Summer Vacation and Measles: The perfect storm

Summer Vacation and Measles: The perfect storm

By: Lisa Mathis MSN, FNP-BC

Summer is right around the corner! Time for warmer weather and summer vacation for the kids, and lots of family fun. Water parks and theme parks will be packed with families riding thrilling roller coasters and sliding at an unsafe speed down a water slide. Sweaty, hot bodies stand in lines for hours for a 90 second rush of adrenaline.

What does summer vacation have to do with measles, school being out should help right? No, quite the contrary. Measles numbers continue to climb in Texas. At this time, 624 cases have been confirmed since late January. This is an increase of 27 since the April 18 update.¹ Across the US, as of April 17, 2025, a total of 800 confirmed measles cases were reported by 25 jurisdictions: Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Indiana, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York State, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and Washington.² With two confirmed fatalities in school-aged children who lived in the outbreak area. The children were not vaccinated and had no known underlying conditions.

In spring-break and summer travel seasons clinicians and public health officials play an important role in preventing measles spread. APPs should be vigilant when dealing with cases of febrile illness with rash, know diagnostic criteria, and share effective measles prevention strategies, including vaccine guidance.

The current outbreak initially started in an area where many children lacked immunization, with continued spread. Close proximity of children at popular vacation spots could cause a surge in numbers over the spring-break and summer seasons. Keys to help prevent a surge include education and early recognition.

In 2000 the United States deemed measles eradicated. Unfortunately, a setback in measles vaccination rates occurred in 1998, when a fraudulent research paper published in ‘The Lancet’, asserted a link between the MMR vaccine and autism without robust scientific evidence. 

The influence of this paper, along with systemic misinformation by anti-vaccination groups in high-income countries, resulted in a drop in vaccination rates below the level required for community protection. This caused a resurgence in measles cases in England and Wales, as well as parts of the USA and Canada.³ Continued increases in rates of autism have created an atmosphere where parents are reluctant to vaccinate.

APPs serve in a most important role to help in the current and future outbreaks. Both nurse Practitioners and Physicians Assistants are well known for excellent communication and taking time with patients and families to educate and answer questions. The education of parents who are opposed to vaccinations is an area where APPs can stand out. The parent MUST be approached in a non-judgmental way. These parents love their children and have a very real fear of harm from the MMR vaccine. An understanding approach with recognition of concerns, clear data, and an appropriate level of communication to foster understanding are key. For families who refuse vaccination, education on signs, symptoms, and care of measles as a next step.

Consider measles as a diagnosis in anyone with fever (≥101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently traveled internationally, or domestically to a region with a known measles outbreak or has other known or suspected exposure to measles. However, be diligent in asking about vacation spots and theme parks, as they are exposed to so many people in crowded areas. They may answer ‘no’ when asked about travel and exposure, not considering the water park an “at risk” area.

Some parents may feel “measles is just a rash”. Once again, education is imperative, and the parents must realize this highly contagious illness with risk of serious complications. If a patient possibly has measles they should be isolated immediately. Advise the parents NO exposure to others until confirmed testing is completed. This may not be well received especially if that expensive trip to Disney has already been purchased. Remember to stay calm with parents who might be upset and explain a single infected child at the theme park could create a massive outbreak.

There is no specific antiviral therapy for measles. Medical care is supportive to help relieve symptoms and address complications such as pneumonia and secondary bacterial infections. Consistent with guidance from the American Academy of Pediatrics, vitamin A may be administered to infants and children in the United States with measles as part of supportive management while in the hospital. Vitamin A should be administered under the supervision of a healthcare provider for severe cases and is not a substitute for vaccination. Overuse of Vitamin A can lead to toxicity and cause damage to the liver, bones, central nervous system, and skin.⁴

Education regarding prevention and vaccination during the summer season is critical for APPs to remember. The potential for a worsening outbreak is possible, but with accurate education of parents and patients can be preventable. Unfortunately, many APPs are unfamiliar with measles rash and it can be often missed leading to exposure of others. Always remember a person’s perception is their reality so education for parents as well as healthcare providers is the way to once again eradicate measles.

“It is hard enough to remember my opinions, without also remembering my reasons for them!”
― Friedrich Nietzsche

1-https://www.dshs.texas.gov/news-alerts/measles-outbreak-2025

2-https://www.cdc.gov/measles/data-research/index.html

3- https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-measles-vaccination

4- https://www.cdc.gov/han/php/notices/han00522.html