Preventing Measles and More With an Infectious Disease Specialist
Dr. Audrey Stevenson shares what nurse practitioners need to know about vaccination.
The fact that not every person in the U.S. is deeply familiar with measles or how it presents is a vaccine success story. A graph created by the Centers for Disease Control and Prevention shows the national number of annual measles cases reaching almost 500,000 right before a vaccine was licensed in 1963. The number of cases then took a dramatic dip, reaching barely 100,000 in the early 70s before being declared eliminated in 2000.
Unfortunately, measles is back, with the Journal for Nurse Practitioners noting the upward trend beginning about a decade ago. In 2025, a total of 1,214 confirmed cases have been reported in 36 jurisdictions as of June 19. To help put this rise in perspective — and to discuss the role of vaccination in preventing illness — the American Association of Nurse Practitioners® (AANP) spoke with Utah-based nurse practitioner (NP) expert Audrey M. Stevenson, PhD, MPH, MSN, FNP-BC, about her work in public health and how she recommends NPs speak to their patients about the importance of staying safe and measles-free.
Q: Could you tell us about your passion for vaccines and the work you’ve done related to vaccination throughout your career?
Stevenson: I did my doctoral dissertation on vaccines, and vaccines have always been very important to me. I've been highly involved in vaccine research and vaccine policy for 25 years now. When COVID-19 happened, I was named as the vaccine director for all of Salt Lake County, which is 1.2 million people. My responsibilities were designing and developing mass clinic distributions. The governor was the one allocating doses of vaccine to local health departments, so in our state it was the local health departments that were responsible for the vaccine distribution.
If we were sharing it with a hospital, it came to us first and we had to push it out to these other places. As a director, it was all aspects of that — it was determining how we were going to develop the logistics for being able to do mass vaccinations; getting vaccines into communities where there were individuals of color or there was vaccine distrust; making sure that we were getting first responders in hospitals in the early days; and then trying to develop systems for being able to vaccinate people as quickly as possible as each age group was expanded.
Q: We’ll return to vaccination and vaccination strategies, but I’d like to address measles specifically. How does measles differ from other diseases, and what do all health care providers — especially NPs — need to know about the disease?
Measles is a viral rash illness, and the symptoms of measles can mimic many other types of viral diseases. The rashes can look very, very similar. I was fortunate that in my career I was involved with outbreaks because of working in public health; we would do surveillance, and we would do mitigation when we'd have outbreaks within our community. Several years ago, we had a measles outbreak in Utah, and during that time we came in contact with several individuals who had measles.
Measles present with a very high fever. The rash starts at the hairline, and then it seems to go downward from there. They usually have a cough associated with it, or the three Cs: cough, coryza (runny nose) and conjunctivitis. They have what is very symptomatic of so many respiratory illnesses, but they have this very specific rash.
The one thing that really helps you to diagnose it — besides doing the laboratory work for confirmation — is the Koplik spots. These are some little lesions that individuals will have in the back of their throat that are very characteristic of measles.
Q: What can you tell us about treatment?
Treatment is mostly conservative management of the symptoms. On rare occasions, an individual will receive some immunoglobulin for that. But typically, what we're doing is just having to treat the symptoms, and if they get any complication with it — such as development of a pneumonia — it’s treating the pneumonia.
The measles itself doesn't really have a treatment. We've heard in the media about vitamin A. Vitamin A seems to be beneficial for those who are vitamin A deficient, and so providing vitamin A in developing countries and other countries is particularly helpful. There is a recommendation that we provide vitamin A as far as treatment — we just don't do the massive amounts that we've been seeing on social media. For individuals who are exposed but aren't symptomatic yet, we use the vaccination.
Q: The measles, mumps and rubella (MMR) vaccine, is that right?
Yeah, we use the MMR for those who have been exposed to try to keep them from developing the disease. The vaccine continues to be the best prevention, and it protects against three different diseases. These diseases are very serious, and measles is very serious. We've had deaths from measles, and we can have complications from measles, including things like encephalitis. Individuals can get very severe pneumonia with measles. They're miserable and sick.
And the vaccine is very safe. There have literally been millions of doses of this vaccine that have been administered safely. Any risk associated with the vaccine is much, much lower than risk from the disease itself.
Q: Many NPs are working with patients and addressing concerns and hesitancy about vaccinations. What would you say to patients who are concerned about getting vaccinated?
In terms of talking to a patient, I try to find out where the information gap is, or what they've heard and the source. Then I make it very personal. I will tell somebody, “I'm concerned about you, and I personally have received all these vaccines. I have given them to all of my loved ones, and I would never, ever take a vaccine or recommend a vaccine that I didn't have absolute confidence in. If I thought there was any chance that it was going be harmful to someone, I would never, ever recommend it.”
I make it personal to that person: “I'm worried about you being protected. We're seeing outbreaks of these vaccine-preventable diseases, and we're seeing deaths associated with these. I am really worried about your family's protection. Can I give you some more information about this? Can I give you some other reputable sources? Okay, you don't trust the government. Let's talk about some coalitions of families that have dealt with some of these diseases, and they will provide some information to you.” So, giving them reputable resources that aren't necessarily government-based.
Gain More Infectious Disease Resources
Dr. Stevenson’s Immunization Update activity from the 2025 AANP National Conference is part of the on-demand package, and will be available until Aug. 4, 2025. AANP members may also join the Infectious Disease and HIV Community for just $20 annually.