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Measles Update

clock February 2, 2015 16:34 by author Lisa Bonsall, MSN, RN, CRNP

The current outbreak of measles, which has been linked to a California amusement park, continues to make headlines in the United States. The Centers for Disease Control and Prevention (CDC) is tracking data on the states affected and the number of cases. I encourage you to stay informed so you’ll be able to best educate your patients and answer their questions.

Before I get to the purpose of this post – to review transmission, signs and symptoms, and treatment of measles – I’d like to briefly address why we are seeing this resurgence in cases. In 1998, a study was published in the Lancet which suggested a link between the measles, mumps, and rubella (MMR) vaccine and autism. As a result, increased numbers of parents opted to refuse the MMR vaccine for their children. The researchers later retracted their study, and current evidence concludes that there is no association between vaccines and autism.

As nurses, we have a responsibility to educate patients about the importance of vaccinations and the implications when vaccine-preventable diseases reemerge. Measles is extremely contagious and can have serious complications, especially for certain high risk groups. Please stay informed about the current outbreak and recommendations for vaccinations. 

What is measles?

Measles is an acute viral illness, transmitted by direct contact with infectious droplets or by airborne spread. After exposure (the incubation period can range from seven to 21 days), a prodromal syndrome of high fever, cough, runny nose, and conjunctivitis is characteristic. Koplik spots (white or bluish-white spots on the buccal mucosa) may occur and then the development of the characteristic maculopapular rash, which typically spreads from the head to the trunk to the lower extremities, follows. 


Complications of measles

Common:

  • Otitis media
  • Bronchopneumonia
  • Laryngotracheobronchitis
  • Diarrhea

Severe:

  • Encephalitis
  • Respiratory complications
  • Neurologic complications
  • Subacute sclerosing panencephalitis (SSPE)

Who’s at risk for severe complications?

  • Infants and children younger than five years; adults over 20
  • Pregnant women
  • Immunocompromised patients

Need-to-know information for nurses

  • After appearance of the rash, infected patients should be isolated for four days in a single-patient airborne infection isolation room (AIIR).
  • Measles is a reportable disease and local health departments should be notified within 24 hours of suspected measles cases. 
  • Routine childhood immunization for MMR vaccine starts with the first dose at 12-15 months of age, and the second dose at 4-6 years of age or at least 28 days after the first dose. (More vaccine schedules and information, including contraindications to vaccination, can be found here.)

References
Finerty, E. (2008). Did you say measles? American Journal of Nursing, 108(12). 
Skehan, J. & Muller, L. (2014). Vaccinations: Eliminating Preventable Illness. Professional Case Management, 19 (6).
Wade, G. (2014). Nurses as Primary Advocates for Immunization Adherence. The American Journal of Maternal/Child Nursing, 39 (6). 
Centers for Disease Control and Prevention. (2015, January 30). Measles (Rubeola): For Healthcare Professionals.



Enterovirus-D68

clock September 8, 2014 08:34 by author Lisa Bonsall, MSN, RN, CRNP

In the Midwest,  an enterovirus, known as EV-D68, is causing concern. While not a new virus, EV-D68 has recently caused severe respiratory symptoms in affected children in Missouri, and several other states have contacted the CDC for assistance with a possible regional outbreak as well. These are Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma, and Kentucky. Symptoms of a common cold are typical at the onset of EV-D68, however the development of fever, rash, or dyspnea – particularly in children with asthma – is occurring and necessitating hospitalization, and in some instances, ICU admission. 

While details continue to be released, please remember your role in patient education and infection control. Tell parents and caregivers about these symptoms of EV-D68 and advise them to seek care for their child if fever, rash, or breathing difficulties develop. Also, share these basics of infection control:

  • avoiding close contact with people who have respiratory symptoms, such as coughing or sneezing
  • staying home when sick
  • washing hands often with soap and water for 15 to 20 seconds or using alcohol-based hand cleansers 
  • not touching eyes, nose, or mouth 
  • keeping surfaces and objects (especially tables, counters, doorknobs, and toys) that can be exposed to a virus clean
  • practicing other good health habits, including getting plenty of sleep, staying active, drinking plenty of fluids, and eating healthy foods

As more details are released, we’ll be sure to keep you informed! 

Update 9/16/14 - More states have reported EV-D68 infections. Please visit our page on this topic for more information and resources!

Reference:

Bonsall, L. (2009). Be prepared for H1N1 flu. Nursing Made Incredibly Easy!, 7(6).




Thank you to a special nurse

clock March 4, 2013 04:19 by author Lisa Bonsall, MSN, RN, CRNP

Two days ago we received 2 cards in the mail. They come every year at this time. They are never late and there is always a personal note included.

My sons are 12 years old today. These cards, which have come every year for the past 11 years, are not from their grandparents or aunts or uncles. They are not from their friends or my friends. These cards are from one of the nurses who cared for them in the Neonatal Intensive Care Unit (NICU) after they were born prematurely.

So I write this to recognize the continued feelings of gratitude and awe that I have for one special nurse. How can I thank her for caring for my children when I wasn’t able? How can I thank her for showing my boys love and compassion when I couldn’t be there? How can I thank her for helping us through our most difficult days, weeks, and months?

My boys are grateful to receive these cards each year and to be remembered on their birthday; however I’m not sure they grasp how much the cards are appreciated by me and my husband. This day of celebration for our kids still brings mixed emotions to us, feelings which are understood by this special NICU nurse who reaches out to us each year.

As a nurse, I have not had a continued relationship with any patient after discharge, although I can think of several that I wish I had. How about you?

 



Nurses Increase Vigilance for Fungal Meningitis

Nurses must increase vigilance for identifying patients at risk for fungal meningitis following the September 26, 2012 recall of injectable methylprednisolone acetate that was packaged by New England Compounding Facility in Framingham, MA. According to the Centers for Disease Control and Prevention's website, there have been 185 cases and 14 deaths among 12 states and continues to grow (CDC, 2012). The impact is potentially greater because healthcare facilities in 21 states have received the recalled lots of the affected drug. 

Patients who received contaminated injections presented with symptoms from one week to 4 weeks after the injection. It is important for nurses to report patients who are symptomatic of meningitis through the month of October to a physician or licensed advanced practiced nurse. To further assist in the evaluation or referral for meningitis work-up, all health care professionals including those in primary care offices, emergency departments, or retail clinics should go to the CDC website (http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html) for a current list of health care providers who administered the recalled lots. The CDC website also provides continually updated information on the meningitis outbreak and educational information for providers and patients.

Reference

Centers for Disease Control & Prevention. (2012). Multistate Meningitis Outbreat Investigation. Retrieved from http://www.cdc.gov/HAI/outbreaks/meningitis.html. Last accessed 10/12/2012.



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