The Great Measles Come-Back of 2019

In the first 7 weeks of this year, January 1 to February 21, 2019, 159 cases of measles (rubeola) were confirmed in 10 of the United States. So far, there haven’t been any new cases reported in Hawaii. Still, as nurses, we need to be aware of the problem, to encourage immunizations, & recognize the signs & symptoms of measles. Many of us have never seen a patient with measles. After all, measles was declared eliminated from the United States in 2000 when, thanks to a highly-effective vaccination program, there was not a single case of measles for over a year. Sadly, due to lack of immunizations resulting in a susceptible population and people from other countries coming to the US carrying measles, that is no longer the case.
Measles is a serious illness caused by Measles morbillivirus, a single-stranded, negative-sense, enveloped, non-segmented RNA virus with a 90% transmission rate. The virus grows on the nasal mucosa. Before the measles vaccine became available in 1962, 100% of children in the US contracted measles by age 15 years and about 500 died annually.
The incubation period for measles is 10-12 days followed by a prodromal period of two to three days when the patient develops fever, cough, coryza, conjunctivitis and malaise. Two days later, a flat red skin rash develops, covering the whole body. But, the true hallmark of measles infection is the presence of Kopik’s spots. These appear after onset of symptoms and two days before the measles rash itself. They are small clustered, white lesions on the buccal mucosa (opposite the upper 1st & 2nd molars).
Treatment is supportive and directed at any complications that might develop such as nausea, vomiting, diarrhea, dehydration, pneumonia, and otitis media. Measles can result in deafness. encephalitis, seizures, & death. It is believed that Europeans first brought measles to the Americas, resulting in the extermination of indigenous people who had no natural immunity to the virus.
Groups at high risk for severe illness and complications from measles include:
• Infants and children younger
than 5 years
• Adults older than 20 years
• Pregnant women
• People with compromised immune systems.
The measles virus is not associated with birth defects, but can disrupt the placenta resulting in fetal death.
Many parents failed to have their children immunized, for fear of the false research published in 1998 that blamed the MMR for causing autism. This research was fraudulent and the physician responsible lost his license to practice medicine. Still, the rumors persisted and parents unfamiliar with the risks of childhood viral exanthums thought they were making the right choice. This is not the case and we now see the results. With our knowledge and expertise, and the trust our patients place in us, nurses can work to solve this problem and eradicate measles once again.