Community Outbreak

Community Outbreak
The outbreak of measles is at an all time high in 2011 with a confirmed 223 cases, up from 2008 with only a 140 confirmed cases (Iannelli, 2011). In 1989 with the last big measles out break the introduction of the MMR , measles outbreaks were scarce in the United States (Iannelli, 2011). The rise in outbreaks were linked back to foreign travel in the 2008 outbreaks (Iannelli, 2011). Another link in the rise in measles outbreak is the choice not to vaccinate. Many parents now opt not to have their children vaccinated for personal reasons. This makes the child more susceptible to the outbreak and thus passes it on to others. * Epidemiology- although the incidence of measles has risen in recent years efforts to control the outbreaks globally have altered the virus transmission. In developed countries measles has been contained by vaccinations during childhood. Worldwide measles is the cause of morbidity and mortality. Measles was estimated to cause about 31 to 39.9 million illnesses with about 777,000 deaths worldwide (Barinaga & Skolnik). Measles is the fifth most common cause of death in children less than fives years old. The World Health Organization (WHO) put a strategy in place to vaccinate greater than 90 percent of the people with two doses of the MMR vaccine and to monitor that population very carefully. This would include case investigations of anyone suspected of contracting the virus (Barinaga & Skolnik). * Analogy- there has been a major increase in the measles transmission due to non-vaccination. The Health Protection Agency in England and Wales urged parents in 2011 to have their children vaccinated. The agency reported 334 cases in 2011 as compared to 2010 with 144 cases (Roxby, 2011). The Health Protection Agency in England believes the outbreak originated in France from unvaccinated people less than 25 years old. This population is centered on universities, schools and families that have traveled abroad (Roxby, 2011). Although there has been an increase in the outbreaks worldwide the HPE and the WHO are taking steps to control the outbreak by insuring that all unvaccinated and infants are vaccinated to prevent the spread of the measles virus any further (Roxby, 2011). * Transmission- measles virus is spread through droplet transmission from the nose, throat, and mouth of someone who is infected with the virus (Iannelli, 2011). The droplets are sprayed out when the infected person coughs or sneezes. The infected person is extremely contagious for four days before the rash appears until four days after the rash appears. The measles virus can remain in the air and still be able to cause disease for about two hours after an infected person has left a room (Iannelli, 2011). An outbreak of measles in a community could be devastating. Today, many parents opt for ethical reason to not vaccinate their children. As represented in the graph, if one child becomes infected then the possibility of hundreds of people getting infected is possible. Once the outbreak and the cause is known the public would need to be notified of the outbreak and what to look out for. Hospitals and doctors offices could possibly be over capacity depending on the severity of the outbreak. Families who are infected or suspected of having the virus may need to be quarantined. Depending on how long the individual has been exposed or infected this virus can cause death, especially in infants and young children. Immediate vaccinations and attempts to stop the spread of the virus need to be implemented to avoid further exposure and death in the community. There is no cure for measles so stopping the spread of the virus and vaccinating the community population is important. There is always the need for the community to be educated about the possibility of contracting the virus if they travel to foreign countries or remain unvaccinated. If SARS is suspected and confirmed in a community it needs to be reported immediately. Once SARS has been confirmed the local health clinic must report the incidence to the states local health department. The state health department will then report the SARS outbreak to the Centers for Disease Control (CDC) in Atlanta Georgia. Since the people who are infected with SARS traveled abroad the CDC will then notify the World Health Organization (WHO) of the confirmed SARS outbreak. These organizations need to know all of the confirmed reports of people infected and all others that may be infected ("Supplement b: Sars," 2004). Patients that have respiratory problems such as asthma or COPD are at risk for respiratory distress if the air quality index is poor. The community health nurse should plan on educating and modifying their care to eliminate further respiratory issues. The community health nurse should advise her patients to: 1. Check the air quality index daily 2. Avoid being outdoors for long periods of time 3. Try and avoid high traffic areas 4. Plan outdoor activities early in the day 5. Always have rescue medication nearby 6. Check pollen and mold count daily Hopefully, the community health nurse can educate the patients to breath better and have a better quality of life ("Air quality index," 2012).

Unvaccinated child and family go to Switzerland for vacation
Unvaccinated child and family go to Switzerland for vacation Anatomy of Measles Outbreak
As the measles virus spread the total number of children infected was
839!!!!
All from 1 unvaccinated child

As the measles virus spread the total number of children infected was
839!!!!
All from 1 unvaccinated child

2 weeks later child and family return home from Switzerland
2 weeks later child and family return home from Switzerland

3 children were infected < 12 months old
8/9 children unvaccinated children infected
70 children placed under quarantine
3 children were infected < 12 months old
8/9 children unvaccinated children infected
70 children placed under quarantine

Child returns to school only to become ill and develop a high fever and rash while at school
Child returns to school only to become ill and develop a high fever and rash while at school

SPREAD
SPREAD

Parents take child to family physician, pediatrician then to the ER because fever and rash continue to worsen. Child is diagnosed with measles.
Parents take child to family physician, pediatrician then to the ER because fever and rash continue to worsen. Child is diagnosed with measles.

This one child infected 2 of his siblings, 5 children at his school, and 4 children at pediatrician’s office
This one child infected 2 of his siblings, 5 children at his school, and 4 children at pediatrician’s office

References
Air quality index. (2012). Retrieved from http://www.baltimoreasthma.org/

Barinaga, B., & Skolnik, P. (n.d.). Epidemiology and transmission of measles. Retrieved from http://www.uptodate.com/contents/epidemiology-and-transmission-of-measles

Centers for Disease Control, CDC. (2004). Supplement b: Sars surveillance v. reporting of cases of sars-cov disease a. reporting in the absence of person-to-person transmission of sars-cov in the world.

Iannelli, V. (2011, December 21). International measles outbreak. Retrieved from http://pediatrics.about.com/od/measles/a/measles-outbreak.htm?p=1

Roxby, P. (2011, May 27). Measles outbreak prompts plea to vaccinate children. Retrieved from http://www.bbc.co.uk/news/health-13561766?print=true