Measles Outbreak Nursing Paper Example Essay

With the advent of globalization, increased human mobility has expanded the possibility of spreading communicable diseases across borders. In the US

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The most recent outbreak of measles in the USA occurred as a result of the Disneyland event. The first report of the outbreak was on the 5th of January, 2015, where an 11-year-old child was reported to have symptoms of measles after the onset of a rash in December (Zipprich, 2015). The report of the symptoms was delivered to the California Department of Health. Moreover, the institution received two other reports on the same day. The prevailing characteristic of the reports was that all patients had made visits to the Disneyland theme parks in Utah in the period around December 17th of 2014 (Zipprich, 2015).Measles Outbreak Nursing Paper Example Essay

Measles is caused by the virus Morbillivirus, which normally manifests as a moderately severe or mild illness (Kutty & Rota, 2015). The patients display symptoms such as fever, cough, conjunctivitis, and rash. As the illness is not severe, measles tend to cause few deaths with a normal ratio of about two in every one thousand. However, the patient with the measles can develop other serious diseases such as pneumonia (Zipprich, 2015).

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As of February 21st, 2015, about 141 people had reported cases of measles since the first patient (Chang, 2015). The majority of patients were in California, but there were more cases in other states such as Illinois, Nevada, and Arizona. According to the CDC report, most of the infected patients in California (about 55%) had been vaccinated against measles (Chang, 2015). The rest, who were not vaccinated, included young children that had not attained the vaccination age, and others that avoided the immunization. Further, about 52% were above 20 years old, while 17% of patients were aged between 1 and 4 (Zipprich, 2015).Measles Outbreak Nursing Paper Example Essay

The outbreak was related to the theme part visit, as 35% of the patients in California visited the Disneyland theme parks. Thus, their exposure was likely to have a direct correlation with the source (Zipprich, 2015). 31% were secondary cases, the majority of which were household contacts, while the rest were in a community setting. One patient was reported to encounter measles symptoms in Mexico, having visited the theme parks twice. The analysis of the genotype revealed that the disease was Measles B3, which caused a recent outbreak in the Philippines (Chang, 2015). Therefore, the country has been identified as the most likely source of the Disneyland measles outbreak. Regardless of the number of reported cases, the CDC has been unable to identify objectively the country as the origin of the outbreak.Measles Outbreak Nursing Paper Example Essay

Epidemiological Determinants of the Outbreak
The epidemiological determinants of the measles outbreak take three perspectives. The perspectives include the factors inherent to the agent, host factors, and the environmental elements (Kutty & Rota, 2015). The agent factors entail the agent itself, such as the subtype B3 that characterized the California outbreak. Other agent factors include the communicability, which is highest during the time of the rash eruption. The period lasts four days before the eruption and four days after (Kutty & Rota, 2015). In the California epidemic, the secondary attack rate was limited to household contexts.Measles Outbreak Nursing Paper Example Essay

Additional determinants of the outbreak include host factors. In the area, the most vulnerable group seemed to be people aged above 20 and less than four years old (Zipprich, 2015). There was a minimal gender difference. The most notable difference was with regards to immunity, where vaccinated individuals formed the majority of the infected group. The clarification on the phenomenon was limited; however, the research suggests the doses used may have been inadequate to create immunity (Chang, 2015).

The environmental perspective suggests that the population and movement within and outside the USA were a critical factor propagating the outbreak. The majority of the patients got direct infections during their visits to Disneyland, despite the fact that they were coming from different countries and states. The measles virus can spread during any weather, indicating little correlation with the December weather and the outbreak.Measles Outbreak Nursing Paper Example Essay

Route of Transmission
The transmission of measles occurs from the infected person to the next individual. The measles virus resides in the mucus in the nose or throat of the infected individuals. The transmission through droplet nuclei implicates the dried residue, which comes from sneezed or coughed droplets after evaporation (Minetti et al., 2013). The droplets may be inhaled by another person, who will catch the measles infection in the process. However, the most common route of infection is through contact with the infected droplets (Kutty & Rota, 2015).Measles Outbreak Nursing Paper Example Essay

Notably, the human body is the only viable host for the measles virus. However, the virus can survive in the air for up to two hours after its release. Measles has an incubation period of about ten days before the fever begins. The appearance of the rash takes 14 days accompanied by coughs during the late prodromal stage, which is the most infectious phase of the disease (Kutty & Rota, 2015). Since the person does not become sick immediately, it is possible for them to transmit the disease before displaying the symptoms. Notably, urine remains infected for some time after the viral secretion ceases, but the phenomenon is not identified as a usual route of transmission (Siegel, Rhinehart & Jackson, 2007).Measles Outbreak Nursing Paper Example Essay

The CDC provides extensive definitions of risk factors associated with measles outbreaks. They include contact with measles-infected patients, the recent travel destinations of an individual, and the return date from the trips. Additional factors include the total dosage of measles vaccination, as well as the latest date of immunization (Kutty & Rota, 2015).

The contact with a person suffering from the illness automatically elevates the degree of risk. Most of the cases were related to the direct contact in Disneyland, while the majority of secondary infections were caused by the household contact. Further, the first patients to report the symptoms of measles had visited Disneyland (Chang, 2015). The visits were the dates between the 17th and 20th of December, suggesting that both travel destinations and return dates are significant risk factors in the epidemiology of measles.Measles Outbreak Nursing Paper Example Essay

The immunity of an individual to measles also influences the possibility of its spread into an outbreak. The California outbreak demonstrated the importance of dosage in vaccination. According to the CDC, “49 (45%) were unvaccinated; five (5%) had one dose of measles-containing vaccine, seven (6%) had two doses, one (1%) had three doses, 47 (43%) had unknown or undocumented vaccination status” (Zipprich, 2015).

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Measles Outbreak Community Effect
The occurrence of a measles outbreak affects the community systems and their functioning. The most notable impact would be on the local government and hospitals, as previous epidemics have demonstrated. For instance, in 2008 in San Diego, the cost incurred by the public health department was about $124,517, which was allocated to contain a measles outbreak (Kutty & Rota, 2015). The system also incurred additional costs through families that had to quarantine their contacts at home. In a similar scenario the same year, eight people with measles cost hospitals $800,000 to contain expenditure reaching more than $100,000 per person (Kutty & Rota, 2015).Measles Outbreak Nursing Paper Example Essay

Further, it is possible that the outbreak will affect the functioning of schools and businesses. In the outbreak scenario, infected people require quarantine measures in order to reduce the spread of the disease. In addition, it is likely that people will experience panic after hearing details on the outbreak. Consequently, a notable decline in school attendance will be witnessed. Businesses may experience a significant number of absenteeism among employees. The absent people may be under quarantine, or avoid the work for fear of infection. Therefore, an outbreak of measles is bound to reduce productivity both in business and education.Reporting Protocol
The reporting protocol requires the practitioner to react to the situation according to their role in the provision and protection of public health. In the case of infection detection by any health care provider, the expectation is that notification reaches the local health jurisdiction. Consequently, a case detected by a nurse within Stevens County in Washington should be sent to the North-East Tri-county Health District immediately. The notification usually involves filling the investigation and reporting form, indicating details about the source, presumed immunity, and contacts of the individual (Council of State and Territorial Epidemiologists, 2012). The detailed approach is expected to follow any detection of measles within a health care facility such as hospitals.Measles Outbreak Nursing Paper Example Essay


In the case of measles investigations in laboratories reveals the possibility of an epidemic, the laboratory requires reporting to the local health jurisdiction as well. The report should include lab samples, which must contain an isolated specimen with a positive result (Council of State and Territorial Epidemiologists, 2012). However, in case the detection of an outbreak is at the local jurisdiction level, the report must go to the state public health department. In the case of Stevens County, the jurisdiction would issue a report to the Washington State Health Department. The protocol ensures the dissemination of information to the top level in healthcare before it is distributed to the general population.Measles Outbreak Nursing Paper Example Essay

Reporting Outbreak to Community Stakeholders
The process of reporting outbreaks to the community begins at the pre-reporting phase. The step will involve the identification of key stakeholders in the community that will be affected by the report. In the measles case, the key stakeholders include:

Public health officials
Local government
Community representatives (e.g. school heads, religious clerics, business management)
General community
Each of the groups requires specific communication channels that allow them to take timely and appropriate action. The first report should be issued to the local government and public health officials. The government requires information on the extent of the outbreak, and the prospective future costs it may incur (Minetti et al., 2013). The communication requires a meeting with government officials in order to facilitate effectiveness and clarifications. Public health professionals require communications in the form of directives regarding the next course of action. Sending representatives from outbreak control teams in the local jurisdictions, accompanied by official letters or emails, should accomplish the task. The communication from public health officials will reach clinicians in the same form.Measles Outbreak Nursing Paper Example Essay

Over the past 12 months there has been an increase in cases of measles across England; in 2018 there had been 828 confirmed cases of measles by 13 August, with 55% occurring in over-15-year-olds (Public Health England, 2018a). The European Centre for Disease Prevention and Control (2018) warned in March that there was an ongoing risk of transmission of measles within European countries. The European Region adopted the goal of eliminating measles in the entire region by 2015 but this objective was not met. According to World Health Organization (WHO) data, 22,373 cases were reported in the region in 2017, including 35 deaths (PHE, 2018b).

With increased infection risks it is vital that health professionals promote uptake of vaccination, recognise possible cases of measles and manage them appropriately.Measles Outbreak Nursing Paper Example Essay

Measles is a highly contagious viral illness that can cause the following complications:

Otitis media;
Despite having an effective vaccination programme in England we continue to see outbreaks of measles. The people at increased risk of contracting the disease are partially vaccinated or unvaccinated. The consequences of measles infection for pregnant women (who may experience miscarriage, stillbirth or preterm delivery), babies younger than one year old and immunocompromised individuals can be especially severe (PHE, 2017).Measles Outbreak Nursing Paper Example Essay

Signs and symptoms
Classical clinical presentation of measles often consists of:

A maculopapular rash that starts on the face (Fig 1);
Temperature of more than 390C;
Cough and cold symptoms;
Koplik spots (white spots in the mouth) (Fig 2).

Community Health Communicable Disease: Measles The recent outbreak stemming from exposure at an amusement park in the California has brought attention to the continuing global impact of measles (“Measles Outbreak CA,” 2015). The measles is a viral disease primarily effecting unvaccinated children and adults, however, is known to affect vaccinated individuals. The purpose of this paper is to describe the characteristics of the virus, the epidemiology of a recent measles outbreak, risk factors, and impact on Stevens County Washington. Also provide reporting protocol and local preventative strategies. Through education, investigation, and planning a community health nurse will be able to employ this information to better prepare the community for potential communicable disease outbreaks.Measles Outbreak Nursing Paper Example Essay
Measles is a serious viral respiratory illness of which there has been a licensed vaccine since 1963 (“Measles,” n.d.). Signs and symptoms include fever, feeling ill, cough, nasal congestion, conjunctivitis, followed by clusters of white lesions in the buccal mucosa, and lastly a wide spread maculopapular rash. The person is considered contagious approximately four days prior to the appearance of the rash and days after its disappearance. Some common complications from the disease include otitis media, bronchopneumonia, laryngeal/trachea/bronchitis, and diarrhea. Serious complications include; encephalitis causing brain damage, death related to respiratory and neurologic complications, and sclerosing panencephalitis, which is rare but fatal. The Center for Disease Control and Prevention (CDC) also reports 1-2 out of every 1000 children who become infected can develop respiratory and neurologic complications resulting in death (“Measles,” n.d.). The virus is considered one of the most highly contagious diseases and is transmitted through direct contact or airborne exposure with infectious droplets. This virus remains communicable on surfaces for up to two hours after contamination. Children under five years, adults over the age of twenty, pregnant women, and immune-compromised individuals are most susceptible to complications (“Measles,” n.d.). Immunity is determined by adequate vaccination, laboratory confirmation, or birth in the U.S. prior to 1957 (“Measles,” n.d., p. 2).Measles Outbreak Nursing Paper Example Essay
2014-2015 California Outbreak On January 5th, 2015 the California Department of Public Health (CDPH) received notification of five suspected measles cases with all cases having reported a visit to a popular theme park between December 17th- 20th (“Measles Outbreak CA,” 2015). By January 7th, seven cases had been confirmed in California and the state released a notification to the Epidemic Information Exchange alerting other states of the occurrence. The initial source has not yet been identified, however, the specific measles genotype B3 is related to a large epidemic in the Philippines, detected in 14 other countries, and six states in the last 6 months (“Measles Outbreak CA,” 2015, para. 4). The amusement park associated with the outbreak receives an estimated 24 million visitors annually with many from countries where measles are widespread. As of February 11th, 2015 the related cases with rashes reported in seven states, Mexico, and Canada total 136. The majority of the affected population resides in California (110 patients). It is reported 35% (39 patients) of those patients visited the park during the dates in question and 34 patients had secondary exposure related to “household or close contacts” (“Measles Outbreak CA,” 2015, para. 2). Not all cases in California have been directly linked to the theme park exposure time. The CDC states 37 California patients have an unknown exposure source and 5 patients were at the park, but not during the December 17-20 dates. Eight of the patients were exposed in a community setting. Measles Outbreak Nursing Paper Example Essay

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