Measles is making headlines, as nurses and other frontline care providers battle to care for infected patients and prevent the disease's spread.
The Centers for Disease Control and Prevention reports that from January 1 to April 26, 2019, there were 704 individual measles cases confirmed in 22 states. This means the public is in need of vaccine education. Rising numbers of measles cases are not limited to the U.S. The World Health Organization (WHO) reported on April 15 that preliminary global data suggests a 300% spike in cases in the first three months of 2019, compared to the same period in 2018.
"Measles is one of the world's most contagious diseases, with the potential to be extremely severe," according to a WHO news release. "Even in high-income countries, complications result in hospitalization in up to a quarter of cases, and can lead to lifelong disability, from brain damage and blindness to hearing loss. The disease is almost entirely preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85%. This is still short of the 95% needed to prevent outbreaks, and leaves many people, in many communities, at risk. Second dose coverage, while increasing, stands at 67%."
Measles prevention efforts in full force
To curb the outbreak in this country some lawmakers are working to limit parents' options for legally opting out of Measles, Mumps and Rubella (MMR) vaccinations for their children. One example is Washington state lawmakers recently voted to remove parents' ability to claim a personal or philosophical exemption from vaccinating their children for measles. Medical and religious exemptions will remain, according to a report on ABC News.
"Washington is among 17 states that allow some type of non-medical vaccine exemption for personal or philosophical beliefs," the report stated.
Other states are mulling bills aimed at increasing measles' vaccination rates. Policymakers in Maine are in the process of voting on a bill that would eliminate all non-medical exemptions for MMR. A similar proposal also is making headway in Oregon, where vaccine opposition is strong. "A similar proposal is advancing in Oregon, despite strong anti-vaccine sentiments in parts of the state," according to a recent article posted on The Hill. New York City officials announced in early April they were requiring some Brooklyn residents to get vaccinated against measles or face up to $1,000 fine amid an outbreak there, according to Time Magazine. Arthur Caplan, head of the division of medical ethics at the New York University School of Medicine and director of its Vaccine Ethics Project, told Time there's nothing ethically wrong with requiring vaccination in times of public health danger. Caplan said one can fine and quarantine people in times of public health danger, but cannot physically force a person to get a shot they don't want to get. Rather, one can threaten legal, financial or other consequences for noncompliance.
The threat and how nurses can help
Melody Butler, BSN, RN, CIC, founding executive director of Nurses Who Vaccinate, said there's a lot of dangerous misinformation about measles and how to prevent it. [caption id="attachment_55444" align="alignleft" width="300"]
Melody Butler, BSN, RN, CIC[/caption] "Nurses need to know that measles anywhere is a threat everywhere," Butler said. "Even though you may not have measles in your area, it is still a threat and it's something that we need to protect our patients from and advocate that everyone vaccinates on time." Unless children fall into certain categories, including being immuno-compromised or allergic to vaccines, they should be vaccinated, according to Butler. There also are other groups at risk for measles:
- People born before 1957 who were thought to be immune but are not
- Adults who think they might have had measles in childhood but did not
- Others who had only one of the two required MMR vaccines
"It's important that adults inquire about their immunization records and make sure they got both required boosters," she said. "And if you're a healthcare worker or are traveling to an area with an ongoing outbreak, you should talk to your healthcare provider about getting a titer, to see if you have the built-up antibodies present to protect you."
Why vaccine education is important
An April 17, 2019, post about Butler's organization Nurses Who Vaccinate on our Facebook page resulted in a flurry of responses suggesting even nurses are divided on the issue of whether to require children be vaccinated to prevent diseases like measles. Vaccines aren't perfect. Like any medication or medical intervention, vaccines can increase the risk of side effects or complications, according to Butler. "The most common side effect from being vaccinated is a sore arm or a slight low-grade fever prompted by the immune response," she said. "Your body is reacting as it should. It's building those antibodies." 
When one compares the risks from vaccines to the larger risk from the disease itself, time and time again, the vaccine wins, according to Butler. Butler said it's important nurses educate themselves by getting information from credible organizations, including the CDC and WHO. Nurses and others can even monitor U.S. settlements and claims regarding vaccines through the National Vaccine Injury Compensation Program. One way nurses can advocate for vaccines or educate parents and others about MMR and other vaccines is by becoming involved in Nurses Who Vaccinate, which has about 1,000 members, Butler said. Membership is free to those who want to join. Nurses Who Vaccinate is funded through private donations, primarily from nurses and parents, she said. "In our community we provide a forum for collaboration," she said. For example, nurses can meet other nurses in their states to come up with plans to meet with Departments of Health and work together to meet disease prevention needs and strengthen vaccination laws.
"It's not even always about the laws," Butler said. "Sometimes it's about hosting Q-and-A sessions for parents and getting the word out there or promoting social media advocacy, by helping to answer questions from mommy groups or communities when new parents are asking when their children should get vaccinations and what they should look for."
Butler, who works as an infection preventionist at Good Samaritan Hospital Medical Center in West Islip, N.Y., said nurses and other providers who suspect a patient has the measles should isolate the patient immediately in a negative pressure room. "Make sure you have N95 masks available to protect yourself," Butler said. "Measles is an airborne disease. Measles can stay airborne in a room for two hours after the infected patient has left, so you need to make sure that if you suspect measles that you are isolating that patient and not placing others at risk for getting that disease."
Take these courses about measles and vaccine education:
Measles: How to Approach Parents About Vaccination (1 contact hr) Measles is primarily a disease of childhood, but it can also occur in adolescents and adults. It is one of the most highly infectious human pathogens known. With exposure, up to 90% of susceptible individuals develop the disease. Measles is transmitted directly person-to-person via contact with respiratory droplets. Airborne transmission via aerosolized droplet nuclei has also been documented in closed areas (e.g., examination rooms), where the virus can remain suspended in the air for several hours. This module provides information for RNs, APNs, and physicians about measles and parental concerns regarding the safety of the MMR vaccine for their children. Childhood and Adolescent Immunization Update (1 contact hr) The 2014 measles outbreak in the U.S. brought home the challenges healthcare providers face in meeting Healthy People 2020 goals for prevention of infectious diseases related to living in a mobile society where diseases do not stop at geographical borders. Regular updates are made to the U.S. immunization schedule with an ongoing need for educating parents and the public. This updated CE module provides the background information needed to increase understanding about current recommendations and vaccination information needed to immunize children and adolescents appropriately. Adult Immunizations (1 contact hr) Vaccine-preventable diseases strike millions of adults annually. Not long ago, what nurses needed to know about immunizations was simple: Infants and young children received most of the vaccines, and adult immunizations could be counted on one hand, with a few fingers left over. However, recently the number of recommended immunizations for people of all ages has increased to a level not seen before, and the number of vaccines keeps rising. This module addresses various vaccine formulations and indications and provides resources for healthcare professionals to stay up to date on vaccine recommendations.
