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
- Otitis media
- 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.)
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.
I’m a bit ashamed to be admitting this to a group of nurses, but I figure that if I shame myself enough maybe I won’t let this happen again. Ok, here it is…I didn’t get a flu shot. There, I said it. No reason, really, I just got busy and it kept getting pushed to the bottom of my to-do list. My husband got his at work, I took the kids for theirs, but mine – I just never got around to it. I am embarrassed and yes, more than a little nervous about getting sick.
I’ve been reading a ton about this year’s influenza viruses "taking the U.S. by storm." I get emails from the CDC with the latest numbers and maps showing flu activity around the country. Our Nursing News page has links to updates and articles about this year’s virus. Our twitter timeline and facebook newsfeed also contain quite a bit of flu-related news, opinions, and personal stories these days.
Not only am I “virtually” surrounded by the virus, but my kids come home from school each day with a report of who was absent, or more concerning, who was sick at school. My husband returns from his work as a respiratory therapist with a flu update from the hospital floors. And of course, I’m aware of every sniffle and sneeze around me when I’m out.
My plan, which has been working well so far, consists of the usual recommended practices: frequent handwashing, not touching my face, getting enough rest and eating well, and doing my best to avoid those who are sick. However, while I’ve dodged illness thus far this flu season, I will surely be calling my nurse practitioner this week to schedule my vaccination!
Any other advice?
Although the H1N1 influenza pandemic has been officially declared over (you can read the statement from the World Health Organization here), it is not too soon to start thinking about the upcoming 2010-2011 flu season. Actually, during a recent visit to our local pharmacy, I noticed the sign “Flu shots available here.” Hmmm… there is a difference between thinking and doing - is it really time to vaccinate now?
Here’s what I found:
- The 2010-2011 flu vaccine will protect against 3 flu viruses: an H3N2 virus, an influenza B virus and the H1N1 virus.
- Routine influenza vaccination is recommended for everyone ages 6 months and older.
- As in the past, all children aged 6 months to 8 years who receive a seasonal influenza vaccine for the first time should receive 2 doses.
- For the 2010-2011 season, children 6 months to 8 years who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine should receive 2 doses of a 2010-2011 seasonal influenza vaccine.
- And lastly, yes…the Centers for Disease Control and Prevention is encouraging health care providers to begin vaccinating patients as soon as the vaccine arrives (shipments have already begun.)
You may remember from an earlier post that I never got my flu shot or H1N1 vaccine during the 2009-2010 season. The reason was simply one of convenience, or actually, inconvenience. The vaccines weren’t available when I had a visit with my physician and then there wasn't enought staff to administer the vaccines when they did become available.
I’m planning on getting vaccinated this year. How about you?
Red Book Online Influenza Resource Page from the American Academy of Pediatrics
Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010
Earlier this week, Lancet retracted an article published by Dr. Andrew Wakefield in 1998 which stated the MMR vaccine could increase childrens risk of developing autism. "According to the judgment of the U.K. General Medical Council's Fitness to Practice Panel on January 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al, are incorrect in particular the claims in the original paper that children were consecutively referred and that investigations were approved by the local ethics committee have been proven to be false. Therefore, we fully retract this paper from the publishing record."
While numerous studies following this paper reported that there wasn't a relationship between the MMR vaccine and Autism, the damage was already done. This study resulted in parents not having their children vaccinated and led to an outbreak of measles in the U.S. in 2008 and an increase in disease in the U.K. Too often lay persons and clinicians accept the results of one study as being enough to change assumptions and practice. As nurses we need to educate our peers and the public that research must be reviewed for validity and accuracy. Just because something is published, doesn't make it good science. We must use established evidence-based and best practice resources to guide our practice. Cochrane Systematic Reviews, the Joanna Briggs Institute, and other established evidence-based practice resources and journals can help us improve practice and improve outcomes. What resources are you or your facility using to improve patient outcomes?
Since last April, a big part of my job has been reading, researching, and writing about H1N1 influenza. Many friends, family members, and colleagues were aware of this and came to me for information about the virus, and then, in the fall, about the H1N1 vaccine.
I’ll admit that I was skeptical about the vaccine at first; however, I made the decision to follow the recommendations of the CDC and get vaccinated. I called my doctor’s office….”No vaccine in yet”. This was the response for several weeks. In the meantime, my children got vaccinated at school (seasonal and H1N1) and my husband got both vaccines at work (he’s a respiratory therapist). We also all got....THE FLU! H1N1? Maybe.
So, here it is, January 20th, and still no vaccine for me. I contemplated skipping both my seasonal and the H1N1 vaccines this year since we are so far into flu season already. Then last week, in an open letter to the American people, the CDC reminded me (and the rest of Americans) that flu season traditionally lasts until May. In that same letter, I also learned that there are currently over 110 million doses of the H1N1 vaccine available. Great – I thought – I’ll do it! I called my primary care office to make appointments for the seasonal and H1N1 vaccines but wasn’t able to schedule them because while they do have the vaccines, they don’t have enough staff to administer them. I was instructed to call back next week.
This got me thinking... While it is great that we educate and encourage people to get vaccinated, how can we make it easier for them to do so? One colleague recently needed several vaccinations as well as a titer drawn for varicella before some upcoming travel abroad. Luckily she was able to get all of her needs met at occupational health where she works. While I am happy my colleague could get her needs met in a timely fashion, in one appointment, in a convenient setting, would this be as easy for a layperson? My husband got both his vaccines at work, during his shift – great for him, but how about the patients he cares for who have to wait for appointments and may have to schedule multiple visits to get their needs met?
While it is great that we educate our patients and the public about staying healthy, how can we improve the system?