STOP Measles: Nurses on Alert

Looking through my Facebook posts the other night, I noticed our friendly local pediatrician had posted a photo of herself in the protective garb associated with examining someone with measles. It looked a little like a space suit and reminded the viewers of her site of the potential dangers associated with the current active measles cases in our country.

The outbreaks of measles around the country, particularly in the New York area and in California are alarming. “From January 1 to April 26, 2019, 704 individual cases of measles have been confirmed in 22 states. This is an increase of 78 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.” (https://www.cdc.gov/measles/cases-outbreaks.html) Mostly related to unvaccinated youngsters, this outbreak highlights with devastating clarity the problems that the unvaccinated portion of our population creates for the greater population. In 2018, the United States suffered 17 outbreaks, 3 of which were in New York State, New York City and in New Jersey. A variety of other pockets of infection accounted for the remaining cases, many related to travel abroad.

A simple rash and runny nose are now viewed with a heightened sense of caution and alert. It is striking how contagious measles is. In fact, it is hard to believe that after an infected person sneezes or coughs, the airborne virus stays active in the air or on surfaces for two hours and anyone that passes through who is unvaccinated stands a 90% chance of becoming infected.

The period of contagion is from 4 days before the outbreak of the rash until 4 days after, making for a long window of infectious opportunity. The efficiency of the contagion of this particular virus makes in a public health menace and a national scourge, set to upend many lives.

Besides being highly contagious, the measles virus is also responsible for severe illness. The cough, coryza , conjunctivitis and high fever (up to 104 F) develop after an incubation period of 7 to 14 days. Before the rash breaks out, patients may exhibit Koplik spots (tiny white spots) inside the mouth. The rash usually begins 3-5 days after initial symptoms and spreads down from the head until it reaches the feet, gradually becoming more contiguous until many of the spots are joined.

Medical care is supportive but complications are frequent and include ear infections with potential for permanent hearing loss, pneumonia and encephalitis. Children under 5 and adults over 20 are most at risk for developing problems related to measles infection.

Nurses are on the front line when it comes to addressing the current cases and providing information. What do we need to do?

Stay informed and provide patients and families with accurate sources of information: CDC.gov or your local health department.

Encourage vaccination. This is a “well, duh” point but it has to be on the list. There are, however, a surprising number of questions to be answered. If you are not working directly with children or immunizations you may not be completely familiar with the protocol:

• The MMR (measles, mumps, rubella) is given at 12-15 months with the second dose at age 4-6. If the child will be traveling, the parents have the option of considering an accelerated schedule so as to avoid contagion.
• Adult vaccinations- There is lots of “fine print” related to the need for vaccination in adults, but bottom line: look at your immunization records to be sure you have been vaccinated. If you are traveling to an area with a current outbreak, you may want to consult with your doctor about your individual needs. One dose is 93% effective in protecting the recipient from measles and 2 doses are 97% effective.

The Oregonian reports regarding its recent outbreak:

"Between Washington and Oregon, 77 people got sick. The outbreak also forced schools to exclude unvaccinated students and teachers, disrupted local business in the Vancouver area and prompted a public health emergency declaration in Washington state.”

The article went on to clarify that most of the cases were in children who were completely unvaccinated. Additionally, one person had to be sequestered in Hawaii and another in Georgia where they traveled before developing symptoms. Authorities are looking into the possibility that the outbreak was related to a child that traveled to the area from Ukraine.

In our mobile world, where long-distance travel is increasingly easy, accessible and inexpensive, we will continue to see increased rates of spread of infection. As nurses, it is part of our work to stay abreast of the current events and to help transmit accurate information regarding vaccinations and their effectiveness to combat disease.