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
• Bronchopneumonia
• Laryngotracheobronchitis
• Diarrhea

• 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.