Measles Outbreak Communicable diseases are present in every community, city, state, village and country throughout the world. They are easily spread and, in some cases and places, easily prevented. International travel and parents not vaccinating their children are major contributors to the measles outbreak. As a nurse it is pertinent that we are educated on the signs, symptoms and the treatment of any communicable disease. It is imperative that we are also able to educate the general public on them as well.
A1. What is the Measles Virus
The measles virus is a paramyxovirus, there is only one antigenic type, and it is rapidly inactivated by heat and light (CDC, 2014). Once infected, the person will exhibit symptoms such as a fever, runny nose, a cough, loss of appetite and red water eyes for about 4 days; it is then followed by a rash (ODH, 2014). The rash typically lasts for 5-6 days, begins at the hairline, moves to the face and neck and then moves down the rest of the body (ODH, 2014). People infected with the measles virus are typically contagious 4 days prior to the rash appearing and 4 days after it goes away, meaning the person is contagious before they realize they are infected. It is diagnosed based on the patient’s symptoms and using blood tests. One a person is infected with the measles virus they cannot contract it again and will experience lifelong immunity against it.
A2. Epidemiology of Measles The 2014 outbreak of measles in Ohio came as a result of unvaccinated people traveling to the Philippines (ODH, 2014). Measles is a disease that happens in all parts of the world. The MMR vaccine has resulted in very few cases of the disease in the US. Measles is only found in humans and is transmitted person to person via respiratory symptoms such as coughing and sneezing. The disease typically peaks in later winter to spring and is highly contagious (CDC, 2014).
A2a. Route of Transmission The measles virus is spread through respiratory secretions of the infected person and is highly contagious. If a person coughs or sneezes the virus is in the droplets and can infect people around them and can remain active for up to 2 hours. It can also be spread by sharing a cup or utensils with an infected person. Treatment for people infected with the measles virus consists of bed rest, fluids and controlling the fever. While there is not a medication or specific medical treatment, the virus can be prevented with the MMR vaccine. The vaccine is given to children in two steps, the first dose at 12-15 months of age and the second at 4-6 years of age. Every person traveling internationally should have at least one dose of the MMR vaccine to prevent contracting the virus (ODH, 2014).
A2b. Risk Factors Risk factors for contracting the measles virus include being unvaccinated and traveling abroad. Unvaccinated people include children who are too young for the vaccine, people born prior to 1957 when the vaccine was first given, and those who have decided against vaccination. Traveling abroad puts people at risk because there are developing nations that do not have access to the vaccine and could expose the traveler to the disease.
A3. Systems Level A measles outbreak would affect the community on multiple levels. Schools are a prime breeding ground for this disease. Children are contagious before anyone realizes they are ill and they will spread it to a classmate. That classmate will then spread it to others and take it home and infect a younger sibling who has not had the opportunity to be vaccinated. When that younger sibling goes to day care they will spread it to the rest of the infants who haven’t had the vaccine. These children can no longer go to school or daycare, which means a parent must stay home from their job at the community hospital. The hospital is at full capacity with ill people and understaffed due to staff members staying home with their sick children. With so many systems in the community being affected there are many organizations that can be called in to help assist. In this community we have the Fairfield County Emergency Management Agency to assist with the relief efforts and to assist with vaccinating those who are eligible, also the local chapter of the American Red Cross would be called in to assist.
A4. Reporting Protocol In the even a case of active measles comes into the emergency room of the hospital where I work, the triage nurse will report the signs and symptoms of the patient to the physician. The physician on the case then must report it to the infection control nurse and the infectious disease specialist. From there they will report it to the local health department which then reports it to the Ohio Department of Health. The ODH will then report to the CDC if it is a confirmed case of measles. Any sort of restrictions will come down from the Ohio Department of Health and the CDC.
A5. Key Stakeholders A measles outbreak would affect the community in many different ways as listed in A4. The people interested in the community include the mayors in the county, the governor, the local Red Cross Chapter, the Fairfield County Emergency Agency, the hospital CEO and chief nursing officer, school officials, and ODH. If a primary care provider or hospital encounters a case of measles they are first required to report to it to the local chapter of the Ohio Department of Health. The ODH will then test the specimen themselves to confirm the diagnosis while the person is isolated until 4 days after the onset of the rash. They will then look into the person’s activity and identify any points of possible transmission and infection during which the person was contagious. Educating the local officials on how to do this is essential to prevent further transmission and infection. If the sample tested by the ODH is confirmed to be measles they will then contact the CDC.
A6. Patient and Community Education Education is key to preventing a measles outbreak in our community. Measles can be prevented by receiving the MMR vaccine and parents need to be educated on the importance of immunizing their children as their physician sees fit. The community also needs to be educated on the signs and symptoms of measles, how it is transmitted to others and how long the person infected is contagious. In addition to preventative measures, the public needs to be educated on the negatives and what could happen if the preventative measures aren’t taken. This disease is 100% preventable if proper measures, like the MMR vaccine, are taken. As nurses we must advocate for the health and safety of our patients, families, and our communities and we can do this through proper education.
A7. Conclusion The measles virus is a highly contagious disease that is spread through respiratory secretions of the infected person. The symptoms of the disease include fever, cough, and runny nose for 4 days, followed by a rash. The infected person is contagious 4 days prior to the rash appearing and for 4 days after the rash has cleared up. It is a disease that is completely preventable in the US, provided people have been properly vaccinated. As nurses it is important that we are educators and advocates for our patients and for our communities. Education is the key to prevention and transmission of the measles virus.

References
ODH (2014). 2014 Measles Outbreak. Retrieved from http://www.odh.ohio.gov/features/odhfeatures/Measles%202014.aspx
CDC (2014). Measles Epidemiology and Prevention of Vaccine-Preventable Diseases. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html