Question

In a one-page essay, summarize the recent outbreaks of Measles from the standpoint of health

care providers. What is measles? How is measles spread? What must a health care provider be

looking out for (e.g. what are the 3Cs). At a clinic, pharmacy, or hospital, what precautions must

be taken if a patient presents with measles. Then, comment on how effective the vaccine is and

why people are not all people in LA vaccinated? Are there people that shouldn’t get the vaccine

for medical reasons? Are there people that should get it that don’t get it? Why

Answer 1

What is measles? How is measles spread? What must a health care provider be looking out for (e.g. what are the 3Cs). At a clinic, pharmacy, or hospital, what precautions must be taken if a patient presents with measles. Then, comment on how effective the vaccine is and why people are not all people in LA vaccinated? Are there people that shouldn’t get the vaccine for medical reasons? Are there people that should get it that don’t get it? Why

Ans:-

What is measles?

Measles is a highly contagious viral disease that can be fatal. In most people, the disease produces fever (temperature > 101 F [38.3 C]), a generalized rash that lasts greater than 3 days, cough, runny nose (coryza), and red eyes (conjunctivitis). The complications of measles that result in most deaths include pneumonia and inflammation of the brain (encephalitis).

Measles, or rubeola, is a viral infection that starts in the respiratory system. It still remains a significant cause of death worldwide, despite the availability of a safe, effective vaccine.

There were about 110,000 global deaths related to measles in 2017, most of them in children under the age of 5, according to the World Health Organization (WHO)Trusted Source. Measles cases have also been increasing in the United States in recent years.

People at High Risk for Complications

People at high risk for severe illness and complications from measles include:

· Infants and children aged <5 years

· Adults aged >20 years

· Pregnant women

· People with compromised immune systems, such as from leukemia and HIV infection

Learn more about the symptoms of measles, how it spreads, and how it can be prevented.

Measles symptoms

Symptoms of measles generally first appear within 10 to 12 days of exposure to the virus. They include:

• cough
• fever
• runny nose
• red eyes
• sore throat
• white spots inside the mouth

A widespread skin rash is a classic sign of measles. This rash can last up to 7 days and generally appears within 14 days of exposure to the virus. It commonly develops on the head and slowly spreads to other parts of the body.

Measles causes

Measles is caused by infection with a virus from the paramyxovirus family. Viruses are tiny parasitic microbes. Once you’ve been infected, the virus invades host cells and uses cellular components to complete its life cycle.

The measles virus infects the respiratory tract first. However, it eventually spreads to other parts of the body through the bloodstream.

Measles is only known to occur in humans and not in other animals. There are 24Trusted Source known genetic types of measles, although only 6 are currently circulating.

How is measles spread?

Transmission of Measles

Measles is highly contagious. It spreads when an infected person coughs or sneezes.

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed.

If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.

Infected people can spread measles to others from four days before through four days after the rash appears.

Measles is a disease of humans; measles virus is not spread by any other animal species.

Is measles airborne?

Measles can be spread through the air from respiratory droplets and small aerosol particles. An infected person can release the virus into the air when they cough or sneeze.

These respiratory particles can also settle on objects and surfaces. You can become infected if you come into contact with a contaminated object, such as a door handle, and then touch your face, nose, or mouth.

The measles virus can live outside of the body for longer than you may think. In fact, it can remain infectious in the air or on surfaces for up to two hoursTrusted Source.

Is measles contagious?

Measles is highly contagious. This means that the infection can spread very easily from person to person.

A susceptible person that’s exposed to the measles virus has a 90 percent chance of becoming infected. Additionally, an infected person can go on to spread the virus to anywhere between 9 and 18 susceptible individuals.

A person that has measles can spread the virus to others before they even know that they have it. An infected person is contagious for four days before the characteristic rash appears. After the rash appears, they’re still contagious for another four days.

The main risk factor for catching measles is being unvaccinated. Additionally, some groups are at a higher risk of developing complications from measles infection, including young children, people with a weakened immune system, and pregnant women.

Diagnosing measles

If you suspect that you have measles or have been exposed to someone with measles, contact your doctor immediately. They can evaluate you and direct you where to be seen to determine if you have the infection.

Doctors can confirm measles by examining your skin rash and checking for symptoms that are characteristic of the disease, such as white spots in the mouth, fever, cough, and sore throat.

If they suspect you may have measles based on your history and observation, your doctor will order a blood test to check for the measles virus.

The 3 Cs of measles

"Measles is a viral infection that can present in a number of ways, typically referred to as the three Cs: cough, coryza and conjunctivitis, plus fever and then a rash

Initial symptoms of measles include:

• Dry cough
• Coryza - running nose
• Conjunctivitis - inflamed watery eyes (pink eye)
• High fever

"The typical rash progression usually starts at the head and works its way down, but that doesn’t happen in all cases. Kids can feel quite miserable, like with many other viral infections, but there are some serious complications that can develop as well,"

Complications from measles can range from an ear infection or diarrhea to more severe medical problems such as encephalitis.

The severe complications can be long-lasting and possibly lead to death. The CDC says out of 1,000 children infected with measles, one or two children will die.

"We know that one dose of measles, mumps and rubella (MMR) vaccine is about 93% effective. Two doses, which is the recommendation, is about 97% effective. Any childhood case of measles or death from measles is completely preventable at this point."

The Centers for Disease Control and Prevention recommends all children get two doses of MMR vaccine, starting with the first dose at 12–15 months and the second dose at ages 4–6.

Prevention and Control Recommendations for Measles in Healthcare

Fundamental Elements to Prevent Measles Transmission

Measles is most commonly acquired from persons in the household or community, but spread of measles can also occur in healthcare settings.

During 2001-2014, 6% of non-imported measles cases in the United States resulted from transmission in healthcare facilities. Fiebelkorn AP, Redd SB, Kuhar DT.

While the most important measure to prevent measles transmission in all settings is ensuring community immunization, core measles prevention in healthcare settings requires a multi-faceted approach including:

• Ensuring HCP have presumptive evidence of immunity to measles
• Rapidly identifying and isolating patients with known or suspected measles
• Adhering to Standard and Airborne Precautions for patients with known or suspected measles
• Routinely promoting and facilitating respiratory hygiene and cough etiquette
• Appropriately managing exposed and ill HCP

This interim guidance should be implemented in the context of a comprehensive infection prevention program to prevent transmission of all infectious agents among patients, HCP, and visitors.

Definition of healthcare personnel (HCP): “HCP” includes all paid and unpaid persons working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. HCP include but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).

Definition of healthcare settings: “Healthcare settings” refers to places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute care facilities, inpatient rehabilitation facilities, nursing homes and assisted living facilities, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, and others.

Definition of exposure to measles for HCP in healthcare settings: HCP exposures to measles in a healthcare setting include spending any time while unprotected (i.e., not wearing recommended respiratory protection):

• In a shared air space with an infectious measles patient at the same time, or
• In a shared air space vacated by an infectious measles patient within the prior 2 hours

Treatment for measles

There’s no specific treatment for measles. Unlike bacterial infections, viral infections aren’t sensitive to antibiotics. The virus and symptoms typically disappear in about two or three weeks.

There are some interventions available for people who may have been exposed to the virus. These can help prevent an infection or lessen its severity. They include:

• a measles vaccine, given within 72 hours of exposure
• a dose of immune proteins called immunoglobulin, taken within six days of exposure

Your doctor may recommend the following to help you recover:

• acetaminophen (Tylenol) or ibuprofen (Advil) to reduce fever
• rest to help boost your immune system
• plenty of fluids
• a humidifier to ease a cough and sore throat
• vitamin A supplements

Measles prevention

There a few ways to prevent becoming ill with measles.

Vaccination

Getting vaccinated is the best way to prevent measles. Two doses of the measles vaccine are 97 percentTrusted Source effective at preventing measles infection.

There are two vaccines available — the MMR vaccine and the MMRV vaccine. The MMR vaccine is a three-in-one vaccination that can protect you from measles, mumps, and rubella. The MMRV vaccine protects against the same infections as the MMR vaccine and also includes protection against chickenpox.

Children can receive their first vaccination at 12 months, or sooner if traveling internationally, and their second dose between the ages of 4 and 6. Adults who have never received an immunization can request the vaccine from their doctor.

Some groups shouldn’t receive a vaccination against measles. These groups include:

• people who’ve had a previous life-threatening reaction to the measles vaccine or its components
• pregnant women
• immunocompromised individuals, which can include people with HIV or AIDS, people undergoing cancer treatment, or people on medications that suppress the immune system

Side effects to vaccination are typically mild and disappear in a few days. They can include things like fever and mild rash. In rare cases, the vaccine has been linked to low platelet count or seizures. Most children and adults who receive a measles vaccine don’t experience side effects.

Some believe that the measles vaccine can cause autism in children. As a result, an intense amount of study has been devoted to this topic over many years. This research has found that there is no linkTrusted Source between vaccines and autism.

Vaccination isn’t just important for protecting you and your family. It’s also important for protecting people who can’t be vaccinated. When more people are vaccinated against a disease, it’s less likely to circulate within the population. This is called herd immunity.

To achieve herd immunity against measles, approximately 96 percentTrusted Source of the population must be vaccinated.

Other prevention methods

Not everyone can receive the measles vaccination. But there are other ways that you can help to prevent the spread of measles.

If you’re susceptible to infection:        

• Practice good hand hygiene. Wash your hands before eating, after using the bathroom, and before touching your face, mouth, or nose.
• Don’t share personal items with people who may be ill. This can include things like eating utensils, drinking glasses, and toothbrushes.
• Avoid coming into contact with people who are sick

If you’re sick with measles:

• Stay home from work or school and other public places until you aren’t contagious. This is four days after you first develop the measles rash.
• Avoid contact with people who may be vulnerable to infection, such as infants too young to be vaccinated and immunocompromised people.
• Cover your nose and mouth if you need to cough or sneeze. Dispose of all used tissues promptly. If you don’t have a tissue available, sneeze into the crook of your elbow, not into your hand.
• Be sure to wash your hands frequently and to disinfect any surfaces or objects that you touch frequently.
• avoid work or school for at least 4 days from when you first developed the measles rash
• try to avoid contact with people who are more vulnerable to the infection, such as young children and pregnant women, while you're ill

Measles during pregnancy

Pregnant women who don’t have immunity to measles should take care to avoid exposure during their pregnancy. Coming down with measles during your pregnancy can have significant negative health effects on both the mother and fetus.

Pregnant women are at an increased risk for complications from measles such as pneumonia. Additionally, having measles while pregnant can lead to the following pregnancy complications:

• miscarriage
• preterm labor
• low birth weight
• stillbirth

Measles can also be transmitted from mother to child if the mother has measles close to her delivery date. This is called congenital measles. Babies with congenital measles have a rash after birth or develop one shortly afterward. They’re at an increased risk of complications, which can be life-threatening.

If you’re pregnant, don’t have immunity to measles, and believe that you’ve been exposed, you should contact your doctor immediately. Receiving an injection of immunoglobulin may help to prevent an infection.

Measles prognosis

Measles has a low death rate in healthy children and adults, and most people who contract the measles virus recover fully. The risk of complications is higher in the following groups:

• children under 5 years old
• adults over 20 years old
• pregnant women
• people with a weakened immune system
• individuals who are malnourished
• people with a vitamin A deficiency

Approximately 30 percent Trusted Source of people with measles experience one or more complications. Measles can lead to life-threatening complications, such as pneumonia and inflammation of the brain (encephalitis).

Other complications associated with measles may include:

• ear infection
• bronchitis
• croup
• severe diarrhea
• blindness
• pregnancy complications, such as miscarriage or preterm labor
• subacute sclerosing panencephalitis (SSPE), a rare degenerative condition of the nervous system that develops years after infection.

Measles Vaccination

Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.

Measles can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles virus-containing vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others.

Contraindications for MMR vaccination:

Contraindications for MMR vaccination include history of a severe (anaphylactic) reaction to a previous dose or to any component of the vaccine (such as gelatin or neomycin), pregnancy and immunosuppression.

The attenuated vaccine strain of measles is propagated in chick embryo cell culture and is grown in a buffered salt solution (Medium 199) plus sucrose, phosphate, glutamate, neomycin and recombinant human albumin. Sorbitol and hydrolyzed gelatin are added as a stabilizer for rubella virus. MMR vaccine does not contain penicillin. A history of penicillin or cephalosporin allergy is not a contraindication to vaccination with MMR or any other U.S. vaccine.

Women known to be pregnant should not receive measles vaccine, although evidence does not suggest an increased risk of adverse effects among infants born to women who inadvertently receive MMR during pregnancy. Close contact with a pregnant woman is not a contraindication to MMR vaccination of the contact.

Breastfeeding is not a contraindication to vaccination of either the woman or the breastfeeding child. An immunized person does not shed or transmit the attenuated vaccine measles strain.

Replication of attenuated vaccine viruses can be prolonged in people who are immunosuppressed. Patients who are severely immunocompromised should not be given MMR vaccine. Healthy susceptible close contacts of severely immunocompromised people should be vaccinated. Patients with leukemia in remission who have not received chemotherapy for at least three months may receive MMR.

Precautions to MMR administration include acute severe illness, high-dose steroid use, recent receipt of a blood product or a history of thrombocytopenia.

People with moderate or severe acute illness should not be vaccinated until the illness has improved. This precaution is intended to prevent complicating the management of an ill patient with a potential vaccine adverse reaction, such as fever. Minor illness (e.g., otitis media, mild upper respiratory or gastrointestinal infections) or concurrent antibiotic therapy is not a precaution to measles vaccination. Fever alone is not a contraindication.

Unless benefit is felt to outweigh risk, a person receiving daily high-dose corticosteroid therapy (2 or more milligrams/kilogram per day or 20 mg or more per day of prednisone) for 14 days or more should not receive MMR vaccine. MMR administration should be avoided for four weeks after cessation of high-dose therapy. In most cases, people receiving low-dose (less than 2 mg/kg/day) or short-course (less than 14 days) corticosteroid therapy, alternate-day treatment, maintenance physiologic doses, or topical, aerosol, intra-articular, bursal or tendon injections may be vaccinated.

Receipt of antibody-containing blood products (e.g., immune globulin, whole blood or packed red blood cells, intravenous immune globulin) may interfere with seroconversion after measles vaccine administration.

In the past, people with a history of anaphylactic reactions following egg ingestion were considered to be at increased risk for reactions after receipt of MMR. The risk of a hypersensitivity reaction (anaphylaxis) to egg protein (ovalbumin) now is recognized as extremely rare following MMR administration, and egg allergy is no longer a contraindication. Skin testing with vaccine is not recommended because it does not predict an allergic reaction.

People with a history of thrombocytopenia may be at increased risk for developing thrombocytopenia after MMR vaccination. However, no reports describe hemorrhagic complications due to thrombocytopenia after MMR administration. The benefits of immunization usually are greater than the potential risks, and vaccination is justified because of the even greater risk for thrombocytopenia after measles disease.

Epidemiological surveillance

· Surveillance systems must continue to carry out early detection and the management of VPD cases, at a minimum for diseases with global surveillance mandates and elimination objectives such as measles and rubella, among others.

· During an outbreak and when it is not possible to confirm the suspected cases by laboratory, classifications of a confirmed case may be based on clinical criteria (fever, rash, cough, coryza and conjunctivitis) and epidemiological link, in order to not delay the response actions.

· Routine surveillance for other VPD should continue as long as possible; when laboratory testing is not possible, samples should be stored appropriately for confirmation when laboratory capacity permits testing. Countries should ensure sufficient sample storage capacity at the provincial and central levels and this should be monitored regularly.

· Strengthen epidemiological surveillance in border areas to rapidly detect and respond to highly suspected cases of measles.

Rapid response

· Provide a rapid response to imported measles cases to avoid the re-establishment of endemic transmission, through the activation of rapid response teams trained for this purpose, and by implementing national rapid response protocols when there are imported cases. Once a rapid response team has been activated, continued coordination between the national and local levels must be ensured, with permanent and fluid communication channels between all levels (national, sub-national, and local).

· During outbreaks, establish adequate hospital case management to avoid nosocomial transmission, with appropriate referral of patients to isolation rooms (for any level of care) and avoiding