Applying the Concepts of Epidemiology and Nursing Research on Measles Nursing Paper Essay


Before the 20th century, infectious diseases comprised the most severe health globally until they were replaced by degenerative diseases, particularly in the developed countries. A defining characteristic of infectious diseases is that they are caused by organisms like viruses, bacteria, fungi, and parasites and can be transmitted from one person to another by transferring pathogens. The primary preventive strategy is to isolate the infected individual to stop the spread of the pathogen. They include common cold, tuberculosis, chickenpox, and measles. On the other hand, a non-infectious disease cannot be spread through a pathogen and is caused by a host of circumstantial factors like genetics, malnutrition, environment, or lifestyle and include diseases like cancer, Alzheimer’s disease, and epilepsy. Current literature demonstrates that the impact of infectious diseases in humanity’s history was underestimated, yet these diseases’ role was as important as economic and military determinants in shaping human civilization’s historical evolution (LePan, 2020). The occurrence of infectious diseases mainly through epidemics was instrumental in determining the day’s social, political and theological opinion as the explosive characteristic and unpredictability of the epidemic s served to cause fear, insecurity, and panic even in modern times. Beginning with Hippocrates in 435 BCE to Fracastoro and many other scientists in between, there was established a relationship between the occurrence of diseases and the environment in which people lived and the conceptualization that some diseases could be spread between people through minute particles. These findings marked the development of epidemiology herein defined as how the disease is distributed in the populations and the factors that influence the distribution. It is imperative to apply epidemiology and nursing research concepts in understanding the development and manifestation of measles.

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Overview of Measles

Measles is an acute viral infection caused by a virus within paramyxovirus, genus Morbillivirus. It manifests with a high fever of up to 40 degrees Celsius or 105 degrees Fahrenheit, accompanied by the general malaise, cough, and maculopapular rash. Measles is a highly contagious disease as the Morbillivirus lives in the nose and throat mucus of an infected person and is mainly spread through coughing and sneezing. Using the communicable infection model, the measles virus portal of entry is through the lower respiratory tract and the nose. The portal of exit is through the nose as the infected coughs or sneezes. If an uninfected person breathes the contaminated air or touches the infected surface, then touches their eyes, nose, or mouth, they too become infected. If untreated, measles can lead to complications like pneumonia, encephalitis, and even death. A rare long-term sequalea of measles is sub-acute sclerosing pan encephalitis (SSPE), a life-threatening disease that develops seven to ten years after infection. Treatment of measles includes administering acetaminophen or ibuprofen to reduce fever, a humidifier to ease the cough and sore throat, vitamin supplements, and plenty of fluids. Getting plenty of rest also boosts the patient’s immune system. According to Misin et al. (2020), about 350 000 measles cases were reported globally were about 142 300 deaths resulted. The World Health Organization further reported that from January 2019 to September 2019, 1234 cases were reported in the US (Sanyaolu et al., 2019). The mortality rate is estimated at 1-2 per 1 000 cases. Three hundred seventy-two cases were reported from 25 states in 17 outbreaks in 2018(CDC Presentation, 2018). In the US, Measles is a reportable disease where the CDC reports the cases through the National Notifiable Diseases Surveillance System (NNDSS) whether the cases are probable or confirmed.

 Social Determinants of Health and How They Contribute To the Development of Measles

Measles is a vaccine-preventable disease that continues to be associated with high mortality and morbidity rates. According to Rivadeneira et al. (2018), a total of 134 200 deaths were reported globally despite a 79% decrease in mortality between 2000 and 2015. Defined as conditions in the places where people live, learn, work and play, social determinants of health (SDOH) also play a significant role in developing measles. Some of the SDOH include income and social status, social support networks, education, literacy levels, the social and physical environment, and many more. As a childhood disease, persistent lack of immunization in some children contributes to measles development.

            The researchers further observed that even in countries where measles is controlled, potential outbreaks exist due to importations. Factors like the child’s parent’s education status are likely to determine the parent’s social-economic status and the family income. Other factors like geographical mobility and cultural elements will also determine the health practices that would isolate the parents’ practice. The family’s living conditions are also pegged on income levels where low-income families are likely to be living in overcrowded conditions measles. A measles outbreak would spread very fast. In summary, the socioeconomic characteristics mainly determine the family head’s educational attainment, while the incidence of measles is likely to be higher in pediatrics, especially those below 12 months. Environmental factors like urban-rural status impact crowding while access to healthcare services measles the individual is likely to have had prior measles immunization and antenatal care coverage.

The Epidemiologic Triangle of Measles

        The epidemiologic triangle synonymously referred to as the epidemiologic triad, is a tool that scientists use to address the three components contributing to the spread of disease as an external agent, a susceptible host. An environment brings the agent and the host together. The term host refers to the organism exposed to and harbors the disease. According to Haga et al. (2017), several host factors that expose the individual to measles include but are not limited to age(less than five years) and hygiene practices. Other factors are absent or incomplete MMR vaccination and travel to countries with measles outbreaks (Vemula et al., 2016). While humans are the primary host, non-human primates can also be hosts. It is essential to state that special populations at risk are children and pregnant women.

        Workers who are malnourished and immunocompromised are at a higher risk of developing complications. Likewise, agent factors that make the measles virus more virulent are those factors that enable the virus to replicate, those that impact on the host defense mechanisms, those that affect tropism to spread throughout the body and transmissibility, and those that encode or produce products that are directly toxic to the host(Burrell et al., 2017).  The agent may survive less than 2 hours on surfaces or objects, while respiratory droplets can remain infective for about an hour in a close space. Lastly, environmental factors capture the intrinsic factors that can affect the host’s exposure and susceptibility to the pathogen. In the case of measles, environmental factors like crowding and poor sanitation, and the presence of non-human primates that are infected.

        Literature also indicates that hot and cold temperatures may decrease measles incidence, but low relative humidity is a risk factor for measles morbidity (Yang et al., 2014). To break the epidemiologic triangle, all its vertices have to be considered to break at least one side of the triangle. This entails the healthcare staff following best practices and procedures to stop the spread of infection at the healthcare organization and wear appropriate personal protective equipment (PPE). The clients should also follow proper hand hygiene to mention some measles preventive measures. LePan (2020) notes that in tracking infectiousness, measles tops the list as the most contagious communicable disease with an R0 range of 12 to 18. This implies that, on average, a single individual infected with measles can infect anywhere between 12 to 18 people in an unvaccinated population.

Explain the role of the community health nurse in Case Finding, Reporting, Data Collection, Data Analysis, and Follow up in Measles Outbreak

            The Americas is the only region that has so far eliminated measles successfully, and the momentum towards its eventual eradication continues to grow (Gastanaduy et al., 2018). In the US, just like in any other part of the world, community health nurses have a role in case finding. Case finding is a strategy that involves targeting resources at individuals or groups suspected to be at risk of a particular disease, which in this paper is measles. The CHNs are actively involved in the systematic search for measles’ risk instead of waiting for them to present with symptoms or signs of active measles. As mentioned in this essay’s preceding sections, measles is a nationally – notifiable disease whose cases should be reported to the appropriate health department with states reporting to CDC through NNDSS. The CHN is expected to collect information depending on the outbreak, but the data can be categorized as identifying information, demographic information, clinical information, and risk factor information. Once the collected data is analyzed, line listing follows. Line listing allows information about time, person, and place to organize to keep track of the different cases. These groups may be possible, probable, or confirmed cases. The confirmed cases could cover laboratory-confirmed, clinically confirmed, or both. Liner listing is created on paper or a computer with entries like case identification number, report date, onset, physician diagnosis, accompanying signs and symptoms, laboratory and demographics. The CHNs are expected to follow up measles cases where case management of uncomplicated measles ensues.

            It is expected that many children would experience uncomplicated measles and require supportive measures like administering Vitamin A, advise the mothers to treat the child at home if no complications develop, and keep the child cool to control the fever. Case management of complicated measles involves referral to a hospital for further management amongst other secondary case management measures. According to Van Dongen et al. (2019), the demographic data collected are necessary to the community’s health because they give communities information needed to plan the future regarding investments and services provided in the healthcare sector.

            Measles is one of the many vaccination-preventable diseases that continue to infect many Americans. To address this, Healthy People 2030 focuses on preventing it by increasing vaccination rates. Suffice it to say that the Centers for Disease Control (CDC), another Federal agency recommends routine childhood immunization for MMR vaccine commencing with initial dose at 12 to 15 months of age with the second dose administered at 4 -6 years. Alternatively, the second dose can be administered 28 days after the first dose.

Global Implication of Measles

            The WHO reports that measles is a severe disease with a high mortality rate of 10%, where malnutrition is significant.  In the temperate zone, most cases occur during winter and early spring. Portnoy et al. (2019) opine that to decrease measles under-five mortality globally, there is a need to increase immunization coverage. With an estimated death rate of 1-2 people in every 1 000 people out of the 25% of the measles patients hospitalized.  Other common measles complications include ear infections and diarrheas, while more serious complications may see lung infection like pneumonia and swelling of the brain (encephalitis), which increases the measles disease burden, particularly in developing countries. Onoja & Ajagbe (2019) note that the highest mortality rate occurs in children living in impoverished communities bedeviled with overcrowding, malnutrition, and low vaccination coverage. The duo further opines that most of the measles infections are recorded in Africa and Asia, with endemic areas being restricted to the tropics. Measles transmission in the tropics increases after the rainy season. Be that as it may, safety regulations and the efficacy of measles vaccines are being strengthened in the developing countries as steps towards eradicating measles continue to take shape.


            In conclusion, this paper has outlined the significance of epidemiology in public health, focusing on measles. The author believes that until measles is eradicated globally, the importations of measles are bound to challenge public health systems in countries that have either achieved or are close to achieving the elimination of endemic measles transmission. In developing, countries vaccination strategies offer an effective measure to fill in the immunity gaps that foster measles transmission.

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