Communicable diseases are leading causes of death among humansglobally claiming millions of lives people yearly. They are caused bypathogenic organisms such as bacteria, viruses, fungi, or parasites.They can be transmitted either directly or indirectly from one personto the other. One of the major distinctive factors of these diseasesis that they are highly preventable. In this paper, we shall discussin detail the epidemiology, risks and preventive strategies ofmeasles.
Measles is a highly contagious disease that is caused by a virus thataccounted for approximately 2.6 million deaths each year beforewidespread vaccination in 1980 ("CDC Press Releases,"2014). The disease is still one of the leading cause of death amongyoung children worldwide despite the availability of adequate, safeand effective vaccine. A single-stranded RNA virus causes the diseasefrom the family paramyxovirus, genus Morbillivirus andit is transmitted through direct contact or air ("Measles | ForHealthcare Professionals | CDC," 2015). The disease affects therespiratory tract and the rest of the body. It is not known to occurin animals. There are have been several measles outbreaks in severalstates in the United States, China, a majority of countries in theSub-Saharan Africa since the introduction of the vaccine in 1980("CDC Press Releases," 2014). One case of measles isconsidered an outbreak according to the World Health Educationguidelines.
Humans are the only natural hosts of the measles who sustain themeasles transmission, and this makes eradication of the diseasefeasible.
In the United States, one of the most recent outbreak was experiencedbetween 1st January to 24th August 2013("Measles — United States, January 1–August 24, 2013",2013). During that period, 159 cases were reported in 16 statesaccording to the data evaluated by the Centers for Disease Control.Majority of those cases were unvaccinated. The cause of the outbreakduring that period was the importations from, World HealthOrganization, European Region that accounted for 42% of all theimported measles cases, while others were from the Philippines("Measles — United States, January 1–August 24, 2013",2013).
Measles is transmitted from one person to the other through the largerespiratory droplets coughed or aerosolized nuclei droplet sneezedout by an infected person. The disease is one of the most contagiousviral diseases known to humans (Fiebelkorn & Goodson, 2015).Scientists approximate that the secondary attack rates of the diseaseare over 90% of any susceptible households and institutionalcontacts. It can also be transmitted through contact with eithernasal secretions or saliva.
The incubation period of measles is 10 to 12 days before its firstsymptoms that include high fever appear after the exposure to thevirus, and they persist for around 4 to 7 days ("WHO EMRO |Disease and Epidemiology | Measles | Health topics," 2017). Theinitial stage follows, and the patient develops a cough, runny nose,red and watery eyes, and small white spots that develop in thecheeks. Several days later, a rash erupts on the face, and the neckand three days later it spreads to the entire body covering bothhands and feet. The rash can last for five to six days and isapproximated to develop fourteen days after the exposure to the virus("WHO EMRO | Disease and Epidemiology | Measles | Healthtopics," 2017).
Measles-related deaths occur due to the complications that accompanythe infection seen especially among children that under the age offive years and adults over the age of twenty. Serious complicationsassociated with the disease include encephalitis, diarrhea, anddehydration, infections of the ear, and respiratory illnesses such aspneumonia ("WHO EMRO | Disease and Epidemiology | Measles |Health topics," 2017). Measles affects poorly malnourishedchildren especially those that lack adequate vitamin A and theimmunocompromised.
In 2015 approximately 134,200 deaths occurred worldwide. There hasbeen a 79% drop in measles cases following consistent vaccinationsince the year 2000 to 2015 ("CDC Press Releases," 2014).This exercise prevented about 20.3 million possible deaths, making itone of the most successful public health initiative.
Epidemiologicaldeterminants of measles
Measles is airborne, and that makes it a highly contagious disease. Close contact with the infected increases the number of cases amongthe population. People suffer the disease when in contact with coughdroplets or secretions from the nose or saliva ("Measles | ForHealthcare Professionals | CDC," 2015). Measles is a disease ofhigh virulence when it is managed poorly, or when the health systemsof a particular nation lack adequate coordination and resourcemanagement. It is transmitted easily where there is congestion andinadequate fresh air.
Nationaland international route of transmission
The United States is currently on the verge of eliminating measles,but the past infections have mainly been caused by immigrants whoenter the United States via air travel, land travel and sea ports("Measles | For Healthcare Professionals | CDC," 2015). Anincrease in the number of measles cases is attributed by unvaccinatedpeople who are mainly the residents of the United States who travelto other countries, thus bringing the virus back to the country. Itis feasible to eliminate measles since humans are the only hosts, butdue to international travels, and national travels across differentstates initiates new outbreaks in the country (Fiebelkorn &Goodson, 2015). Following travel to the Philippines in 2013, therehave been pockets of outbreaks in the country, since October the sameyear. Of the 288 cases that were reported in 2013, 280 were importsfrom at least 18 countries. However, with the current travelregulations, the United States has become more vigilant in ensuringthat international travelers have measles vaccination to limit thenumber of emerging cases.
Poor nutrition accelerates measles transmission especially amongchildren under the age of five years ("Measles | For HealthcareProfessionals | CDC," 2015). Poor ventilation in social placessuch as schools and prisons also increases transmission rates. Also,caregivers who are in close contact with the patients are at highrisk of getting the infection. Children and adults who areimmunocompromised as a result of HIV infection or chemotherapy arealso at very high risks ("Measles | For Healthcare Professionals| CDC," 2015). During outbreaks, children who have not receivedthe measles vaccine are also at a higher risk than those who havebeen immunized.
Measles outbreak in the community disrupt social systems such asschools, hospitals, transport and other amenities. Due to itsinfectious nature, areas where people gather there is a more risk oftransmission. Where there are large outbreaks, hospitals may overflowrequiring extra facilities and may call for outsourcing foradditional resources from other health facilities ("Measles,"2017). System overflow may be experienced resulting in delays in theprovision of other healthcare services.
The economy is mainly affected if there are outbreaks in othercountries for it may restrict travels to those countries for businessor trade. The economic productivity in some sectors for instance airtravel may be affected. Since the children under the age of five aremost at risk, closure of elementary schools may be necessary, otherinstitutions may not be closed, but adequate surveillance in case ofa suspicious case will have to be instituted ("Measles,"2017). Extra surveillance activities in other institutions will haveto be undertaken to ensure earlier notification of any suspiciouscase in the community ("Measles | For Healthcare Professionals |CDC," 2015). The healthcare providers will have to be extravigilant when handling suspicious cases to ensure that any case ofmeasles is contained.
Measles is categorized as a notifiable disease by the world healthorganization, and one case is considered an outbreak. Therefore, acountry or a state has to have a very systematic reporting protocolin the case of any suspicious case ("Data Collection andReporting | NNDSS," 2015). In the State of Oregon for instance,Health care providers, are charged with reporting any suspicious caseto the local public health authorities. Meanwhile, public healthnurses will be deployed in high-risk areas such as schools to carryout surveillance, and inspections carried out in restaurants andother facilities to increase field surveillance officers. When thelocal public health authorities are not available within that period,reporting is made directly to Oregon Health Authority. The authoritymaintains round the clock public health consultation services("Oregon Disease Reporting: What is Reportable and When"2015). Samples from the suspected cases are then transported tolicensed laboratories, who shall then give a complete report if thesuspected case is positive of measles and reports back to the StateHealth Authority. Reports can then be made to the Centers for DiseaseControl when extra logistical requirements and human resource arerequired and also for notification ("Data Collection andReporting | NNDSS," 2015).
Measles is a single host-virus hence its prevention is easier thanother complex infections for instance Ebola (Fiebelkorn &Goodson, 2015). One of the prevention strategies is mass vaccinationcampaigns that should target 95% of all children under the age offive years, for they are some of the high-risk groups ("Measles| For Healthcare Professionals | CDC," 2015). Vaccination ofpeople who are visiting countries where there are frequent outbreaksshould also be done. These campaigns should be carried out inhospitals and door to door in case of an outbreak.
The other strategy is creating awareness on measles through massivehealth care education among women in healthcare facilities or socialgatherings (Fiebelkorn & Goodson, 2015). Health education shouldfocus on the importance of measles vaccination, ways of identifying achild or any case with measles, ways of preventing others fromcontracting the disease, and also the importance of good nutritionand hygiene among the high-risk groups ("Measles | ForHealthcare Professionals | CDC," 2015).
In conclusion, communicable diseases such as measles have continuedto kill millions of people every year, yet preventive strategies thatare effective and efficient can be put in place to combat thesituation. Measles can easily be eliminated since it is a singlehost-virus. Its risks can be eradicated if sound public healthstrategies are put in place to address it, hence reducing outbreaksand deaths adequately.
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