20 INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE | 2019 | www.elitecme.com use of these vaccines was not widespread. Since these early years, vaccines have been developed and licensed for at least 21 infec- tious diseases. Along with the introduction and common usage of these vaccine products, great progress has been made in controlling many infectious diseases and now include a significant decrease in morbidity and mor- tality. In addition to the eradication of four diseases, the incidence of measles among chil- dren under five years of age has been reduced to levels lower than that observed previously (MMWR, 1999). It is evident that the burden of conta- gious diseases has been significantly reduced through the use of successful vaccination pro- grams in the U.S. However, even significant achievements in infectious disease can be reversed. Measles, a highly contagious infec- tious disease, was considered eliminated from the U.S. in 2000; for approximately 10 years, the majority of cases reported in the U.S. were imported from overseas. Despite this achieve- ment, recent years have seen significant increases in the number of measles cases in the U.S. This has increased concerns that inad- equate vaccination has created a resurgence of a disease that was once considered eliminated (McLean, 2013). VACCINATIONS Vaccinations are the most important modern tool available to health care providers (HCP) in the U.S. to maintain low levels of conta- gious diseases. Immunization rates in the U.S. are high, but gaps in care exist throughout the country. Economic and racial disparities exist: This leaves vulnerable populations at a higher risk for contracting and transmit- ting contagious diseases. Maintaining high immunization rates, especially in vulner- able populations, is critical to sustaining low levels of vaccine-preventable illnesses. Additionally, immunization providers are perfectly poised to ensure that vaccinations are administered in a timely manner to everyone who needs them. Strict adherence to vaccination schedules and patient educa- tion on the safety of vaccinations, as well as the importance of immunizing, are essential in order to maintain high immunization levels (McLean, 2013). The contagious viral illnesses of measles, mumps, and rubella can be prevented through the appropriate use of vaccinations. This con- tinuing education program is designed to review the history, epidemiology, symptoms, treatment, and prevention of these three illnesses. Nursing Consideration: Proper immuniza- tions are likely the most critical tool in main- tain the low level of contagious disease enjoyed in the U.S. Nonetheless, critical immunity gaps exist. Due to the high level of rapport enjoyed by nurses and ANPs, these clinicians are in an ideal position to confirm proper vac- cination profiles in their patients and to take appropriate actions when deficiencies are noted. MEASLES: DEFINITION Measles, also known as rubeola, is a viral infection caused by a virus that belongs to the genus Morbillivirus. Morbilliviru is transmitted between people through airborne respiratory droplets, such as with coughing or sneezing. It is characterized by high fever, conjunctivitis, coryza (runny nose), cough, as well as a rash that appears three to five days after symptoms’ onset. The measles virus is highly contagious; up to 90% of people without previous immu- nity will become infected when exposed to measles. Prevention of measles can be achieved through the use of measles-con- taining vaccinations administered follow- ing recommended vaccination schedules (McLean, 2013). HISTORY OF MEASLES Measles has a long history: The first doc- umentation of the disease occurred in the 7th century. In the 10th century, measles was described as “more dreaded than small- pox” by a Persian physician named Rhazes. Hundreds of years later in the 19th century, Peter Panum discussed the lifelong immunity shown in patients who have recovered from the disease, as well as the incubation period between exposure and disease manifestation. After the virus was isolated from kidney tissue in 1954, the first live attenuated vac- cination was licensed for usage in the U.S. in 1963 (CDC, 2016). EPIDEMIOLOGY OF MEASLES Before vaccination was made available in 1963, most people experienced measles infection before adulthood. Epidemic cycles occurred every two to three years. While approximately 500,000 cases were reported annually, the actual infection counts in the U.S. were estimated to be between three and four million people annually. Over 50% of people experienced measles infection before age six—over 90% were infected by age 15. The highest incidence of infection was seen in children between five and nine years old: over 50% of cases occurred in this age range (CDC, 2016). Once the vaccination against measles was released in 1963, a vaccination program was implemented to administer one dose of mea- sles vaccination during childhood, specifically to infants between the ages of nine and 15 months. This program significantly reduced the incidence of measles in all age groups— reported cases in the late 1960s and early 1970s decreased to between 22,000 to 75,000 per year. While the number of reported cases decreased drastically, outbreaks occurred in the 1980s in school-aged children who had received a single dose of measles vacci- nation. This led to the recommendation by the Advisory Committee on Immunization Practices (ACIP) of a second dose of mea- sles-containing vaccine in all children to induce immunity in the small subset of patients whose initial vaccination did not result in adequate antibody development (McLean, 2013). Major measles outbreaks occurred in the U.S. from 1989 to 1991. This resulted in approximately 55,000 reported cases of mea- sles, which were largely associated with unvac- cinated, or inadequately vaccinated, children. These outbreaks led to increased efforts to vaccinate all preschool-aged children against measles. The federal program, Vaccines for Children, was introduced in 1993 to increase access to vaccinations recommended by ACIP. It allowed eligible children under 19 years of age to receive recommended vaccinations at CONTINUING EDUCATION  | To take this course online for FREE, go to https://www.elitecme. com/nursing/courses/measles%2c- mumps%2c-and-rubella%3a- prophylactics-and-clinical-updates/ and use the code INFECTION20 at checkout to get 20% off if used by July 30, 2019.