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Pediatric Measles Resurgence: Implications for Acute and Critical Care Nursing Practice
Janakiram Rameswaran1, Jessica Strohm Farber2, Kristin Atlas3
1Janakiram Rameswaran is a nurse practitioner in the pediatric emergency department, Children's Hospital of Philadelphia, Pennsylvania, and a pediatric intensive care nurse practitioner, Bristol-Myers Squibb Children's Hospital, New Brunswick, New Jersey.
Background:
The United States declared endemic measles eliminated in 2000. However, outbreaks continued, with resurgences in 2019 and 2025. In 2025, more than 2200 cases across 48 outbreaks, the most since 1992, were reported. In the first half of 2026, 2073 cases were reported. Declining measles, mumps, and rubella vaccination rates have increased susceptibility among children. Acute and critical care nurses are central to early recognition and management of measles for optimal outcomes.
Objective:
To summarize current evidence on measles epidemiology, pathophysiology, clinical presentation, complications, treatment strategies, and acute and critical care nursing implications, emphasizing preparedness amid rising case numbers.
Methods:
A literature review was conducted using PubMed and CINAHL databases and websites of Centers for Disease Control and Prevention, World Health Organization, professional organizations, and pediatric hospitals. English-language sources published from 2015 to August 2025 were prioritized; relevant earlier studies were included. Reference lists were searched for additional articles.
Data Synthesis:
Measles is among the most contagious human diseases. Typical features include fever, cough, coryza, conjunctivitis, and morbilliform rash. Severe respiratory and neurological complications may require critical care hospitalization. Complications like encephalitis may present weeks to years after acute infection. Management remains supportive, with vitamin A supplementation recommended. Acute and critical care nursing priorities include early recognition, isolation precautions, specimen collection, respiratory and hemodynamic support, neurological monitoring, serial assessments, hydration, nutrition, and caregiver education.
Conclusion:
Measles is resurging in the United States despite being vaccine preventable. Nurse preparedness, including knowledge of clinical features, complications, and infection control, is essential to mitigate morbidity and mortality and to support outbreak prevention. (Critical Care Nurse. Published online ahead of print July 17, 2026).
Insights
Measles is resurging in the US due to declining vaccination rates. Nurse preparedness is crucial for recognizing measles symptoms, managing complications, and preventing outbreaks.
Area of Science:
- Public Health
- Infectious Diseases
- Nursing
Background:
- Measles, a vaccine-preventable disease, has seen resurgences in the US, with over 2200 cases reported in 2025.
- Declining vaccination rates have increased childhood susceptibility to measles.
- Acute and critical care nurses play a vital role in early measles recognition and management.
Purpose of the Study:
- To review current evidence on measles epidemiology, pathophysiology, clinical presentation, and complications.
- To outline treatment strategies and acute/critical care nursing implications for measles.
- To emphasize the importance of nurse preparedness for rising measles cases.
Main Methods:
- A comprehensive literature review was performed.
- Databases searched included PubMed and CINAHL.
- Information was supplemented by CDC, WHO, and hospital websites, prioritizing 2015-2025 publications.
Main Results:
- Measles is highly contagious, presenting with fever, cough, coryza, conjunctivitis, and rash.
- Severe complications, including respiratory and neurological issues like encephalitis, may necessitate critical care.
- Supportive management, vitamin A, and nursing interventions are key.
Conclusions:
- Despite being preventable, measles is resurging in the US.
- Nurse preparedness regarding clinical features, complications, and infection control is essential.
- Enhanced nursing knowledge aids in mitigating measles morbidity, mortality, and supporting outbreak prevention.
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