Running head: MEASLES 1

Measles
Erin Ludwick
Ferris State University

NURS 319


MEASLES 2
Abstract
The measles is a very contagious viral illness. It is spread through aerosol transmission, making
it very easy to contract. History has noted measles in medical documentation since the ninth
Century, and it was almost inevitable that a person would contract the illness sometime
throughout their lifetime. It was not until the 1960s that the vaccine was made available, which
all but eliminated the disease. Recently, a vaccine scare in the United States meant many parents
chose not to vaccinate their children. This caused the number of measles cases to surge for a
short time. Many studies have been completed on the validity of the scare and it was proven time
and time again to be false, leading to parents vaccinating their children again. The number of
measles cases is back on the downslope, but its only a matter of time before the next epidemic
affects the numbers again.

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Measles
The measles is a respiratory illness caused by a virus. Although the measles were almost
completely wiped out due to immunizations, recent social factors have contributed to a lack of
vaccinations and a significant increase in cases. Here, we will discuss measles as a whole,
critically analyze the data received about the measles, and examine the recent issues regarding
immunizations.
Descriptive Summary
The measles, also known as Rubeola, is a respiratory illness. Caused by a morbillivirus,
the measles is a member of the Paramyxovirus family (Hunt, 2008). According to the Centers for
Disease Control (2014), the virus grows within the cells that line the back of the throat.
The measles virus is typically transmitted through aerosol route. Infected patients
contract the virus by making contact with droplets from the nose, mouth, and throat of infected
persons. Sneezing and coughing are two main ways measles gets transmitted ("PubMed," 2012).
According to the Mayo Clinic (2011), the virus can live on untreated surfaces for hours. It is
estimated to have an eight to twelve day incubation period (Mayo Clinic, 2011).
The clinical presentation of measles appears typical to other virus-caused illnesses with a
few obvious manifestations. Generally speaking, patients infected with the measles will present
with flu-like symptoms such as blood-shot eyes, cough, fever, sore throat, and muscle pain
("PubMed," 2012). The measles virus will produce a distinct rash that appears approximately
three days after symptoms show and typically lasts for four to seven days. The rash consists of
both macules, which appear flat and discolored, and papules, which are raised, red, and solid.
Eventually, both the macules and papules will join ("PubMed," 2012). The rash will start at the
head and work its way down the body, affecting the trunk and upper extremities next and lower
MEASLES 4
extremities last. It will generally cause extreme itchiness. According to the Mayo Clinic (2011),
fever will increase as the rash makes its way down the body.
Measles patients may also present with Kopliks sign. Kopliks sign is tiny, white spots in
the mouth. These spots resemble white grains of sand with rings of red around them ("Kopliks,"
2012). Although they can be found all over the mouth, they are typically found inside the cheek.
Complications of the measles can include ear infections, pneumonia, encephalitis, and
death. According to the Centers for Disease Control (2014), approximately one in every 10
children will develop an ear infection and one in every 20 children will develop pneumonia. It is
highly unlikely the patient will develop encephalitis or die, but it is still a risk. Pregnant women
who become infected with the measles may miscarry or develop preterm labor.
The measles is diagnosed with a combination of clinical manifestations and measles
serology. Rarely, a virus culture is completed (Centers for Disease Control [CDC], 2014).
Unfortunately, there is no treatment for the measles virus. The goal is to treat the manifestations
and any complications that occur. According to the Mayo Clinic (2011), patients who have been
exposed to the measles and have not previously received the immunization may receive the
vaccine within 72 hours of exposure. This can be difficult to achieve due to the long incubation
period and vague flu-like symptoms that appear before the discernable manifestations. Pregnant
women, infants, and people with weakened-immune systems may receive an immune serum
globulin. An immune serum globulin is an injection of antibodies (Mayo Clinic, 2011). As is the
vaccine, the immune serum globulin is only utilized within a few days of exposure to the virus.
Treatment of symptoms includes the use of anti-pyretic, antibiotics, and Vitamin A. Vitamin A is
given in the hope that the severity of symptoms will decrease, although they will not completely
cease. Management should also include minimizing exposure to others.
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Being vaccinated is still considered the best way to avoid the measles. Currently, a live
attenuated vaccine is used. The measles vaccine is part of a three-part vaccine, which also
includes a Mumps vaccine and Rubella vaccine. Utilization of this vaccine has all but eliminated
the measles altogether.
Analysis
According to the CDC (2014), the measles virus was first noted in medical documents by
an Arab doctor around the nin
th
century. It was not until the 1960s that a vaccine became
available. From the time it was first discovered until a vaccine was introduced, the measles was
thought of as an inevitable illness, much like the common cold is today.
Prior to the vaccine being available, measles was continuously being spread throughout
the population. For many, it was inevitable that they got the measles. The first documented case
of the measles in the United States was in 1657 in Boston, Massachusetts. It started spreading
like wildfire due to its highly contagious mode of transportation, infecting entire colonies and
Native American tribes. The measles even played a role in the Civil War in the 1860s, with over
67,000 cases reported. Of those cases, over 4,000 patients died (Oldstone, 2009). This means that
4,000 soldiers sent to war died not from battle, but from the measles.
In the few years before the measles vaccine was available, studies showed that threefour
million people in the United States became infected each year (CDC, 2014). Of those infected,
400500 died, 48,000 were sent to the hospital, and another 1,000 developed chronic disability
from measles encephalitis (CDC, 2014). Extensive use of measles vaccine has resulted in a more
than 99% reduction in measles cases in the U.S. In 2012, only 55 cases of measles were reported
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in the United States (CDC, 2014). However, measles is still quite common in other countries. It
is estimated that in 2008 there were 164,000 measles deaths worldwide (CDC, 2014).
Initially, there were two types of vaccines developed to combat measles. One vaccine
was established from a virus that had been destroyed. The second vaccine was developed using a
live measles virus that was diminished, or attenuated (Hooker, 2014). This weakened virus was
unable to cause a full case of measles. Unfortunately, the vaccine made with destroyed parts of
the virus was not effective in preventing people from getting the disease, and it was discontinued
in 1967. The live virus vaccine has been further attenuated to make it safer and today is
exceptionally effective in preventing the disease. The vaccine used currently is an attenuated
vaccine.
Although the measles vaccine, now part of the MMR vaccine (measles, mumps, and
rubella), has little to no side effects, all vaccines carry a risk. The Institute of Medicine
conducted a study regarding to review the evidence between adverse health problems and
vaccines (Institute of Medicine, 2011). This study was to help determine whether the adverse
health problems were due to the vaccines or if they were purely coincidental. It included
numerous vaccines, including the MMR vaccine. According to the Institute of Medicine (2011),
the results showed that the MMR vaccine had a convincingly supports a relationship to
measles inclusion body encephalitis, febrile seizures, and anaphylaxis. Measles inclusion body
encephalitis is when the white and gray matter of the brain become inflamed, causing seizures,
coma, and death (Chadwick, Martin, Buxton, & Tomlinson, 1982). These cases include
immunosuppressed patients who have had the measles or the vaccine within the past year
(Institute of Medicine, 2011).
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The study also suggests a strong correlation between the MMR vaccine and transient
arthralgia, which is temporary joint pain. Adult females are particularly vulnerable to this
adverse effect. Although the correlation is strong, there is no concrete evidence to absolutely link
the two together (Institute of Medicine, 2011).

Promoting Factors
The main factor promoting the influx of measles cases is lack of vaccination. In the late
1990s, a research article emerged citing a connection between the MMR vaccine (Mumps,
Measles, and Rubella vaccine) and Autism, a developmental disorder of the brain that causes
communication difficulties, repetitive behaviors, motor dysfunction, and difficulties with social
interactions (Wakefield et al., 1998). After the article, numerous people made it their lifes
mission to dispan the vaccines by initiating an anti-immunization campaign. Even though at the
time there were numerous studies citing no such correlation, the group pressed on and continued
to grow. Finally, an impressive amount of medical associations (including the Centers for
Disease Control, Pediatric Medical Associates, and Autism Speaks Association) came together
and provided an overwhelming amount of research against the correlation. Many of the authors
of the original article published and retracted their research, and the main author, Dr. Andrew
Wakefield, was even found guilty of callous disregard for the pain of children for his
contributions and lack of authentic research ("The New Yorker," 2013, para. 3).
Even though the article was retracted and proven to be false, the damage has been done.
Concerned parents are still firmly against the research and public health officials in a tight debate
between the pros and cons of vaccinating children. As more and more families refuse the barrage
of shots to protect the population against diseases such as the measles, public health risks rise for
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everyone else (American Society of Registered Nurses, 2008). Parents who opt not to vaccinate
their children usually do so for one of two reasons. First, parents believe they are protecting their
children from feared risks of vaccinations, such as autism. They may also feel that their children
will be safe from diseases like the measles due to the "herd" factor. The theory distinguishes that
vaccinated children cannot act as vectors to spread illness (American Society of Registered
Nurses, 2008). As a result, unvaccinated children will be protected by association with the
majority of children who have been immunized. This way of thinking is that if everyone else is
vaccinated, why should I vaccinate my child?
There are significant two flaws in this logic. First, vaccines are not 100% effective. The
measles vaccine, for example, is only 95 percent effective (American Society of Registered
Nurses, 2008). Second, vaccinations have a recommended schedule to follow. If a given disease
is reintroduced to a population, children who arent quite old enough for certain vaccinations are
especially vulnerable to infection and able to spread that infection to others (American Society of
Registered Nurses, 2008).
Conclusion
Measles is a viral infection that is highly contagious. History has shown the affects it can
have on mass populations. Vaccination has decreased the number of cases significantly, although
it is still a choice for parents to make. Parents should research all evidence in order to make an
informed decision on whether or not to vaccinate against the measles. The number of measles
cases is back on the downslope, but its only a matter of time before the next epidemic affects the
numbers again.

MEASLES 9
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