22 INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE | 2019 | www.elitecme.com lead to convulsions, which may result in per- manent hearing loss or mental retardation. Fatalities from measles are also possible: The rate of death is one child per 1,000 afflicted with measles (LSU). In addition to the acute complications dis- cussed above, measles is also associated with rarer long-term complications that may not appear until years after resolution of the dis- ease, even in cases where the patient appears to have fully recovered. Subacute sclerosing pan- encephalitis (SSPE) has been only sparingly reported in the U.S. since the 2000 eradication of the measles. Although rare, SSPE is a fatal disease of the central nervous system and gen- erally develops between seven to 10 years after the occurrence of measles (LSU). A frequency of four to 11 cases of SSPE out of 100,000 mea- sles patients was estimated during the measles resurgence of 1989-1991. Data also suggested that the risk may be increased in patients who contract measles at less than two years of age. Nursing Considerations: Although most cases of measles will pass without interven- tion, it can be associated with a variety of com- plications, especially in the youngest or oldest patients. Nurses and ANPs have a responsibil- ity to be vigilant for occurrences of complica- tions and to facilitate appropriate treatment. MEASLES AND PREGNANCY Evidence-Based Practice: Measles is known to be hazardous to both pregnant women and fetal health. Chiba et al. described the clinical course of eight cases of gestational measles during a measles outbreak. In the four cases of measles that occurred prior to 24 weeks of gestation, three spontaneous abortions or stillbirths were recorded. This was in contrast to the four measles infections that occurred after 25 weeks of gestation. In those cases, all pregnancies resulted in live deliveries. Nonetheless, two of four infants were born with congenital measles. Investigators concluded that gestational measles has the potential to do great fetal harm and should be considered one of the more serious complications that can occur during pregnancy (Chiba, et al. 2004). Nursing Consideration: Due to risks asso- ciated with measles during pregnancy, nurses have a responsibility to provide patient edu- cation regarding these dangers and carefully review immunization records when work- ing with all patients, especially those that are pregnant, or who are considering becoming pregnant. SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 3. Of all conditions associated with the mea- sles, which of the following is likely the most serious? a) Diarrhea. b) Pneumonia. c) Ear infection. d) Gestational measles. MEASLES AND BREASTFEEDING Although it is unclear if the measles virus is able to pass through breast milk, mea- sles-specific antibodies have been isolated in the milk of immunized women. In the case where measles infection is identified in a nursing mother, the infant should receive immunoglobulin and the mother should stop breastfeeding for at least 72 hours after the appearance of a measles-associated rash. During this period, the mother should be encouraged to dispose of the breastmilk as she pumps (Lamounier, et al. 2004). Nursing Consideration: Based on the limita- tions of available data concerning the presence of measles antibodies in breast milk, nurses and ANPs should advise any of their breast- feeding patients to discontinue the practice until at least three days after the measles-asso- ciated rash appears. DIAGNOSIS AND LABORATORY TESTING FOR MEASLES Patients presenting with febrile rash illnesses should be tested for measles, especially if they were exposed to another person with febrile rash illness or recently traveled inter- nationally. Suspected measles cases should be reported to the local health department within 24 hours (McLean, 2013). Confirmation of a measles diagnosis through laboratory testing is necessary for all potential measles cases. Serum samples and throat swabs should be collected at first con- tact with any patient that presents with mea- sles symptoms. The measles virus can also be present in urine and respiratory secretions; collecting and analyzing these samples can also improve the chances of detecting the measles virus. Measles-specific IgM anti- bodies can be measured but may be altered or missing in patients who received a mea- sles-containing immunization. Measles RNA can be measured through real-time poly- merase chain reaction (RT-PCR) and can also be used to confirm measles infection (CDC, 2017-1). Throat swabs should be collected from patients with suspected measles and sent to state health department or the U.S. Centers for Disease Control and Prevention (CDC). Viral concentrations are the highest within three days of rash onset, so the collection of speci- mens should not be delayed. (McLean, 2013). Protocols for collecting specimens from mea- sles patients can be found at http://www.cdc. gov/measles/lab-tools/rt-pcr.html. TREATMENT OF MEASLES Treatment of measles should be focused on relieving symptoms through supportive care CONTINUING EDUCATION  |