Many who work in healthcare today are too young to remember the measles epidemics of years past. Therefore, their knowledge and care of this previously eradicated disease is extremely limited and quick identification of infected individuals could be limited.

As we learned last year from our Ebola exposures, our lack of knowledge of uncommon, yet highly communicative diseases is our Achilles' heel. As healthcare providers, we owe it to ourselves and our patients to remain informed of such diseases. So, once again, with the recent measles outbreak, we must become educated.

What is measles?

Measles is a viral respiratory illness. It is one of the most contagious infectious diseases with a 90 percent transmission rate to a susceptible person in close contact. Humans are the only natural hosts; however, it usually affects mostly children.

How is it transmitted?

Since it is a respiratory illness, it is transmitted via droplets from the nose, mouth or throat of an infected person. It can be transmitted by direct contact with the droplets or by airborne spread as the infected person breathes, coughs or sneezes.

According to the Centers for Disease Control (CDC), the virus can "remain infectious on surfaces and in the air for up to two hours after the infected person leaves an area."

Signs and symptoms

The typical first heralding sign is a high fever, which will usually begin about 10-12 days after exposure, lasting four to seven days. As the patient may also develop a runny, nose (coryza), cough, red and watery eyes (conjunctivitis), the CDC is asking healthcare providers to be on the look out for the three "C"s.

Patients may also develop small white spots inside the cheeks (Koplik spots). About 14 days after exposure, a maculopapular rash appears, however, the incubation period is up to 21 days. The rash typically starts at the head and spreads down to the trunk, including the palms of the hands and on to the lower extremities. It recedes in the same route.

Patients are considered to be contagious from four days before to four days after the rash appears, according to the CDC and the World Health Organization (WHO). However, immunocompromised patients may not develop the rash.

Once measles is suspected, the patient need to be immediately isolated form others. The area need to be immediately cleaned and disinfected. The healthcare providers should also report the diagnosis to the local health department and the CDC.

Complications

The most common complications include otitis media, bronchopneumonia, laryngotracheobronchitis and diarrhea. Complications are more common in children under 5, adults over the age of 20, pregnant women and immunocompromised persons.

The most serious complications include blindness, encephalitis leading to long-term neurologic deficits and, occasionally, death.

Treatment

There is no specific antiviral treatment for the measles virus. Most of the care is supportive, including optimizing nutrition and hydration status. If a person is exposed and cannot demonstrate evidence of immunity, they can be offered post-exposure prophylaxis.

The Measles Mumps Rubella vaccine (MMR), if administered within 72 hours of exposure, or immunoglobulin (IG), if administered within six days of exposure, has been shown to provide some protection against the disease.

According to the CDC, patients who are at risk for severe illness and complications from measles should receive IG. The guidelines for administration can be found at the CDC's website. However, it does advise that it should not be used to control outbreaks, but instead to reduce complications in vulnerable populations.

Prevention

Although this outbreak has spurred the vaccination debate, the current recommendations are for all children to receive their first MMR vaccination at 12-15 months, followed by a second dose between 4 to 6 years of age.

Students who enter post-high school education who do not demonstrate immunity are also recommended to receive two doses of the MMR. The CDC also recommends that adults born after 1957 who do not demonstrate immunity should get at least one dose of the vaccine.

Since the implementation of the MMR vaccine in the 1960, there has been a drastic and consistent decrease in infectious rates. In fact, measles was considered eradicated from the United States in 2000. This was defined by the fact that there had been no endemic cases for the previous 12 months.

There have been small outbreaks in the US, mostly among unvaccinated populations exposed to foreign travelers from countries experiences outbreaks. The CDC saw the largest numbers of measles cases in 2014 with 644 cases from 27 states.

On Jan. 23, the CDC issued a Health Advisory to inform public health departments and healthcare facilities about the outbreak that included 14 states. The current outbreak is linked to an amusement part in California with 102 subsequent cases reported in January.

As we learned from Ebola, most diseases are a plane ride away. Although it may appear the outbreak is far way, a traveler can bring to any neighborhood emergency room and we need to be prepared.

Therefore, every healthcare facility and healthcare worker needs to be informed, educated and aware. The public relies on our vigilance. The CDC has provided a site dedicated to information for healthcare professionals, including photos and a quick 5-minute video discussing what healthcare workers need to know if they suspect measles so they can act quickly and appropriately.

Please take the time to educate yourself and help in preventing the spread — our patients are depending on us.