As of March 7, 2025, the Centers for Disease Control and Prevention (CDC) stated that a total of 222 measles (rubeola) cases had been reported in 12 different U.S. jurisdictions: Alaska, California, Florida, Georgia, Kentucky, New Jersey, New Mexico, New York City, Pennsylvania, Rhode Island, Texas, and Washington. Among those cases, 94% were either unvaccinated or had an unknown vaccination status. Seventeen percent were hospitalized, with the majority of those cases among children 19 years of age or younger. Unfortunately, measles has already claimed the life of an unvaccinated child in Texas, which is reporting the largest outbreak, at 159 cases. The cause of a second death, of an unvaccinated deceased adult in New Mexico who was found to have measles, is still under investigation.

Measles is an airborne, highly infectious, and potentially severe illness. The vaccine [measles-mumps-rubella (MMR)] vaccine is more than 97% effective in preventing disease. In the United States, MMR coverage among kindergartners is now below the 95% coverage target, with rates much lower in some communities, and is continuing to decrease. In addition, global measles activity is increasing, leading to more opportunities for an unvaccinated person to become infected when traveling outside the U.S. or for an infected person visiting or living in the U.S. to transmit to a susceptible unvaccinated person. Groups of unvaccinated individuals provide opportunities for ongoing transmission and the resultant illness. These outcomes are preventable.

What can nurses do?

Recognizing that nurses remain members of the most trusted profession, what are some actions nurses can take to address this outbreak and its underlying causes? Let’s think about this in several ways: protecting self and patients, protecting family, protecting community.

Protecting self and patients:

Reduce your susceptibility to measles by being completely vaccinated. This means two doses of the MMR vaccine appropriately spaced (at least 28 days between those two doses).
Current CDC guidelines recommend either two doses of vaccine or verification of immunity for health care personnel. The standard screening test for rubeola immunity starts with measuring rubeola immunoglobulin (Ig), the antibody level in the blood.
If you are unsure of your status, contact your employee/occupational health office to verify.
Recognize the early symptoms of rubeola, which include cough, coryza, and conjunctivitis (often called the three Cs). A red flat rash starting at the hairline and moving downward usually follows several days later.
If you are preparing for international travel, seek the counsel of a health care provider with expertise in travel-related risk assessment and vaccination. They can assist with vaccination, titers, and documentation of vaccination/titer status. Rubeola is a worldwide disease and a risk for the unvaccinated.

Protecting family:

Measles is among the most contagious viral diseases known; secondary attack rates are ≥90% among susceptible household and institutional contacts. Infected people are usually contagious from 4 days before until 4 days after rash onset. Since families share air space within the home, transmission among family members is highly likely if one is infected and others are unvaccinated or incompletely vaccinated. This current outbreak situation is a reminder for nurses to ensure their family members, even those not living within the same home, are vaccinated.
If someone in the home or family is unable to be vaccinated (for example, because severely immunocompromised), then families should recognize their susceptibility and take steps to avoid transmission opportunities, including avoidance or delaying international travel.
Maintain copies of children’s vaccination records and ensure information in state immunization information systems (immunization registries) is current and accurate. This will be important if preparing for international travel. Some countries may initiate a requirement for documentation of vaccination/immunity, particularly during outbreaks. Visiting a travel clinic can help you with vaccination verification as well as documentation.

Protecting community:

Use your voice as members of the most trusted profession to answer questions regarding the disease, its outcomes, and vaccination. Take time to refresh your memory regarding this disease as well as the vaccine. Immunize.org is an excellent resource and has both short print materials as well as short videos, current guidelines, news on outbreaks of concern, and much more.
Identify community resources regarding vaccine access. Your local health department is likely to have immunization clinics and be able to provide information regarding where those with insurance coverage, those who are eligible for the Vaccine for Children (VFC) program, and the uninsured can access vaccine.
Reach out and be a resource to your local school system, as many schools are trying to address vaccination gaps among school-age children. Your knowledge and competencies may be a welcomed addition to their efforts.
Reach out to your state nurses’ association or specialty association chapters to learn about any local initiatives that may be able to use your skills.
Be prepared to address misinformation and share accurate information to others in the community. Our job is to be a partner to patients and community members, recognizing that individuals have the right to accept or decline vaccination. We all have the same goals—healthy lives and healthy communities. Use your knowledge and your voice to ensure local decisions are based upon accurate information.

Ruth Carrico, PhD, FNP-C, CIC, FSHEA, FNAP, FAAN, is an adjunct professor in the Division of Infectious Diseases at the University of Louisville School of Medicine and a board certified family nurse practitioner. She has worked in the field of infection prevention and control for more than 30 years and is also board certified in infection prevention and control. Her research and clinical practice focus on disease prevention in all settings where care is delivered and involves public health and care of vulnerable populations.

The author’s recent posts for this blog include “H5N1 Avian Influenza (Bird Flu) Update for Nurses and Other Health Providers” and “Norovirus, a Formidable and Underappreciated Hazard: What Nurses Need to Know.”

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