NURS 832 Week 6 Outbreak Paper Outline on the 2025 West Texas Measles Outbreak Example

Outline for an Outbreak Paper: The 2025 West Texas Measles Outbreak, 762 Cases, 99 Hospitalizations and Two Children's Deaths, Organized by Person, Place, Time and Response

Topic and Thesis

Topic: the 2025 measles outbreak in West Texas, which began in Gaines County in January 2025 and became the largest Texas outbreak in decades. I chose it because I practice in the region, because it was well documented in CDC and state reports and because it raises the core questions of this course: how disease spreads in a population with low vaccination coverage and how measurement guides response.

Thesis: The 2025 West Texas measles outbreak spread rapidly because a close-knit community with low MMR coverage met one of the most contagious viruses known, and its course shows that case-based control measures can slow an outbreak but cannot substitute for population immunity.

Outline

I. Introduction and Significance

• Measles elimination in the United States in 2000 and its erosion in 2025 (Mathis et al., 2025)
• 2025 national count: more than 2,200 cases in 48 outbreaks, most since 1992 (Rameswaran et al., 2026)
• Thesis statement

II. The Agent and Its Transmission

• Airborne virus; among the most contagious human diseases; clinical course and complications (Rameswaran et al., 2026)
• Genotype D8 lineage identified by whole-genome sequencing (Juntawong et al., 2026)
• Epidemiologic triangle applied to this outbreak (Macha & McDonough, 2012)

III. Timeline

• January 29, 2025: first case reported in an unvaccinated school-aged child (Wang et al., 2026)
• Two deaths of unvaccinated school-aged children during the spring (Texas Department of State Health Services, 2025)
• 762 cases by August; outbreak declared over August 18, 2025 (Texas Department of State Health Services, 2025)

IV. Descriptive Epidemiology: Person, Place, Time

• Person: mostly unvaccinated children; 96% of national cases unvaccinated or unknown status by April (Mathis et al., 2025)
• Hospitalization: 18.5% of the first 325 cases; 72.2% of reviewed inpatients had pneumonia; 70.4% needed oxygen (Wang et al., 2026)
• Place: Gaines County and spread to neighboring counties, New Mexico and Oklahoma; model predicted at least 80% probability of local outbreaks in eight neighboring counties (Ndeffo-Mbah et al., 2026)
• Time: epidemic curve by rash onset; peak and decline

V. The Investigation

• Case definitions and laboratory confirmation by RT-PCR
• Child care investigation in Lubbock: seven children and one grandparent, no travel (Ly et al., 2026)
• Genomic surveillance marker for tracking the lineage (Juntawong et al., 2026)
• Serologic testing surge among veterans: 60.3% increase; 9.18% seronegative (Gentry et al., 2026)

VI. Control Measures

• Isolation, quarantine and exclusion of exposed unvaccinated children
• Post-exposure prophylaxis: MMR in the first three days after exposure, immune globulin up to day six
• Vaccination clinics and community engagement with trusted messengers (Mathis et al., 2025)
• Child care measures: separating infants too young for MMR, limiting shared spaces (Ly et al., 2026)

VII. Analysis: Transmission and the Effect of Interventions

• Effective reproduction number median estimate and its interval (Oraby & Ndeffo-Mbah, 2026)
• Modeled effect of school and daycare closures plus reactive vaccination: up to 21% fewer cases, with diminishing returns
• Interpretation: why late interventions have limited effect when coverage is low

VIII. Costs and Consequences

• Societal cost of the related New Mexico outbreak: $5.4 million, $53,522 per case (Pike et al., 2026)
• Hospital and family burden; deaths

IX. Implications for Advanced Practice and a Biblical Perspective

• Nurse practitioner roles: recognition, isolation, reporting, catch-up vaccination, respectful conversations with hesitant families
• Stewardship of children's health and love of neighbor (English Standard Version Bible, 2001/2016, Matthew 22:39)
• Conclusion restating the thesis

Planned Figures and Tables

• Figure 1: epidemic curve of Texas cases by week of rash onset
• Table 1: hospitalized patients' age, vaccination status and complications
• Table 2: control measures by date and setting

Each will be built from the published reports rather than copied, with the source noted beneath it, so that the paper analyzes the outbreak rather than retelling it.

Planned Sources

The paper will rely primarily on CDC Morbidity and Mortality Weekly Report investigations, peer-reviewed modeling and genomic studies published in 2025 and 2026, the Texas Department of State Health Services final outbreak report, the course textbook and Scripture. All journal sources fall within the five-year window. If the paper cannot point to a number from the investigation, it has not yet studied the outbreak, only heard about it.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gentry, C. A., Kurdgelashvili, G., & Scofield, R. H. (2026). Characterizing measles IgG-related seroprevalence in the US veteran population during the 2025 West Texas outbreak. American Journal of Infection Control. Advance online publication. https://doi.org/10.1016/j.ajic.2026.08.004

Juntawong, P., Oh, B., Bovio, R., Lu, J., Stanley, S., Potter, R. F., Sun, Y., Schroeder, C., Smith, O. A., Huebner, E., White, S. L., Rai, S., Shetty, V., & Kubin, G. (2026). Whole-genome sequencing of measles virus from 2025 outbreak, Texas, USA. Emerging Infectious Diseases, 32(10), 1716-1720. https://doi.org/10.3201/eid3210.260494

Ly, A. N., Shotts, A., Torres, T., Peacock, G., Sugerman, D. E., Crisp, C., Rodriguez, G., Dang, T., Martinez, D., Rai, S., Shetty, V., Meehan, A., Hocevar Adkins, S., Filardo, T. D., Dowling, N. F., & Wells, K. (2026). Measles outbreak in a child care facility: Lubbock, Texas, March-April 2025. Morbidity and Mortality Weekly Report, 75(21), 266-270. https://doi.org/10.15585/mmwr.mm7521a1

Macha, K., & McDonough, J. P. (2012). Epidemiology for advanced nursing practice. Jones & Bartlett Learning.

Mathis, A. D., Raines, K., Filardo, T. D., Wiley, N., Leung, J., Rota, P. A., Martinez, D., Rai, S., Shetty, V., Holzinger, N., Stanislawski, E., Daskalakis, D. C., Chatham-Stephens, K., Patel, M., & Sugerman, D. (2025). Measles update: United States, January 1-April 17, 2025. Morbidity and Mortality Weekly Report, 74(14), 232-238. https://doi.org/10.15585/mmwr.mm7414a1

Ndeffo-Mbah, M. L., Mokhtar, S., Pandey, A., & Wells, C. R. (2026). Risk and spatial spread of a measles outbreak in Texas. Viruses, 18(6), Article 648. https://doi.org/10.3390/v18060648

Oraby, T., & Ndeffo-Mbah, M. L. (2026). The 2025 measles outbreak in Texas. BMC Infectious Diseases, 26(1), Article 1430. https://doi.org/10.1186/s12879-026-13663-2

Pike, J., Holzinger, N., Xiao, H. T., Stanislawski, E., Leung, J., Romero, A., & Smelser, C. (2026). Economic impact of the 2025 New Mexico measles outbreak: Highlighting the cost of efforts to prevent future outbreaks. Annals of Internal Medicine. Advance online publication. https://doi.org/10.7326/ANNALS-26-00718

Rameswaran, J., Farber, J. S., Atlas, K., & Shields, K. (2026). Pediatric measles resurgence: Implications for acute and critical care nursing practice. Critical Care Nurse, 46(5), 10-20. https://doi.org/10.4037/ccn2026877

Texas Department of State Health Services. (2025, August 12). Measles outbreak: August 12, 2025. https://www.dshs.texas.gov/news-alerts/measles-outbreak-2025

Wang, D., Rogers, C. C., Lutz, C. S., Sajewski, E. T., Almas, S., Clemmons, N. S., Gressick, K. A., Hernandez, C., Holbrooks, Z., Kidd, M. T., Martínez, D. L., McClaran, K., Mendoza, E., Milton, J. S., Northcott, K. D., Raines, K., Rai, S., Wells, K., Sugerman, D. E., . . . Shuford, J. A. (2026). Characteristics of patients hospitalized with measles during an outbreak: West Texas, January-March 2025. Morbidity and Mortality Weekly Report, 75(20), 252-257. https://doi.org/10.15585/mmwr.mm7520a1