Measles: Eliminated but Not Eradicated

In the June editorial (Critical Care Nurse. 2015;35[3]:10–14), several errors appeared in the table and text. This is a corrected version of the editorial published in the June issue.

If you were a critical care nurse as old as I am, you would most likely have personal experience with the measles virus, gained first-hand while attending elementary school, when you had your turn feeling foul and febrile while wearing a nasty red rash for a week or so. Some of us were provided with an additional opportunity to develop antibodies against measles by contracting both its more benign as well as more serious form. In addition to conferring immunity to future instances of this illness, one or more bouts of measles could also leave us with enduring recollections of how it looks and feels, memories that can serve in later years to recognize the reappearance of measles in children, grandchildren, or patients.

Critical care nurses whose academic and professional years have spanned only the past few decades, however, have had little opportunity to see measles in clinical practice. Since the first measles vaccine licensed in 1963¹  started eroding the scourge of this disease through the year 2000, when it was declared eliminated in the United States,²  and throughout the next decade, a median of only 60 cases of measles were reported in the United States annually. As a result, it would be entirely plausible for younger generations of critical care nurses to be more familiar with the measles- mumps-rubella (MMR) vaccine used since 1971³  than with specific attributes of the clinical entity itself.

Critical care nurses who are not members of the baby boomer generation may also be less familiar with the morbidity and mortality associated with measles that existed before an effective vaccine was produced. Centers for Disease Control and Prevention (CDC) estimate that between 1963 and 1973, some 3 to 4 million people in the United States were infected with measles annually, of whom 48 000 required hospitalization, 4000 were left with chronic disability from measles encephalitis, and 400 to 500 died.⁴  Measles was then and remains much more than an annoying childhood disease; it can and does disable and kill.

Between 2000 and 2013, the number of measles cases reported annually in the United States has varied from a low of 37 in 2004⁵  to more than 200 cases in 2011 and a few less than 200 in 2013. Nearly all of these cases were imported into this country from outbreaks originating in other parts of the world. A measles case is categorized as imported when exposure to the virus occurred outside the United States 7 to 21 days before the rash developed and the rash occurred within 21 days following entry into the United States, with no known exposure to measles within the United States during that time.⁶  In 2014, the United States experienced 644 cases of measles,⁷  the highest number reported in the past 20 years. Through April 24, 2015, the CDC reported a total of 5 outbreaks and 166 cases of measles in the United States, with the largest count in California⁷  (see Figure).

Owing to the current resurgence of this disease as well as to its potential for causing serious and even fatal outcomes together with the possibility that some critical care nurses may not be as familiar with it to recognize and protect against it, I am devoting this editorial to providing Critical Care Nurse readers with a synopsis of the essentials that critical care nurses need to know about this disease (see Table), derived primarily from our major resource for that information, the CDC.

Measles has never been eradicated from the United States. As the past 2 years have strikingly illustrated, cases will likely continue to arise as our citizens reenter or visitors newly enter our borders after contracting it elsewhere. Virtually all of the cases reported for 2014 (97%) were associated with importations rather than domestic origins.⁸  A majority of the importers are unvaccinated, as are those most likely to develop and spread the disease within the United States. The issue of some US citizens choosing to forego vaccination for themselves and/or their children has the potential for inflicting widespread public health burdens across our nation’s health care system. As the CDC so cogently summarized,⁶ 

Although critical care nurses may not be able to mitigate the introduction of measles into our homeland, we can surely make our contribution to minimizing the potential harm that measles can inflict upon our patients, our unit, our health care facility, and community. Our prompt recognition, isolation, confirmation, reporting, and management of measles can surely assist in curtailing its further penetration into our lives for generations to come.