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From Patient Zero to Public Health Emergency

Kennedy, Maureen Shawn, MA, RN, FAAN

AJN The American Journal of Nursing: June 2019 - Volume 119 - Issue 6 - p 7
doi: 10.1097/01.NAJ.0000559783.71064.eb
Editorial
Free

The measles outbreaks may be a wake-up call to reinvigorate vaccination campaigns.

AJN Editor-in-Chief E-mail: shawn.kennedy@wolterskluwer.com

Figure.

Figure.

I remember watching the 1995 movie Outbreak, in which an airborne virus spreads throughout the United States, killing everyone who contracts it. One vivid scene shows a person sneezing in a movie theater, the resulting infectious droplets flying through the theater and landing on people sitting several rows away.

Science fiction became reality in New York in October 2018, when measles spread through a Brooklyn community after an unvaccinated child contracted the illness while visiting Israel. That initial case has led to 423 cases as of April 29, prompting New York City officials to declare a public health emergency. Like the fake “Motaba” virus in Outbreak, measles is a highly contagious airborne virus; 90% of those exposed and susceptible (not immune from having had the disease or the vaccination against it) will contract the illness. Fortunately, measles doesn't have a 100% mortality rate like the virus in the movie, but it is by no means harmless. Complications include hearing and vision loss, pneumonia, encephalitis, and, for pregnant women, preterm birth or a very low-birth-weight infant.

Prior to the introduction of the measles vaccine in 1963, the disease resulted in over 2.5 million deaths globally each year, according to the World Health Organization (WHO). After years of coordinated vaccination campaigns, however, that number was brought down to 110,000 in 2017. But this year, the United States has surpassed the greatest number of cases recorded since measles was declared eliminated in this country in 2000. As of May 3, the Centers for Disease Control and Prevention reports that there have been 764 cases of measles in the United States, with 23 states confirming cases and six states reporting outbreaks. And the United States is not alone—according to the WHO, there was a 300% increase in the number of cases worldwide over the last year; in Africa, the ­increase was 700%. Even more sobering is the WHO's estimation that only one-tenth of cases are reported.

So why the increase now, years after the availability of a vaccine? For many throughout the world, the issue is a lack of access because of poor health infrastructure, conflicts that hinder delivery, or funding. For U.S. residents, it's more about lax practices (measles was no longer considered a threat) or parental choice based on personal or religious beliefs or fears that vaccines can cause harm.

Much of the vaccine fears stem from the now well-debunked 1998 research paper by Andrew Wakefield and colleagues, whose assertion of a link between the measles, mumps, and rubella vaccine and autism was based on fabricated data. And while experts have repeatedly declared this work to be invalid and have conducted other studies that have refuted these findings, this fake research has taken on a life of its own and is still popularized by misinformed celebrities, antigovernment conspiracy groups, and misleading social media sites.

What can be done to help consumers move past their fears? This is an area where nurses can excel. A nurse is often the first face someone sees when they access health care, whether it be in the ED, a primary care office, an urgent care center, a school, or a community health clinic. Each contact can build a trusting relationship and be a teachable moment. Nurses are regarded as sources of information in the community. How many times have neighbors asked you about health matters?

As a result of the recent outbreaks in New York, some nurses have taken it upon themselves to initiate campaigns. Melody Butler, for example, a nurse at Good Samaritan Hospital on Long Island, started Nurses Who Vaccinate (https://nurseswhovaccinate.org), and Blima Marcus, a nurse at Memorial Sloan Kettering Cancer Center in New York City, is working with colleagues in the Orthodox Jewish Nurses Association to counteract antivaccine messages circulating in their community. We can use our influence and relationships to educate those in our sphere. Get the facts and volunteer to present them at home–school association meetings; write an evidence-based article for your local paper; ask local cable stations to provide accurate public service messages. Patient education is one of our core functions and strengths—now is a perfect time to flex those muscles.

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