Community Health Communicable Disease: Measles
Renae Fitzgerald, R.N.
Western Governors University

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
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).
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. The largest portion of