Rubeola or measles

8 August 2016

Rubeola, or measles, is a communicable disease that is highly contagious and easily spread from person to person through close physical contact or direct contact with infected bodily secretions. “Measles is caused by a virus in the paramyxovirus family” (“Measles,” 2013). Paramyxoviruses are single-stranded RNA viruses that infect respiratory cells. If an infected individual coughs or sneezes they expel mucous membrane cells within their secretions. The virus stays active and therefore contagious for up to 2 hours in the air and on surfaces.

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People can contract the illness by touching contaminated surfaces and then transferring the infected cells to their own person. The primary at risk groups for contracting measles are unvaccinated young children and non-immune individuals. The symptom onset of measles initially presents 10-12 days after exposure has occurred. It begins with a fever greater than 100. 4F, runny nose, cough, conjunctivitis, malaise, and white spots inside the cheeks. A rash follows that typically starts on the head and migrates downward to the hands and feet.

The rash typically remains for 5-6 days and then fades. Dehydration often results secondary to the fever. Serious complications can happen and are more common in developing countries where malnourishment and vitamin A deficiencies are more prevalent. One in ten cases results in ear infections, which is the most common secondary infection seen globally. However, in developing countries, pneumonia and diarrhea are seen in one in five cases. A severe complication that can result from a measles infection is encephalitis.

Encephalitis is swelling in the brain, it starts with the high fever and headaches and progresses to loss of motor function, cognitive impairments, seizures, blindness and eventually death. Death secondary to measles is caused by these secondary infections and severe complications. Should a person exposed to measles survive the disease process they will acquire natural immunity to the disease. Epidemiological Data and Analysis With the discovery of vaccinations and the widespread availability of these vaccinations, the mortality rate of rubeola has been dramatically improved upon. Prior to 1980, and the beginning of the expanded vaccination efforts, approximately 2.6 million deaths occurred each year throughout the world. (“Measles”, 2013).

As of 2000, measles is no longer considered to be endemic in the U. S. , which effectively equates to eradication of the disease throughout the year in this country. However, due to ease of global travel and the disease prevalence outside the U. S. , measles cases continue to occur within our borders. The disease was the cause of approximately 158,000 deaths worldwide in 2011, the majority of which were children under 5 years of age. During the same year only 222 total cases were reported in the U.S. with no deaths resulting.

These cases occurred in 17 separate areas and in each instance the primary infection was found to have originated outside of U. S. borders. The United States has an overall vaccination rate for measles of 90. 8% of children having received initial immunization by 35 months of age per the Centers for Disease Control and Prevention. The elimination of the disease process within the U. S. can be attributed to the high vaccination rate achieved. As previously stated, worldwide there were approximately 158,000 deaths in 2011 secondary to measles.

Per the World Health Organization, this was a 71% decrease from the reporting period ending in 2000 where there was an estimated 548,000 deaths caused by the measles virus. “In 2011, about 84% of the world’s children received one dose of measles vaccine by their first birthday…” (“Measles,” 2013). These vaccination efforts have been effective in decreasing the mortality and morbidity rate on a global scale. Community Effect Should a measles outbreak occur in Bay County Florida, approximately 3,337 people or 9% of the population under the age of 18 would have the potential for exposure to the disease.

Per the 2010 census there were 37,076 people under the age of 18 that resided in Bay County. Florida has a vaccination rate of 91% of all children having received the measles vaccine as recommended. Due to the delayed incubation period of the disease, school aged children may have interaction will their peers and allow for exposure to occur prior to symptoms presenting. SARS Outbreak The reporting system for communicable disease is a five class system dependent on the disease as determined by the CDC and WHO. SARS (severe acute respiratory syndrome) is a class 2 disease.

Upon initial suspicion of the diagnosis of SARS the provider should immediately notify the local health department by phone (24 hours a day 7 days per week) of the suspected diagnosis. Laboratory testing should be ordered at that point and the individuals in question should be quarantined pending laboratory results. The infected individuals’ personal contacts must be traced and all individuals that the suspected infected person had close personal contact with, where the potential for droplet transfer may have occurred, must also be quarantined and tested.

The local health authorities will then notify the state and federal agencies as protocols dictate. Air Quality Index Upon receiving patients into their care, the community health nurse should complete a thorough history and physical on the client. Initial care of the patients should already include ensuring they have and maintain adequate rescue medications in their home and instructions should be given to ensure they keep these medications with them when they venture outside. Education should be provided to ensure the patient is capable of utilizing these medications and that they understand when to implement their use.

Initial intake should also include determining the most effective strategies they can employ during episodes of dyspnea, whether it is a simple position changes or rescue medications, ensuring patient understanding of care is a must. Their homes should be evaluated for potential pollutants and they should be instructed to maintain air filter systems in their homes. Patients should be taught how to monitor for outdoor air quality either through the internet or new media on a daily basis. When the air quality index is poor, patients with asthma and other respiratory diseases can be drastically affected in a negative manner.

The community health nurse must ensure that each patient is safe in their environments. Instructions must be relayed to them that the air quality level could adversely affect them. A phone tree or automatic messaging system could be employed to ensure each patient receives and update as to the condition changes and its potential effect on their health. They should be instructed to avoid being outdoors and to maintain in home air quality utilizing air filtering through their heat or air conditioning units.

The clients should be directed to utilize masks that cover their mouth and nose should they need to leave their homes, and they should be directed to avoid additional triggers while out of their homes. Should travel be necessary they need to be directed to use the in cabin air filters of their vehicles. Lastly, each patient should be reminded of when and how to seek emergency care should their condition deteriorate.

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