Clinical Update
Measles: Making a Comeback
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
OUTBREAKS of vaccine-preventable diseases including measles (rubeola) are
occurring with increasing frequency in the United States. In fact, the 644
measles cases reported in 27 states during 2014 is the highest number of
cases reported since 2000, when the Centers for Disease Control and Preven-
tion (CDC) declared measles eliminated in the United States. Elimination of a
disease means that there has been no endemic disease transmission for at
least 12 months. Although measles is no longer endemic in the United States,
outbreaks still occur each year. The ongoing multi-state measles outbreak
linked to two Disney theme parks in California, which began in December
2014, shows that measles remains a threat in the Unites States despite exten-
sive vaccination efforts.
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As the incidence of measles rises, all healthcare
providers must ensure they can recognize the disease and know the appropri-
ate steps to manage it.
How Outbreaks Occur
Outbreaks of measles occur in the United States when measles is imported by
unvaccinated travelers (U.S. residents traveling abroad and foreign visitors)
who acquire the infection while in other countries where the disease is en-
demic or where an outbreak is occurring. Measles continues to circulate in
many parts of the world, with an estimated 20 million cases occurring world-
wide each year.
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Once imported into this country, measles can spread readily
in communities with low measles/mumps/rubella (MMR) vaccination rates.
Measles is one of the most contagious viral diseases known, with secondary
attack rates >90% in susceptible household and institutional contacts. Most
people who get measles are unvaccinated or incompletely vaccinated. For ex-
ample, of the 118 measles cases reported over a 19-week period in 2011, 89%
occurred in unvaccinated persons.
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In the recent California outbreak, 45% of
cases were unvaccinated and another 43% had unknown or undocumented
vaccination status.
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Inside
Clinical Update ................. 1
Review Courses............... 10
Certification Q&A............; 11
Update: Immunization ... 15
News Briefs ..................... 17
Fitzgerald Faculty in the
News .............................. 23
2015 Live Courses
Pharmacology Update
(2-day course)
The Art of Wound Repair
(1-day course)
NP Certification
Exam Review
Course Tracks
Family, Adult-Gerontology,
and Adult Primary Care
Acute Care, Adult-
Gerontology Acute Care
Pediatric Primary Care
Psychiatric-Mental
Health
Women's Health
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Fitzgerald Health Education Associates, Inc. 978•794•8366 Volume 15, Issue 3, March 2015
Continued on page 3