vaccinations sorted out. It took like a 20 minute office appointment. We went to an insta-care type clinic at a pharmacy. So, you should do the same. I personally considered it an immediate emergency type situation to get everyone immunized for pertussis (or at least, double-check to ensure that all immunizations were up to date), when one family member had been exposed.

Though it is true that it can take some time for immunizations to kick in, two weeks is enough for most. So get it done today. Don't procrastinate or think you don't have time.

Instead, think immediate medical emergency and prioritize your time and effort appropriately.

- Many vaccinations do gradually lose effectiveness over time and need (or at least, benefit from) boosters in adulthood anyway. So it might be helpful to think of it as, even if partner had received all childhood vaccinations, some of the vaccinations partner should get now are probably a wise idea at this point regardless of past immunization status. If partner didn't actually get any of the diseases up to this point, and gets the needed vaccinations now ASAP, then you all lucked out and--unlike the situations of my own idiot family and friends--there is no total actually harm in this situation (though only through luck, not good planning).

- The other top-priority vaccination your partner will need is MMR (mumps/measles/rubella). That develops immunity in 2-3 weeks so, again, getting it ASAP should be a priority. It would be better to have gotten it a good 3 weeks before traveling but the 2 weeks you actually do have is a LOT better than nothing.

They even give MMR vaccinations to people up to 72 hours after exposure and it still helps (see heading "Is there anything" here).

Also, the usual practice is to give two dosages of MMR several months apart. However, better than 90% of the benefit is from the first dosage; the second helps approx. 2-5% of people who don't develop full immunity from the first dosage. Even after two dosages your immunity isn't perfect--something like 3% of those immunized are still susceptible. So . . . the vast majority of your personal benefit comes from the first dosage.

Personally I would be 1000% more comfortable traveling to a measles outbreak area with the first MMR vaccination 2 weeks under my belt, than nothing. Yes, it might increase to 1010% or so with three weeks instead of just 2, and to 1020% with both dosages. But the vast, vast majority is still attainable if you act quickly.

- As to whether to discuss this with mum, personally I wouldn't. I can't see what good could possibly come of it. Get the vaccinations; do the right thing now. That is modelling smart & sensible behavior and actually is likely to have more of a good effect if you just do it and don't moralize, than if you do it and then get into a giant argument about it.

Also, it's worth thinking about that at least mum spoke up about this now so that you have full information. It would have been really easy for her to just keep quiet about it, and then you & partner would be in this situation but without knowing or having the opportunity you do now, which is to act immediately to massively reduce the risk.
posted by flug at 12:21 PM on November 9, 2019 [11 favorites]

I think that your partner should be the one discussing this with their parents, and you can be most effective here talking it through with your partner and being there for support. But it’s really a conversation between your partner and their parents (not just the mother but the father as well, as both are responsible) and it’s about a ton more than just the effect on the planned vacation.
posted by sallybrown at 12:23 PM on November 9, 2019 [1 favorite]

These aren’t crowdsourcing questions, they’re questions for a doctor. Ask your doctor, follow their advice. So far as taking it up with mum, why would you, the deed is done, you’d only be venting and partner is an adult now who makes their own health decisions. Mum’s responses aren’t going to affect whether partner goes forward with the trip or vaccinations, the drs advice will.

This is also not your discussion to have anyway and you’re clearly not in a calm frame of mind to have it regardless, it sounds like you want to blow your partner’s relationship with their mother out of the water. Relax. Breathe. Your partner has the medical information they need going forward and it’s a manageable situation.
posted by Jubey at 12:29 PM on November 9, 2019 [6 favorites]

wrt Q3: pretty much the only reason to bring this up with your partner's mom would be in the context of having your vacation ruined and even then it's not worth it. you can't travel back in time to make her more responsible. the only reason to worry about this in the future is if you and your partner end up having kids and feel like this will become a source of conflict with her, in which case, again, there's no point in bringing it up because it's none of her business.

i 100% get wanting to flip the fuck out on her and imo this is a flip the fuck out-worthy thing that she's done, but it won't have any kind of useful outcome for you or your partner other than the brief and fleeting satisfaction of telling a moron that they're a moron.
posted by poffin boffin at 12:33 PM on November 9, 2019 [1 favorite]

My children are about the same age as your partner. Please be aware that your partner’s mum was making decisions about vaccinations in a very different world. I did get my kids vaccinated because their doctors advised it, but the parents of that time period were often not vaccinated (I wasn’t) because the vaccine was first developed while we were children, so we often had had measles (I did) and thought of it as a normal childhood illness that was no big deal. Of course, now I know measles can be dangerous and kids should be vaccinated, but none of the many kids I personally knew who had it suffered adverse effects from the disease. There was no major anti-vaxxer movement that public health officials were countering, so she may not have thought much about it at all. So please don’t judge a decision she made decades ago based on what you know now. And definitely do not “discuss” it with her. Be glad she told you, and go from there.
posted by FencingGal at 12:35 PM on November 9, 2019 [22 favorites]

Question 3: I’m actually really impressed that she actually admitted to you that she hadn’t vaccinated. She must know it might ruin your chances of visiting her and some people might have kept it to themselves and hoped for the best. I would be kind to her for that.
posted by catspajammies at 1:10 PM on November 9, 2019 [3 favorites]

First off are you super sure you've never been vaccinated? I'm in my thirtys and I have been tested for my vaccination status multiple times and vaccinated (for example because i lose immunity to things quickly, I've had chicken pox and been vaccinated for it twice now a have had the MMR multiple times as well, and have been told i should redo my hep B and haven't gotten around to it). Some sample times are starting college, my Masters degree program, and some employment i have had.

Secondly, the sooner the better and vaccines are available in lots of locations, try and just get it done.

Do talk to your doctor about your travel recommendations.

And echoing it's not worth talking to her about.
posted by AlexiaSky at 1:23 PM on November 9, 2019

There are plenty of people who need to be re-vaccinated as adults. The vaccine is also not 100% and most people don't know if they are effectively inoculated. Just get updated like any other responsible adult would upon discovering they are not currently inoculated -- go get vaccinated.

The only thing to say to your MIL is "thank you for telling us."
posted by DarlingBri at 2:20 PM on November 9, 2019

Vaccines do not confer lifetime immunity. Even if they had been vaccinated as a child, there is a non-zero chance they would no longer be immune.
posted by Automocar at 2:54 PM on November 9, 2019 [2 favorites]

Just as a data point, I'm an adult who was vaccinated, and I also just found out recently via a blood test that I have no immunity and need an MMR. I had it, it's no big deal, and I'm immune again. This is an opportunity for your partner to protect themself and it's great that you got a heads-up, despite the thorny personal issues connected to it.
posted by BlahLaLa at 3:40 PM on November 9, 2019 [2 favorites]

Personally I'd just nip down to the pharmacy and get the MMR today. You have two weeks, you'll be fine.

All the concern about your community and moral issues seems.... overblown. I'm 42 and not American and wasn't vaccinated for measles as the vaccine wasn't available where I grew up at that time. And as noted above, many people loose immunity over time anyway and you're not shunning or lecturing people for that so leave your MIL be. She told you now when you have time to do something about it.

And your partner has been vaccinated against whooping cough, it's included with the TDAP tetanus vaccine which you presumably have been getting every 10 years as a responsible person correct? Whooping cough immunity only lasts about 10 years- which is why it's included.
posted by fshgrl at 3:52 PM on November 9, 2019 [4 favorites]

My local health authority says that a single does of MMR vaccine is 95% effective against measles, and that unvaccinated travellers (or those who don't know for sure that they have been vaccinated, which is a whole lot of us) should receive the vaccination, ideally at least 2 weeks before departure.

Also, while the increase in incidence of Measles is alarming and terrible, the absolute likelihood of exposure is still relatively low.

I can understand your concern but I don't think I would cancel travel plans under these circumstances. (I did go and get a Measles shot in April before international travel for this reason - in my case, I'm almost certain I had at least one dose in childhood, but I also have a small nephew who was at that stage too young to vaccinate).
posted by Cheese Monster at 4:43 PM on November 9, 2019

Mod note: From the OP:
Thank you for your answers. Due to very specific and unusual circumstances, we might not have access to a vaccine for months, too late to go away on a holiday. We can't physically pop in any medical centres and get vaccinated. There are currently no vaccines available - it's not a matter of choice on our behalf. A big part of our concern is the young children here whose parents have chosen not to vaccinate. We don't want to put them at risk on our return. There are also other vulnerable individuals with compromised immune systems. So - under these circumstances - we'd have to decide whether to travel or not. We'd make our choice based on our doctor's advice of course, but it'd be great to get thoughts on how to approach a conversation with the parents.

So if we can't travel, how would you discuss this with the parents-in-law who'd need to know as we'd have to cancel on them?
posted by Eyebrows McGee (staff) at 6:02 PM on November 9, 2019

I'm asking for qualified opinions on whether or not traveling somewhere else is morally permissible at all.

The worldwide measles vaccination rate stands at 85% for the first dose and 67% for the second. So there are 2 billion+ people wandering around who are effectively unvaccinated.

With those sorts of numbers it is inevitable that someone will contract measles and unknowingly spread it around. Also with those sorts of numbers, the odds of it being your partner are miniscule.

As long as you're avoiding places where measles is active I would say you're on solid ground. For measles anyway -- all of the other viruses you'll both be carrying around make up their own moral quandary.
posted by Tell Me No Lies at 6:17 PM on November 9, 2019 [2 favorites]

I wouldn't not travel based on the extremely unlikely event you might get measles and bring it home to a hypothetical un-vaccinated child or person on immune-suppressants somewhere in your community. Unless you live in a hospital for people with compromised immune systems that seems... unlikely? And other people in your community travel, presumably and are not all getting their titers done before and after. You seem to be taking on far more responsibility for this than you need to.

If you're concerned about the vaccine shortage in Australia tell your doctor or pharmacy you plan to travel to an outbreak area and are unsure of vaccine status. They are rationing the most common brands and types of vaccine, not completely out of it and there are alternative vaccines. One of the priority uses is to vaccinate travelers to hot spots.

I'm not sure how you can communicate a decisions based not to travel on what appears to be mostly anxiety about a very unlikely event in an understandable way.
posted by fshgrl at 6:25 PM on November 9, 2019 [4 favorites]

Unless your partners mum lied when asked "am I vaccinated", your partner is 38 and is therefore responsible for knowing what his vaccination status is, and has been for the past 20 years. Has it never come up before? I've been asked multiple times for all sorts of reasons. It doesn't seem worth bringing this up with his parents, apart from expressing the regret that you hadn't thought to ask earlier.
posted by kjs4 at 6:26 PM on November 9, 2019 [2 favorites]

If you're Australia, in 1993 (he was 12), there was a change from rubella only for girls to MMR boosters for all students. It's possible he was vaccinated then. It was done at school, he might remember it.
posted by kjs4 at 6:48 PM on November 9, 2019

I understand that you would prefer he was vaccinated; of course that would have been better. But it's strange to be "livid" about a marginally important choice someone made 38 years ago which has had no negative effect on you to date. Taking all of your anger on the modern collective of "antivaxxers" and delivering it onto your mother-in-law benefits nobody. Given that she isn't going to have a new sibling to your husband in the future, there is no need to bring it up at all.
posted by value of information at 7:17 PM on November 9, 2019 [4 favorites]

Another way of thinking about it: 40 years ago, she probably was told to put her newborn to sleep on their stomach rather than their back. Nowadays, we think that probably gives an infant a 1 in 10000 or so increased risk of death. That was probably more dangerous than not being vaccinated for measles. Are you livid about it?
posted by value of information at 7:23 PM on November 9, 2019

As to question 2, the risk of contracting measles somewhere that there isn't a measles outbreak is very, very small. To reduce the risk even further, you could travel somewhere that he can easily access the vaccinations he needs, get them as soon as you land, and not return to your isolated life for two weeks.
posted by kjs4 at 8:09 PM on November 9, 2019

Can you get vaccinated in New Zealand? if you're Australian or NZ, sorting it out over there might be easier. Yes, you'd be travelling unvaccinated but you don't seem to have easy access to vaccination where you are either.
posted by dorothyisunderwood at 8:28 PM on November 9, 2019

There's currently a MMR shortage here in NZ (as you can imagine) so I doubt getting one here as a traveller is an option. If you can get a serology test that would be excellent but I'm sure the doctor already brought that up.

The rate of infection has calmed down here in Auckland recently. There is a map you can look at online that shows the distribution of cases across the city. There are definitely areas that are over represented so you could choose to avoid them. You could also wear a medical-style facemask while in public, they are pretty common here now so you won't get (many) weird looks for it. Measles isn't a major concern outside of Auckland, so if you were flying out of Auckland soon after landing, you'd very likely be fine.
posted by BeeJiddy at 1:51 AM on November 10, 2019

Would self imposed quarantine after travel be an acceptable way to minimize being a vector? For measles, it's an average of 14 days from exposure to rash. May or may not be possible with other work /life conditions.

If you need to tell the inlaws, I'd do it as dispassionately as possible, and really should come from your partner, not you. A similar issue occurred recently in my family, with the partner of the unvaccinated person using words similar to yours (livid, enabling) to describe what they thought of their inlaws. In their case, it was very much an outlet for long-term simmering problems between the two families. If that's a possibility in your situation, all the more reason for the trip cancelation news to come from your partner and not you.
posted by basalganglia at 3:29 AM on November 10, 2019 [5 favorites]

Mod note: From the OP:
There's a spare vaccine arriving a couple of weeks before travel - hoorah! We're following our doctor's advice on everything else. My partner sent a quick email back to their mum thanking her for letting them know, sharing the news that luckily we'll be able to get a spare vaccine so all's good, and asking whether their sibling knows (they'll let them know directly if appropriate).

Heartfelt thanks to everyone who took the time to answer; even if the answers were sometimes hard to read. Jessamyn's kind question was on the nose: I realize you are having a lot of anxiety about this, is it possible some of that is because of the toxic environment you are in, needing a break, and possibly stress about travel?

Many times yes. Thank you for not making me feel like a monster for writing a question in a moment of anxiety. I never, ever, intended to take out my anger on my mother-in-law whom I love. I'd be upset if someone took out their anger like that to me or anyone else and I would never want to do this to anyone, let alone a member of my family. This didn't come across as clearly as I had intended in my question and so I'm grateful to those who withheld judgement. Thank you also for those who were careful not to assume genders : )
posted by restless_nomad (staff) at 12:09 PM on November 10, 2019 [10 favorites]

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