When a patient presents to the emergency department with a cough and fever, they could have a simple upper respiratory infection. But they could also be sick with something much worse, like the measles. Early measles can mimic a typical viral illness, making diagnosing it challenging, especially for clinicians who haven’t seen this condition in their patients before.
Michael D. Gooch, DNP, APRN, CCP, FAASTN, FAANP, FAEN
“Most of us in clinical practice have never encountered measles in person,” said Michael D. Gooch, DNP, APRN, CCP, FAASTN, FAANP, FAEN, a flight and emergency nurse practitioner at Vanderbilt University Medical Center and assistant professor of nursing at Vanderbilt University School of Nursing.
However the disease, which was once considered eliminated in the United States, is making a major comeback, thanks to factors like vaccine rates that are below the coverage target.
“Last year we had a surge in measles, but this year has been even worse,” Gooch said.
According to CDC data, as of Aug. 6, there were 1,356 confirmed cases of measles in the United States, compared to 285 cases during all of 2024. That’s the highest number since measles was declared eliminated from the United States in 2000. In addition, 13 percent of measles cases have required hospitalization and there have been three confirmed deaths this year.
Past Meets Present
With diseases like measles becoming more prevalent, it’s crucial for ED clinicians to know what to look for and to consider these diseases in their differential diagnosis.
That’s what Gooch will cover during the session, “From Dormant to Dangerous: The Resurgence of Measles, Bubonic Plague, and Leprosy” at Emergency Nursing 2025. He will discuss those infectious diseases, along with their clinical manifestations, management strategies and the necessary isolation precautions to limit their spread.
For instance, with measles, Gooch said patients will usually have a high fever and the “three Cs,” which is cough, coryza (congestion and runny nose) and conjunctivitis. In addition, measles patients may also get little blue-gray spots on the inside of their cheek, known as Koplik spots, but they usually only last about 24 hours.
“When people come in with a cough and fever, I don’t look at their entire mouth all the time. I look at their throat. But now we need to think more conscientiously about looking at the side of their cheeks, which is where these legions appear,” he said.
Gooch hopes that attendees will keep these unfamiliar diseases in the back of their minds when examining patients.
“These used to be a ‘zebra,’” he said. “Now it’s really more a common thing we might run into in certain areas.”