Measles Outbreak: What Nurses Need to Know

By Laura Kincheloe, Ed.D., MSN, RN, NE-BC 

A virus mostly eradicated since the 1990’s has resurfaced in Texas in unprecedented numbers since the last recorded highest case count in 2019 (23 cases). There is currently an outbreak
of the measles virus which is known to have been first recorded in Gaines County, Texas. As of February 28, 2025, there have been 146 cases between Dallam, Dawson, Ector, Gaines, Lubbock, Lynn, Martin, Terry, and Yoakum counties with suspected or
growing cases in the San Marcos, San Antonio, and Central Texas regions. There has been one death reported and multiple hospitalizations. The majority of those hospitalized have been unvaccinated individuals.

Background Measles is a highly contagious virus that if one person has been infected, it is likely that 90% of unprotected people will also become infected (DSHS, 2025). The MMR (Measles, Mumps, Rubella) vaccine is known to provide long-lasting protection
from the virus. Typically, individuals are immunized in childhood at 12 to 15 months with a second dose between the ages of 4 and 6 years of age. This vaccine is highly effective and contributes to 93% effectiveness with the first dose and up to 97%
effectiveness after the second dose. In rare situations (less than 3% of cases), individuals do not achieve immunity and can be given an additional series. Immunity can be suspected after receiving both doses or confirmed through a lab blood test
via titer.

Assessment 

Nurses should remain alert to signs and symptoms of measles:

• Begins with mild to moderate fever
• Cough
• Runny nose
• Red eyes
• Sore throat

2-3 days after symptoms

• Tiny blue-white spots, known as Koplik spots inside of mouth

3-5 days after symptoms 

• Red or reddish-brown rash, typically beginning on face, neck, trunk, arms, legs,
  and feet

• Fever up to or greater than 104 degrees Fahrenheit

The Centers for Disease Control and Prevention provide an image gallery to review various recorded rashes. This is essential to review if you have not been
recently educated on Measles assessment or have never seen measles in your practice.

This illness is highly contagious. In fact, the virus can stay contagious in a room for up to two hours after the infected individual leaves
the room. This is considered an airborne illness.

Recommendation

Nurses need to be prepared to recognize, treat, triage, and manage the care of infected individuals. Ensure adequate supplies
such as N-95 respirators, surgical masks, gloves, gowns, tissues, and disinfectants are available. It is recommended to begin screening patients for signs and symptoms and utilize airborne infection isolation rooms for confirmed or suspected cases,
if possible.

• According to DSHS, for healthcare personnel with known or suspected measles, exclude from work for 4 days after the rash appears.
• For immunocompromised healthcare personnel with known or suspected
  measles, exclude from work for the duration of their illness.
• During an outbreak of measles, health-care facilities should recommend 2 doses of MMR vaccine at the appropriate interval for unvaccinated health-care personnel (HCP) regardless
  of birth year who lack laboratory evidence of measles immunity or laboratory confirmation of disease.

• For asymptomatic healthcare personnel with presumptive evidence of immunity to measles who have an exposure to measles:
  • Implement daily monitoring for signs and symptoms of measles from the 5th day after their first exposure through the 21st day after their last exposure.
• For asymptomatic healthcare personnel without presumptive evidence of
  immunity to measles who have an exposure to measles:
  • Two doses of MMR vaccine, separated by at least 28 days.
  • Exclude from work from the 5th day after their first exposure through the 21st day after their last exposure,
    regardless of receipt of PEP.
• Work restrictions are not necessary for healthcare personnel who received the first dose of MMR vaccine prior to exposure:
  • They should receive their second dose of MMR vaccine as soon
    as possible (at least 28 days after their first dose).
  • Implement daily monitoring for signs and symptoms of measles from the 5th day after their first exposure through the 21st day after their last exposure.

All of this information is subject to change through DSHS or CDC recommendations. We are committed to providing regular updates.

Please review the Department of State Health Services website for the latest information regarding the measles outbreak. If you have any nursing practice-related questions, please contact the TNA Practice hotline at 1.800.862.2022, ext.132.

REFERENCES

CDC 

DSHS