April 24th, 2012
By Jennifer Olin, BSN, RN
Did you have measles as a kid? I did. A lot of the kids I knew did. And, I know for sure we all had our vaccinations against them. I know, because I have my shot records and because I asked my Mom. She said you didn’t get to go to school unless you had been inoculated.
And, yes, you can still get the disease after having the vaccination, but if you do get sick it is usually a very mild case of the disease; much milder than the natural disease.
The first measles vaccines became available in 1963, the year I was born. The mumps vaccine first became available in 1967, followed by the rubella vaccine in 1969. These three vaccines were combined in 1971 to form the measles-mumps-rubella (MMR) vaccine. And, we headed into the new millennium, measles was declared eliminated in the United States in 2000.
Sadly, that supposition was premature. A report released April 19 by the Centers for Disease Control and Prevention (CDC) says infections have risen: last year the U.S. reported the highest number of measles cases in 15 years.
According to the report, 222 measles cases and 17 measles outbreaks were reported to the CDC in 2011. Of the 222 reported cases, 50 percent were associated with the 17 outbreaks and 90 percent were associated with importations from foreign countries: 26 percent from U.S. residents traveling abroad and 10 percent from foreign visitors.
According to the CDC, healthcare providers play an important role in maintaining elimination of measles in the U.S. Patients with measles frequently seek medical care; therefore, healthcare providers should maintain a high awareness of measles and suspect measles in persons who have a febrile rash illness and clinically compatible symptoms (e.g., cough, coryza (symptoms of a cold), or conjunctivitis) and who recently have traveled abroad or have had contact with travelers.
The nurse’s role‚Ä® in preventing diseases like measles is to provide accurate information about vaccine-preventable diseases and to advocate that all children receive appropriate vaccinations at the appropriate times. The MMR vaccine is recommended routinely for all children at age 12–15 months, with a second dose at age 4–6 years.
Two doses of MMR vaccine also are recommended for unvaccinated healthcare personnel, international travelers, and students attending post–high school educational institutions. Other adults without evidence of measles immunity should receive one dose of MMR vaccine, according to the CDC guidelines.
There are many reasons why both adults and children today have not been vaccinated against these preventable diseases. They include:
Parental misconceptions about vaccine safety are a serious problem. Some parents consider vaccinations unnecessary, believing their children won’t be exposed to vaccine-preventable diseases. Ironically, this belief probably arose because vaccines have been so effective in wiping out many diseases in the United States.
According to a study out of the University of Michigan, in 2010, one in four U.S. parents believes some vaccines cause autism in healthy children, even though scientific evidence doesn’t support this claim. Concern about such a link stemmed from a 1998 study involving 12 children; its findings suggested that the MMR vaccine caused bowel problems, which then led to autism. However, the sample size was extremely small and the researchers’ interpretation wasn’t well supported (some of the children had autism before the bowel problems arose). What’s more, 10 of the 13 study authors later retracted their interpretation of the data. Even so, if you search “autism” and “vaccination” on the internet the myth is kept alive on hundreds of websites.
Since then, numerous studies with large samples have found no link between the MMR vaccine and autism. In fact, every day around the world, several million children avoid vaccine-preventable illnesses because they’ve been immunized against them. Yet unsupported claims that vaccines can cause health problems get widespread media attention.
Breaking Down the Barriers
‚Ä®If you encounter clients who are reluctant to have themselves or their children immunized, the first and most important thing you must do is acknowledge their concerns. People who don’t believe they are being taken seriously are much less likely to listen to anything else you say.
Next, we get to one of the most important features of being a nurse—patient teaching. You want to provide education to correct misconceptions, and offer accurate information about the benefits and risks of vaccines. Explain that serious vaccine reactions are rare and that vaccines are approved for use only if the evidence shows their benefits significantly outweigh their risks.
To provide accurate information and accurately answer parents’ questions about vaccines and their safety, you must be familiar with the current status and global and local prevalence of vaccine-preventable diseases, current vaccination recommendations, and vaccines’ risks and benefits.
One source for such information is the Nursing Initiative Promoting Immunization Training (NIP-IT) website. NIP-IT is a program put together as a cooperative agreement between the University of Oklahoma College of Nursing and the CDC. This innovative web-based curriculum about immunizations and vaccine preventable diseases is designed to inform and educate nursing students and nurses nationwide.
The program addresses such topics as vaccine recommendations and vaccine preventable diseases, nursing roles and vaccine administration. All you need do is register on the website and take the free courses. It’s also a great chance to earn some relevant and timely continuing education credits.
What To Do If Disease Is Already Present
According to the CDC, healthcare personnel need to implement isolation precautions immediately if patients are already infected with measles. The case must promptly be reported to the local health department to limit spreading the disease.
In several outbreaks during 2011, despite seeking medical care, the source case was not identified until after the first or second generation of cases was reported. Misdiagnosis and delayed reporting resulted in missed opportunities to prevent additional cases because of delayed implementation of control measures.
Nurses play a vital role in educating the public about the dangers of vaccine-preventable diseases like measles, mumps, and chicken pox. This country has mostly eradicated them, but obviously not completely. And in this age of easy global travel it’s that old saying about “an ounce of prevention being a worth a pound of cure.”