TravelNursing

Measles Outbreaks Point to Need for More Immunization Conversations


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Didn’t we get rid of measles in the United States? If so, where are the new cases coming from?

Measles cases--thought to be nearly eradicated by immunizations with the measles, mumps and rubella (MMR) vaccine in the United States--have increased in recent years.  Although the overall numbers are still small, the number of measles cases reported in three of the last four years has been two to three times higher than the normal 60 cases a year.

This year, the numbers could be even higher. As of April 11, the Centers for Disease Control and Prevention (CDC) had already received reports of 125 cases since the start of the year. The largest outbreaks have been in California and New York City, but measles cases have been confirmed in a total of 13 states.

The sources of the outbreaks have largely been tracked to unvaccinated travelers who go overseas and become infected. The travelers then bring the measles virus back with them and infect other unvaccinated people in their communities. Seventeen of the U.S. cases have been linked to travel in the Philippines.

“Measles is highly contagious. And the vaccine is highly effective, preventing contracting the disease 95 percent of the time or more,” explained Andrew Bonwit, MD, a pediatric infectious disease specialist in the pediatric department at Loyola Medical Center in Illinois. “We are seeing outbreaks because some people are hesitant to have their children vaccinated, because they mistakenly think that the vaccine is more of a threat than the disease.”

“I don’t think parents are choosing not to vaccinate for the wrong reasons, but they are misunderstanding the facts,” he continued. “There is no evidence that measles causes autism. However, measles is a miserable disease with real risks for serious complications, including encephalitis. Encephalitis has a 15 percent fatality rate and 25 percent rate of lasting complications such as deafness and cognitive impairment.”

According to Bonwit, if an unvaccinated person is exposed to measles, there are still preventative measures that can be taken:

• For adults and children 1 year or older, getting a measles vaccine within 72 hours of exposure can prevent or lessen the severity of the disease.
• If infants 6–12 months of age are exposed, they can also receive the vaccine. These children should receive an additional MMR vaccination at one year, however, because the lasting efficacy of the vaccination before 12 months is not yet proven.
• Infants under the age of 6 months, and others who are opposed to an MMR vaccination, can also receive an immunoglobulin shot during an outbreak for added protection.

Jason McDonald, spokesperson for the CDC, encourages health professionals to take every opportunity to talk with patients about immunizations.

“Health care professionals are trusted more by parents than any other sources when it comes to immunizations,” he stated. “We encourage all doctors and nurses to discuss immunizations with parents and patients.”

“All too often we find in national surveys what we’ve coined ‘missed opportunities,’” he continued. “These are when a patient goes to the doctor for illness or other reason and there is no discussion of immunizations. An office visit is a great opportunity for a doctor or nurse to inquire about and/or discuss vaccination history with patients to make sure they are protected against these serious vaccine-preventable diseases.”

If patients or parents of pediatric patients are fearful of vaccines, Bonwitz said that it is important for nurses and other health care providers to talk with them about risks.

“In all of life we are taking risks. There is nothing that is medically effective that isn’t without a risk of an adverse event,” Bonwits asserted. “Vaccines are rigorously tested and shown to be safe before they are put on the market. Nurses should be clear in explaining the risks of not vaccinating versus the risks involved with vaccinating. At the same time, there is no sense in brow-beating people. If a parent or individual chooses not to vaccinate, we need to support them and their health in the best ways we are able.”

Because measles cases are so rare, many health professionals have never encountered the disease.

“Measles outbreaks in health care settings can disrupt care of patients and put them at higher risk for severe disease,” said McDonald. “Therefore, it is important to know the signs and symptoms of measles, and what to do if one suspects a patient has measles.”

McDonald advises:

• Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms such as cough, runny nose and conjunctivitis, especially if the person recently traveled internationally or was exposed to a person with a febrile rash illness.
• Promptly isolate patients with suspected measles to avoid disease transmission and immediately report the suspect measles case to the health department.
• Obtain specimens for testing from patients with suspected measles, including viral specimens for genotyping, which can help determine the source of the virus.

Health care providers can find additional information and tools at the CDC’s website: Provider Resources for Vaccine Conversations with Parents.


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