Measles Outbreak Nursing Paper Example

Measles Outbreak Nursing Paper Example

With the advent of globalization, increased human mobility has expanded the possibility of spreading communicable diseases across borders. In the USA, due to the expanse of travel routes and range of destinations, some diseases find their way into the otherwise manageable environment. The current paper seeks to analyze a recent measles outbreak in the USA. It will offer a description of the disease, and patterns of its materialization within the specific region. The analysis aims to feature its original context and demonstrate the immensity of its occurrence.Measles Outbreak Nursing Paper Example

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 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).

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

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.

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

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.

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).

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).

Risk Factors

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

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).

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.Measles Outbreak Nursing Paper Example

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.

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

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
  • Clinicians
  • 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

Community representatives may require the official letters or emails, as it is difficult to address them all in one meeting. The communication method should detail the plan for controlling the outbreak, and the role the community is expected to play (Council of State and Territorial Epidemiologists, 2012). Finally, the message should reach the general public. The information could be displayed in the media, as well as through verbal means from clinicians and public health officials. The information should bear similar details as in the other levels, ensuring minimal panic among the public.

Strategies to Prevent Outbreak

Preventing a measles outbreak will require employing multiple strategies. The strategies will feature patient education, monitoring, and policy enhancement.

Patient education should focus on the importance of appropriate and timely vaccination. While most people in the USA receive the vaccination, the poor dosage and irregularity expose them to measles infection. Some people decline immunization due to personal beliefs, increasing the possibility of contracting the disease. Thus, public education through campaigns and the use of clinicians should enhance the effectiveness and regularity of measles vaccination.

Monitoring forms is the next plan of the strategies. The local health jurisdictions require enhancing the investigation of measles cases and reporting protocols (Council of State and Territorial Epidemiologists, 2012). The control will allow the clinicians to test any early symptoms for measles and prevent it’s developing to the infectious stage without detection.Measles Outbreak Nursing Paper Example

From the policy perspective, all states should issue directives on compulsory vaccination for measles. Mississippi and West Virginia have enacted the policies, ensuring that all school children are vaccinated for measles unless it endangers their lives (Chang, 2015). The policies would ensure increased safety from measles and reduce the possibility of an outbreak.


The recent case of measles in California demonstrated a case of imported outbreaks. Measles has contact transmission among human hosts, but the range of movement across the globe increases its risk factors. A measles outbreak will reduce productivity in school and businesses, and impose high costs on hospitals and the government. Consequently, detecting an outbreak requires immediate reporting to the next jurisdiction level. The state departments of health issue report to all stakeholders with information on their expected role. However, preventing a measles outbreak will require multiple strategies. It is necessary to educate the public, and also enhance monitoring of the disease and the maintenance of strict laws on vaccination.Measles Outbreak Nursing Paper Example