(HealthDay)—More than half of eligible Americans traveling abroad don't get a measles vaccine, and a key reason is lack of concern about the disease, according to a study published online May 16 in the Annals of Internal Medicine.

Emily Hyle, M.D., of Massachusetts General Hospital in Boston, and colleagues looked at 40,810 U.S. adults born after 1956 who were seen at pre-travel clinics from 2009 through 2014. Of those, 84 percent were immune to , primarily due to vaccinations. Of the remaining vaccine-eligible travelers, 53 percent were not vaccinated during their clinic visit. In 48 percent of those cases, the patients refused the vaccine. In 28 percent, did not suggest vaccination, and in 24 percent of the cases, the traveler was referred elsewhere.

Among those who refused the measles, mumps, rubella (MMR) vaccine, 74 percent were not worried about measles, 20 percent were concerned about , and 6 percent had issues with the cost, according to the researchers.

"We can definitely improve how often providers specializing in pre-travel medical advice offer MMR vaccine to eligible travelers, and encourage clear discussions with patients about the risks of contracting measles and of spreading the disease after their return to the U.S.," Hyle said in a hospital news release. "Since more than 60 percent of the measles importations into the country are due to returning U.S. travelers, increasing the number of travelers who are immune to measles will reduce the number of measles cases."