Topic About Measles: What Is It And Risks Of Its Spread

When discussing measles, an acute and highly contagious viral respiratory infection, it is important to note that it is the number one vaccine preventable killer of children and the most common killer of children less than five years of age (Gans & Maldonado, 2017; World Health Organization [WHO], n.d.-a). In addition to unvaccinated children, high risk populations also include any unvaccinated person, partially vaccinated persons and those individuals where measles failed to provide an immune response (Center for Disease Control and Prevention [CDC], 2017a; Gans & Maldonado, 2017; CDC, 2017b). Measles is caused by a virus in the genus Morbillivirus of the Paramyxoviridae family, which is also responsible for mumps, respiratory syncytial virus (RSV) and human parainfluenza virus (HPIV) infections (Burrell, Murphy, & Howard, 2017). Common symptoms of measles typically emerge after a seven to fourteen day incubation period and typically last seven to ten days (Jiang, Qin & Chen, 2016).

Characteristics are an early fever as high as 105⁰ F, cough, irritation of nasal membranes, conjunctivitis and malaise (CDC, 2017a). The disease progresses to include characteristic Koplik spots, ulcerations of mucous membranes and a maculopapular rash that spreads from the head to the lower extremities (CDC, 2017a). The measles virus, with an attack rate of 90%, is spread through direct transmission via infectious droplets which have been noted to be able to remain airborne for up to 2 hours (CDC, 2017a; Gans & Maldonado, 2017; Jiang, Qin & Chen, 2016). Affected individuals are believed to remain contagious for five days prior to rash appearance to four days after (Gans & Maldonado, 2017). A major sequela of a measles infection is long term immunosupression (Jiang, Qin & Chen, 2016). Because of this fact, potential complications are numerous and often include bacterial super infections (such as otitis media, bronchitis, pneumonia and diarrhea), post infectious encephalomyelitis (PIE), or a sub-acute sclerosing panencephalitis (CDC, 2017a; Jiang, Qin & Chen, 2016). There is currently no treatment for the measles virus; however, the complications of measles can be lessened through appropriate supportive therapies such as fluid replacement, appropriate treatment of secondary infections, and, in children, two supplemental doses of vitamin A (CDC, 2017a; WHO, n.d.-b). Globally, 267,000 measles cases are reported annually with 146,000 estimated deaths (CDC, 2016). These figures result in a mortality rate of 1.96 per 100,000 people, a morbidity rate of 3.59 per 100,000, an incidence rate of 3.32 per 100,000 and a prevalence rate of 5.71 per 100,000 based on the global population and WHO figures for 2016 (CDC, 2016; World Bank, n.d.)

Determinants of Health

When assessing the determinants of health in relation to measles, one must consider the degree of vaccine utilization as a primary source of disease proliferation and prevention. In the United States alone, prior to vaccination, 3-4 million cases were reported annually (CDC, 2016). From a biologic perspective, there is no link between measles infection and gender; there is however, increased risk in the very young, as the measles vaccine is not recommended until the age of 12-15 months. Various studies analyzing different geographic locations have discovered different contributing factors to vaccine utilization.

In low income countries, common hurdles to disease eradication include inconsistent vaccine supply and inadequate infrastructure (causing inadequate health care access, poor parental education, and cramped living situations) (Mazige, Kalwani & Vitalis, 2016). The utilization of traditional healers, religious beliefs, financial factors, war, and government engagement has also been noted as negative contributory factors (Mazige, Kalwani & Vitalis, 2016). High and middle income countries share some of the same obstacles as low income countries, such as urban versus rural location, religious beliefs and financial factors (Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye & Beckles 2016). Additionally, high and middle income countries cite misinformation, vaccine safety concerns, and alternative medicine as influencing factors (Penman-Aguilar et al., 2016). The umbrella hurdles of poor vaccine utilization, overcrowded living conditions and health care access are the greatest factors of disease proliferation.

Host Factors

Host factors increasing susceptibility for measles infection can be listed as a negative protective immune response, presence of diseases that impair immune function (such as leukemia and HIV) and absence of vaccination (CDC, 2017a). Because measles has a higher rate of incidence in developing countries with unstable infrastructure, malnutrition, specifically a vitamin A deficiency, has been noted to be an influencing factor is disease prognosis (WHO, n.d.-b). In addition to malnutrition and vitamin deficiency, many of the above mentioned determinants of health are influential in continued disease presence for the same reasons.Because measles carries an estimated 90% attack rate, its presence is enough to begin the disease process (Gans & Maldonado, 2017). Measles enters the body via infected droplets and binds to host cell surfaces and begins transcription (Jiang, Qin & Chen, 2016). After transcription, replication begins within the host cell via proteins (Jiang, Qin & Chen, 2016). A hallmark of measles replication is the infection of neighboring cells creating a multinucleated cell of the disease positive virus that is responsible for inhibition of T and B cells, amongst others, resulting in temporary loss of immunity and general immune suppression (Jiang, Qin & Chen, 2016). The infected T and B cells then spread the virus throughout the body.

Family Nurse Practitioner Influence

The increased presence of healthcare providers whose focus is prevention is paramount for disease eradication. The family nurse practitioner (FNP) is able to provide necessary education, clarify misinformation and increase access to care, often in rural areas. The astute FNP is able to not only prevent measles through preventative measures, but also to recognize and react in a proactive manner. Because measles is a disease that requires mandatory reporting, the FNP is able to assist and promote the leading organizations in furthering health care promotion through case recognition, data collection and examination, and appropriate follow up (Roush, Mcintyre, Baldy & CDC, 2013). The increased presence of providers enhances surveillance strategies through rapid identification and control and containment (Roush, McIntyre, Baldy & CDC, 2013). In summary, measles, the acute and highly contagious viral respiratory infection, carries significant risk of severe harm to at risk populations. The FNP is able to support global eradication and surveillance efforts through a focus on increased vaccination and improved healthcare access.