The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#156 Measles, Meningitis, TB, and Avian Flu - CDC Updates
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Since mid-March, the CDC has issued several health alerts through its Health Alert Network (HAN). The most recent concerns are the increased number of tuberculosis cases in the U.S., a virulent form of meningococcal disease, and Avian Flu' which are all infectious respiratory diseases. Learn what dental teams need to know and how to protect from these respiratory infections.
Resources:
- Sign up for HAN Email Updates https://emergency.cdc.gov/han/updates.asp
- CDC HAN - Highly Pathogenic Avian Influenza A(H5N1) https://emergency.cdc.gov/han/2024/han00506.asp
- CDC Increase in Invasive Serogroup Y Meningococcal Disease in the U.S. https://emergency.cdc.gov/han/2024/han00505.asp
- CDC Increase In Global and Domestic Measles Cases and Outbreaks https://emergency.cdc.gov/han/2024/han00504.asp
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_02I'm Linda Harvey. I'm Olivia Wan. And together we are the Compliance Divas.
SPEAKER_03Welcome to the Compliance Divas Podcast. I'm Mary Gavoni and I will be the moderator for this episode. We have continued to talk about the need to screen patients for respiratory infections. And even though the COVID pandemic has been declared over, we still need to worry about the health and safety of our patients, but also the health and safety of our dental teams. And we've had a number of alerts from the Centers for Disease Control and Prevention over the last several weeks that we want to highlight and make sure that our listeners are aware of the issues and know what to do about these infectious disease threats that are potential threats to dentistry. At the Compliance Divas, we bring clarity and simplicity to the regulatory world by navigating that regulatory world to keep you on course. You can subscribe to the Compliance Divas podcast at our website, thecompliancedivas.com. And you can also subscribe from your favorite podcast app. We ask you that if you are in your podcast app and listening to this podcast, that you scroll down to the bottom and leave us some comments or give us a rating. All the resources we talk about on this podcast episode will be listed in the show notes on your podcast app. You can submit questions about the podcast to support at thecompliancedeevas.com. So as I mentioned a little bit earlier, we have had a number of health alerts from the CDC Health Alert Network or Han about respiratory type of infections. And we're going to highlight a little bit of one that we talked about a few weeks ago on measles. We're going to talk about meningococcal disease that we have an alert on, and also tuberculosis because the number of tuberculosis cases is on the rise. But the most recent health alert came at the end of last week, and it is about avian flu. The thing we need to know about avian flu is at this point there's only one recorded transmission human to human of avian flu, but it is very infectious among birds. And we are now seeing outbreaks in dairy cows. And there are patients who have contracted avian flu from either birds, chickens in particular, or from dairy cows. The most recent case that was identified is from a dairy cow. So again, I don't think it's a huge issue that we need to be concerned about in dentistry yet, unless we start seeing human-to-human transmissions and the fact that avian flu spreads very, very rapidly and it has a high mortality rate. So keep your radar on and watch for updates to come from the CDC. In the show notes, we will put the link to subscribe to the CDC Health Alerts. So let's start out with Olivia and what updates do we have about the measles health alert that we had just a few weeks ago?
SPEAKER_02Well, Mary, we need to make sure that we are current with the MMR vaccine, and that's Measles, Mumps, Rebella. So CDC alerted us that children should be vaccinated on schedule with the MMR vaccine, and that's two doses. And make sure everyone in your family is up to date on the vaccine if you're traveling internationally. And the recommendation for infants traveling internationally have not changed. Infants six months through 11 months is one dose of MMR before travel. And during outbreaks of measles, public health authorities might recommend an early dose of MMR for infants six to eleven months old. And of course, they recommend a second dose for children one to four years of age andor adults who previously only had one dose, depending on the age of the affected population. So you should check with local health department's website for specific recommendations. Also, I want to point out that the ADA news mentioned that CDC offered this guidance because of the rising measle cases. And so we should make sure that our dental teams and our dentists are up to date on their vaccine if they've not already been vaccinated and Mary to adhere to standard precautions in the workplace to prevent any outbreaks.
SPEAKER_03Thanks, Olivia. That's great. And again, because measles can manifest itself early on with respiratory symptoms. We need to continue to screen our patients for respiratory symptoms. And if they have them, we need to consider reappointing them. Linda, let's talk now about the health alert we got from CDC on meningococcal infections, otherwise known as meningitis.
SPEAKER_01This is the tongue twister virus today, the meningococcal. So the CDC issued their Han alert on March 28th. And this was to advise all health care providers that there is an increase in the invasive meningococcal disease. And let's talk about what some of those stats are. I've got some notes that I'd like to share with our listeners here. In 2023, there were 422 cases that were reported here in the United States. And that was the highest annual number of cases since 2014. But as of March 25th of this year, Mary, there's been 143 cases reported to the CDC. And when you look at from current year to the previous years, about 62 cases over the 81 that was reported this time last year. So in other words, even if you don't remember the numbers, it's just important to know that they're seeing increasing numbers of meningiococcal disease, which, as you mentioned, is meningitis. So let's talk about some of the symptoms and how does this spread? So some of the symptoms include headache, fever, stick, stiff neck, nausea, vomiting. Sometimes it might feel like it's starting out to be the flu, but you need to go and be checked to be on the safe side. This can become life-threatening within hours. So it's something that's don't sit home and ride out the way thinking, oh, I'll just get better in three or four days. And then on top of that, Mary, survivors can have long-term effects such as deafness or amputations of the extremities, even. So that brings us back to how is this spread and why do we care about this in a dental setting? Well, we care because it is a virus and we care about having a safe workplace because it's one required by OSHA. And two, everybody wants to have a safe work, healthy environment anyway. But this virus is spread through coughing or kissing, for example, it's you have to have lengthy contact with someone to spread this bacteria, Mary. So casual contact with somebody is not going to spread this bacteria, but especially kissing, coughing, secretions. And so here where are we in dental offices? We're right in that patient's secretions for a lengthy period of time. And if our PPE is not appropriate or we're not wearing our mask properly, and Mary, this could make the point again for you know N95 being perhaps the better mask than a level three. But certainly just by breathing the air of somebody that's in your office and out pretty quickly is not some way you're going to contract this disease. So I would recommend that we just keep screening our patients, as you mentioned, before they come in. They certainly don't have to sit in their car like we did during the days of the peak of the pandemic with COVID, but we need to be smart about it. All these different viruses and illnesses that are coming back may not seem like they're such a crisis at this point, but we never know when something could change. And as we've said in many other podcasts, prevention is always the best route and having a plan in place. And the plan can simply be starting with screening your patients and not letting your workers come to work that are sick.
SPEAKER_03Absolutely, Linda. And it's not just one like COVID virus, it's a lot of them: RSV, influenza, and this meningiacoccal infection, measles, all of those are coming at us almost at the same time. We're going to call on Leslie to talk about tuberculosis.
SPEAKER_00Well, what's interesting to note, Mary, is that this year there has been an increase in another infectious type of outbreak is tuberculosis or TB as we know it. And in March of 2023's morbidity and mortality weekly report, they showed that there were 9,615 cases of TB in the United States that were reported. And that's a 16% increase from 2022. It's the highest number actually reported since 2013. But we should be paying close attention to TB because really, when it comes to patients, we can't safely treat a patient who has active infectious TB. And first, I'd like to focus on healthcare workers. And healthcare workers should be screened for TB, all healthcare workers upon hire or upon pre-placement before they're placed in a working condition. And the TB screening, uh, according to CDC, is a process that includes a baseline individual TB assessment, a TB symptom evaluation, and a TB test. And the information on the baseline individual TB assessment is actually a risk assessment that should be used to interpret the results of a TB blood test or a TB skin test given upon hire. And healthcare worker with a positive TB test should receive a symptom evaluation and chest x-ray to rule out TB disease. So annual screening, testing, and education is recommended for healthcare workers. In California, we have an aerosol transmissible disease standard where we're required to screen our patients prior to performing any dental treatment. And it's based on the TB guidance from CDC for screening patients. And so it starts out by taking a patient's initial exam and a periodic update, certainly, dental health care providers should routinely ask all patients whether they have a history of TB disease or symptoms indicative of TB. And then observation is one way to see if a patient has unusual symptoms. So we can screen by self-reporting of patients and through direct observation. And what the symptoms are is we may see someone having a cough for more than three weeks that's not explained by non-infectious conditions. And we don't want to rule people out who have allergies. Sometimes people present with allergies. They're not sick, they sound terrible, they have runny nose and pottery eyes and a deep, deep voice that's revely, but they're not sick. They're simply just suffering from allergic conditions. And so again, we can ask our patients how they're feeling if we notice that they're having some signs and symptoms of respiratory illness. And then we also want to pay attention to when patients state that they've had close contact with someone who has a transmissible respiratory disease, such as TV. Thanks, Leslie.
SPEAKER_03That's a great summary. And I think you did a really good job of explaining what we need to do. So the important thing that many employers may not have implemented in their onboarding process is that once you have given what many of the HR specialists will call a conditional offer of employment, that needs to be conditional on or predicated on that person being screened for TB, because if they have TB disease, meaning they are infectious, they cannot work in a healthcare setting. But they may have had a positive TB test either in the past or they test positive currently because they have latent disease. They've had an exposure in the past that will make them test positive. If they have a positive, a positive test in the past, then most likely their screening would be a blood test to determine if they have active disease. So that should be the first thing that's done with a new hire coming in, because you don't want to inadvertently hire someone who has TB disease and comes to work and potentially causes an outbreak from your practice. So, Divas, is there anything else that you would like to add to all of this gloom and doom, infection control, infectious disease information today? Leslie.
SPEAKER_00Well, there's nothing wrong with wearing respiratory protection if you have high rates of respiratory viruses circulating in your community and certainly want to be uh protecting ourselves and know that uh the that we want to make sure that the respirator is NIASH approved these days.
SPEAKER_01Absolutely. Linda? Mary, I think it also goes back to the environmental controls in every office. You know, our our clients and offices across the country implemented a lot of extra precautions during the pandemic, and we see now that many of them have waned away from using those precautions. So if you have air purifier, air purification devices in your operatories, continue to use them, make sure they're placed towards the foot of the chair where they're the most effective, and that's the CDC guidelines. And for hygienists, we we should all be using that high volume evacuator on that tip. Little things that make a difference. It doesn't eradicate the disease, but helps to control the environment. So I think that's just another uh area of preparation, Mary.
SPEAKER_03Absolutely. Thank you, Linda. And just as a quick reminder, that if you have a patient that indicates that they have TB disease, meaning that they have been told by a medical professional that they are infectious, the only type of treatment that you should provide for them would be emergency treatment, something palliative. And to do that, you must wear an N95 respirator to protect yourself. So keep updated, keep listening. We're going to continue to bring these updates to you on infectious disease outbreaks and infectious disease threats because it's not just all about COVID anymore. The compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. Please subscribe to our podcast at the compliancedivas.com or on your favorite podcast app. Any questions that you might have, you can forward to us at support at the compliancedivas.com. And on your podcast app, if you wouldn't mind, please scroll down to the end and give us a rating and send us some comments. We appreciate any and all feedback. Thanks for listening.