Epidemiology Paper: Measles
Concepts in Community and Public Health
Epidemiology Paper: Measles
“Measles (rubeola) is classified as a member of the genus Morbillivirus in the family Paramyxoviridae. Measles is a highly contagious rash illness that is transmitted from person to person by direct contact with respiratory droplets or airborne spread. After exposure, up to 90% of susceptible persons develop measles. The average incubation period for measles is 10 to 12 days from exposure to prodrome and 14 days from exposure to rash (range: 7–21 days). Persons with measles are infectious 4 days before through 4 days after rash onset. In the United States, from 1987 to 2000, the most commonly reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (8%) (8). For every 1,000 reported measles cases in the United States, approximately one case of encephalitis and two to three deaths resulted. The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents. In low to middle income countries where malnutrition is common, measles is often more severe and the case-fatality ratio can be as high as 25%. In addition, measles can be severe and prolonged among immunocompromised persons, particularly those who have leukemias, lymphomas, or HIV infection. Among these persons, measles can occur without the typical rash and a patient can shed measles virus for several weeks after the acute illness. However, a fatal measles case without rash also has been reported in an apparently immunocompetent person”. (McLean, Parker Fiebelkorn, Temte, & Wallace, 2013).
“Pregnant women also might be at high risk for severe measles and complications; however, available evidence does not support an association between measles in pregnancy and congenital defects. Measles illness in pregnancy might be associated with increased rates of spontaneous abortion, premature labor and preterm delivery, and low birthweight among affected infants.”(McLean, Parker Fiebelkorn, Temte, & Wallace, 2013).
“A persistent measles virus infection can result in subacute sclerosing panencephalitis (SSPE), a rare and usually fatal neurologic degenerative disease. The risk for developing SSPE is 4–11 per 100,000 measles cases, but can be higher when measles occurs among children aged <2 years. Signs and symptoms of SSPE appear an average of 7 years after measles infection, but might appear decades later. Widespread use of measles vaccine has led to the virtual disappearance of SSPE in the United States, but imported cases still occur . Available epidemiologic and virologic data indicate that measles vaccine virus does not cause SSPE. Wild type measles virus nucleotide sequences have been detected consistently from persons with SSPE who have reported vaccination and no history of natural infection”. (McLean et al., 2013)
Treatment: There is no specific antiviral therapy for measles. Supportive medical care is provided to assist with symptom relief and address complications such as bacterial infections.
For severe cases of measles among children, especially the children that are hospitalized, Vitamin A should be administered immediately on diagnosis and repeaded the next day. (Measles ( Rubella).
“In 2016, 86 people from 16 states were reported to have measles. In 2015, 188 people from 24 states and the District of Columbia were reported to have measles. In 2014, the United States experienced a record number of measles cases, with 667 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD); this is the greatest number of cases since measles elimination was documented in the U.S. in 2000.”
Measles is a reportable disease and should be reported to the local Health Department within 24 hours of diagnosis per telephone or fax. A report is required by law (State Statute § 35-4-107) from both the attending healthcare provider/hospital and the laboratory performing diagnostic testing. (Infectious Disease Epidemiology Unit, 2018).
According to WHO webside, malnutrition and vitamin A deficiancy play’s a large role in severity of measles and can increase the mortality rate from measles in chldren. Also areas that have more poverty and were the immunisations are not available or unabtanable have a higher rates of measles.
The epidemiologic triangle consists of an external agent, a host and an environment in which host and agent are brought together, causing the disease to occur in the host. I relation to measles external agent is the measles virus and the host is the human body, measles is a human disease and is not found in animals. Its is transmited person to person via large amout of respiratory dropplets. Airborne transmission hase been documented in closed areas, The virus is able to survive for about 2 hours in the area that was occupied by infected person. ( Measles(Rubella)). Measles is a preventable disease and can be prevented trough vaccination. Chidren should be vaccinated at age 12 month and have 2 vaccinations between age 4 -6 years old to archive immunity. Teens and adult should also be uptodate on MMR vaccinasation.
The Community health nurse plays a important role in preventing and treating measles in the community. Nurses are the ones on the front lines, and are interacting with patient in the community and are in involved in case finding. “The purpose of case finding is to identify every case of disease and to provide swift treatment for new cases. Community health nurses often function as case finders. Searching for potential cases begins by identifying individuals with the most intimate contact and proceeds to those with less close contact.” (Maurer & Smith, 2009, p. 230).
“Active surveillance for measles disease should be conducted for every confirmed measles case to assure timely reporting of suspected cases in the population known to be affected as well as other segments of the community that may be at high risk of exposure or in whom vaccination coverage is known to be low. Efforts should be made to obtain clinical specimens for viral detection (see “Laboratory testing” section above). Active surveillance should be maintained until at least two incubation periods after the last confirmed case is reported (e.g., two maximum incubation periods [21 days from exposure to rash] or 42 days after rash onset in last case.”(“Manual for the Surveillance of Vaccine-Preventable Diseases,” 2018). Community Health Nurses duty is to educate the community on how the disease is spread and how to prevent it from spreading, also discuss the prevention of the disease by immunazation of children and the importance on continued immunozation by receiving a buster MMR as teen and adults.
CDC is one of the national agancies that adresses measles and is working on preventing the spread of the disease and attempting to eradicate this disease not only here in the US, but also all over the word.
“The CDC is a United States federal agency under the Department of Health and Human Services, headquartered in Atlanta, Georgia. Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability in the US and internationally.” (Centers for Disease Control and Prevention. (2018, February 03)). CDC is working on preventing ad eradicating measles by working with organizations and communities around the world, by providing education and working on early disease identification and early intervention.
“CDC’s global programs are run by world experts in epidemiology, surveillance, informatics, laboratory systems, and other essential disciplines and provide strong global health leadership capacity. The work of these experts strengthens critical public health services around the world.” (“What CDC Is Doing,” 2017)
“CDC engages foreign governments to help address their health challenges which supports the interests of the American people. In addition to providing health benefits, the collaborations often serve as entry points for broader diplomatic engagement, making CDC’s global work critical. CDC’s global programs address more than 400 diseases, health threats, and conditions that are major causes of death, disease, and disability – building upon our U.S. public health program expertise and knowledge of these diseases to help protect Americans from major health threats, wherever they arise.”(“What CDC Is Doing,” 2017)
According to WHO: In 2016, there were 89 780 measles deaths globally, mostly children below 5 years of age – marking the first-year measles deaths have fallen below 100 000 per year. The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Measles have made a comeback and has been seen in several countries in the African, South-East Asian, European, Eastern Mediterranean and Western Pacific Regions. (Measles, WHO.com, 2018)
Cases of measles went up in some of the European countries such as Germany or France according to an article “Vaccinations around the world: How Countries encourage it – CNN”. The rates are going up due to vaccination rate being down and the changing trends regarding vaccine hesitancy and refusal, which causes some of the Measles outbreaks. Due to increasing numbers of Measles cases Germany introduced Legislation in June last year that made it mandatory for all kindergartens to notify the health authorities if parent have not submitted proof of vaccination for their children. Which is a change to a previous requirement for parent to provide the proof of counseling by their physician on vaccinations, and the Kindergartens did not have to report the parent if they did not provide proof of counseling. (CNN, 2017).
Vaccines is the only way to eradicate this disease. Herd immunity is crucial for protecting the health of a community. The more community members are immunized the better protected is the community and the once that are unable to receive the immunization due to certain health problems. I feel we as nurses need to continue to provide education and the importance on immunize our children. It is important for people to be able to make their own decisions on what they put in their or their children’s bodies. However, by making the decision not to vaccinate themselves, people put everybody else in harm’s way and at risk of contracting measles, Due to lower rates of immunizations for measles, teenagers and adult can be infected with this disease.
Community Nursing is an important piece in keeping our communities healthy.
CNN (2017). How countries around the world try to encourage vaccination. Retrieved from https://www.cnn.com/2017/06/06/health/vaccine-uptake-incentives/index.html
Manual for the Surveillance of Vaccine-Preventable Diseases. (2018). Retrieved from https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
Maurer, F. A., & Smith, C. M. (2009). Community/Public Health Nursing Practice: Health for Families and Populations (4 ed.). Retrieved from Elsevier eBooks
McLean, PhD, H. Q., Parker Fiebelkorn, MSN, A., Temte, MD, J. L., & Wallace, MD, G. S. (2013). Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
Measles (Rubella). (). Retrieved from https://www.cdc.gov/measles/hcp/index.htMeasles. (2015, July 24). Retrieved February 03, 2018, from https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#epml
Reportable Diseases and Conditions. (2018). Retrieved from https://health.wyo.gov/publichealth/infectious-disease-epidemiology-unit/reporting
What CDC Is Doing. (2017). Retrieved from https://www.cdc.gov/globalhealth/what/default.htm
Measles. (2018). Retrieved February 03, 2018, from http://www.who.int/mediacentre/factsheets/fs286/en/