Measles

Abstract

:Measles is a vaccine-preventable, highly contagious virus once considered eradicated in the US. It is still a significant source of morbidity and mortality for children under 5 years of age worldwide. Advanced practice registered nurses are on the frontlines of reducing the spread of disease and educating the community on measles prevention.

The Resurgence of Measles

“…Once a vaccine was made available in 1963, the mortality and morbidity of the disease was significantly reduced. In 2000, the United States declared measles eradicated as there were no endemic cases reported in the previous year; unfortunately, that no longer remains the case (Alves Graber et al, 2020; Feutz & Shirley, 2022; O’Donnell et al, 2019). Despite the availability of an effective vaccine, in 2021 measles claimed over 100,000 lives worldwide, most being younger pediatric patients (Blutinger et al, 2023; O’Donnell et al, 2019; WHO, 2023).…”

“…Usually within 4 days of fever onset, the morbilliform rash appears which starts the viral exanthem phase. A red maculopapular rash (Figure 2) starts on the head, most often in the hairline and behind the ears, then slowly spreads down to the trunk, and then to the extremities (Alves Graber et al, 2020; Blutinger et al, 2023; Feutz & Shirley, 2022; Stinchfield, 2019). As the rash spreads, it often becomes confluent (Figure 3) in nature (Stinchfield, 2019; Strebel & Orenstein, 2019).…”

“…Another differential to consider is scarlatina, sometimes referred to as scarlet fever, usually resulting from group A strep pharyngitis. More significant differentials to consider include Kawasaki disease, dengue fever, tick-borne illnesses, and drug-related reactions and eruptions (Feutz & Shirey, 2022; O’Donnell et al, 2019; Porter & Goldfarb, 2019).…”

“…There are no antivirals currently approved for the treatment of measles. Ribavirin and interferon have been used off-label to manage immunocompromised patients with acute measles, and their use was associated with improved outcomes (Alves Graber et al, 2020; Feutz & Shirey, 2022; Strebel & Orenstein, 2019). Further research is needed to evaluate and demonstrate the safety and efficacy of these medications.…”

“…The American Academy of Pediatrics and the CDC recommend vitamin A supplementation (Table 2) for all pediatric patients with measles, especially those with immunocompromised states, as it is associated with a reduced risk of complications, especially in younger children (Blutinger et al, 2023; CDC, 2020; Feutz & Shirey, 2022; Strebel & Orenstein, 2019). Adults with an underlying deficiency have an increased incidence of complications, and may also benefit from supplementation (Blutinger et al, 2023).…”