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
#197 5 Things Dental Teams Need to Know About Current Measles Outbreaks
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In this episode the Compliance Divas discuss the most recent outbreak of Measles in TX. The cases continue to grow in numbers, and dental teams could be at risk of infection. Learn about the signs and symptoms of this highly contagious respiratory illness, the serious complications from measles infections, especially to pregnant women and what we can do to stay informed about outbreaks, keep our patients and team members safe.
Resources:
- Texas Dept. of State Health Services - Measles Outbreak Feb. 18, 2025 https://www.dshs.texas.gov/news-alerts/measles-outbreak-feb-18-2025
- CDC - Measles Cases and Outbreaks - https://www.cdc.gov/measles/data-research/index.html
- CDC - Measles (Rubeola) https://www.cdc.gov/measles/index.html
- CDC - About Measles https://www.cdc.gov/measles/about/index.html
- CDC MMWR Feb. 15, 2020 - Measles Outbreak - California 2014-2015 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_00I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for this episode. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedevas.com. Any resources that we mentioned during this podcast will be found in our show notes, and we always invite you to submit any questions that you have to support at the compliancedevas.com. For about four years now, the Divas have been bringing you various topics on compliance and in particular sharing information on infection control on various topics. We know that infection control has really come front and center since the pandemic. It was always an important part of patient safety and quality of care in a dental or any healthcare setting, but particularly since COVID. So today we want to bring to your attention something different related to infection control, and that is related to the current outbreak of measles because this can impact you or your practice or your family, depending on what part of the country that you're in. And we know that this is quite a mobile society, and many individuals travel for work or move across the country to travel, visit with relatives and whatnot. So it's very important to keep up with late breaking news. So I'm going to ask our diva Leslie to talk to us about the latest outbreak in measles and catch us up. Leslie, what's going on, please?
SPEAKER_03Hey, Linda. There has been an outbreak. It was reported over the last three weeks, and this is really focusing on the weekend of February 14th, 2025, for the Texas State Department of Health Services has 48 cases that have been identified with symptom onsets in the last three weeks. And 13 of the patients have been hospitalized. All of the cases are unvaccinated, or their vaccination status is unknown. And due to the highly contagious nature of this disease, additional cases are likely to occur in the county where the most cases are, which is Gaines County. It's interesting, the age range of the cases, Linda, from zero to four years old, there are 13 cases. A five to 17-year age range is 29 cases, 18 years and over five cases, and then there's a one case, an unknown uh age of that individual. So it's really quite an interesting outbreak. As you know, Linda, measles has been eradicated really for about the last, oh, 25 years or so. So to see cases come back up like this is startling.
SPEAKER_02I couldn't agree more. And we use the word startling because we know this is not going to become, hopefully it's not a pandemic, but it's startling because, as I mentioned in the very beginning of the podcast, we have a very mobile society. And so just because this is these cases are occurring in Texas right now doesn't mean they can't, they couldn't spread to another community or another state. So thank you for sharing that. And you're right, Misles has been eradicated for 25 years now. So Leslie, another thing that's important about this is that all ages are susceptible to poke. I'm just a little off case today. I'm sorry. It's also important, Leslie, that we recognize, as you mentioned, with the age breakdown, that all ages are susceptible to the measles. But particularly pregnant women, they are particularly vulnerable when it comes to the complications for measles. So I'm going to ask our diva Mary then to talk to us about what exactly is measles and what are the symptoms.
SPEAKER_01Thanks, Linda. And I sort of feel like a broken record that we keep talking about measles outbreaks and how concerning this is. And it's not just Texas, there are other states that are having outbreaks, which is defined by the CDC as three or more related cases. So we have some in Alaska, Georgia, New York City, Rhode Island, and of course in Texas. So measles is a viral infection. And a lot of people think that measles is simply that rash that kids get and they have a fever with it and then they get better. But it can have serious respiratory consequences, and it is a respiratory infection, which makes not only anyone who's not vaccinated vulnerable to getting measles, but it also then lends itself to being a risk in dentistry because we have close proximity, we create aerosols, and we know from all the research on measles that measles can remain airborne from someone who's been coughing or sneezing or speaking in an area for up to two hours. So if we had someone in our reception area or we had someone in a treatment room, and that person was infectious with measles, perhaps didn't know it, then they can certainly be exposing others. So the symptoms of measles include a fever, a skin rash, a cough, conjunctivitis, and some of the consequences of measles include pneumonia, which can certainly affect young children, older adults, but also deafness can be caused by exposure to measles. So we need to be very careful. And Linda, I'm so glad that you mentioned about pregnant women, because we know that exposure to measles for pregnant women can lead to some pretty devastating consequences for miscarriage and birth defects in those babies. So this is a serious thing, and we need to take it seriously, especially from the team perspective, that we need to know as healthcare workers what our measles titer is. In other words, do we maybe need to have a booster of a measles vaccine?
SPEAKER_02Mary, those were some excellent points. So one of the takeaways from your information you just shared was not to downplay the symptoms because sometimes the patient will come in and say, I just they may know they have a fever and don't say anything, or they haven't checked their fever, or they may have a little rash and they're not sure what it is, so they just go to the dentist anyway. And likewise with team members. So it's important not to downplay symptoms. Well, we don't certainly need to panic because we have a rash or we're feeling a little out of sorts. It's important that we pay attention to the symptoms to determine what we may be coming down with. You have some additional thoughts, Mary?
SPEAKER_01Yes, I did have an additional thought because you mentioned a rash. And remember that one of the first signs of measles infectivity, besides some respiratory symptoms, is coplic spots in the buccal or labial mucosa. So we may be seeing those in our patients. And if we do see them, we need to think measles, we need to think infectious.
SPEAKER_02Excellent point, Mary. Thank you so much. Now I'd like to call on our diva Olivia. Olivia, there's some information that we have from the CDC, particularly their health alert network, that maybe you could share with us. And let's talk about the mobility of individuals in our society a little bit more.
SPEAKER_00Well, Linda, last year the CDC and public health officials were aware of this global increase of measles. I was actually talking about this this weekend with some friends, how you know people are not vaccinating for whatever the reasons are, but if they're not vaccinating their children and they're traveling internationally, the potential risk to infect so many people. And we were la not laughing about this happening, but when we were kids, they'd line us up in the hallway of the school and we'd be vaccinated. You didn't have your parents there. I don't remember consent forms. We were just vaccinated. Now it's quite different with the vaccine programs. And when you go to the doctor, you'll see signage on the back of the door with the vaccination series recommendations. But the message that we're trying to communicate as the compliance divas is number one, it's very contagious. And the amount of people that could be infected as a result of traveling. And so it is recommended that we be vaccinated, particularly children age 12 months and older that have been linked to infected cases with travel. And so if the child has not had the vaccine, the measles, mumps, or bella, which is the MMR vaccine, it is recommended. And so, and and I think I've shared this before that when I decided to go back to school, I had to show the school evidence of two dates of injections, and I didn't have that on my immunization record. So my immunizations had to be updated to get into an out-of-state school. So with the declination of measles vaccines, we see the risk of outbreaks, including our own country where this virus we thought had been pretty much uh eradicated. And unfortunately, you know, measles could be entirely uh preventable through vaccination. And these vaccines have been around forever, they've been proven to be very safe, highly effective, with two doses beginning being 97% effective against uh measles. One dose is already at 93% uh effective. So with the health advisory network recommendations for healthcare providers, uh children that are school age should be vaccinated. Children who are not traveling internationally should receive their first dose at age 12 to 15 months old, and their second dose at four to six years. So were those vaccines even completed? I know anytime I've had court involvement with children where I've been appointed by the court, they look at those vaccine records and whether or not the parent was being neglectful of their children and getting vaccines current. And then the guidance tells us also all U.S. residents older than age six months without evidence of immunity or planning to travel internationally should receive the MMR vaccine prior to departure. And additionally, at least one of the following is considered evidence of measles immunity for international travel, birth before 1957, which means you're probably already exposed, or a documented administration of two doses of live measles virus vaccine, or lab proof of immunity. So I think we should take these uh health alert network health advisories very seriously, that you know, people are getting sick. And I think Mary pointed out that you know, you think of okay, well, it's a rash. Well, guess what? It can cause severe health complications, including pneumonia and encephalitis, which is inflammation of the brain. I know I don't want that, and even death. So this is something we can avoid, Linda.
SPEAKER_02Olivia, that's so true. And thank you for sharing that story about your childhood immunization. I too can relate to that from that era. And we know that the vaccination programs have been updated and changed since then, but they're still very important programs. And I'd like to just circle back to everyone's mention of respiratory component with measles. And that brings us back to both respiratory protection and engineering controls that we focused on so heavily during the pandemic. There were many viruses, illnesses, airborne transmitted diseases, of course, before the pandemic. So let's make sure that we're taking good care of ourselves now with proper respiratory protection. And truly the N95 respirator mask is the mask that provides the most protection for you in an aerosol-generating environment. And the engineering controls are priceless. I was just on site with a new practice last week in Florida, and the doctor still had her air purifiers down in the corner of the room, just like we all taught everybody during COVID, where it's down at the foot, not on the side of the countertop. And she says, Yeah, when I close the door here, I know for a fact that the room is the air circulating in this room every five minutes. So she had purchased a really nice device that provides high-level protection for her and her team. And so we want to be sure that we're still providing ourselves with that same high-level protection. Divas, did you have any additional thoughts? I think Leslie, you said you had some one thing you wanted to share.
SPEAKER_03You know, Linda, it's interesting when you look at the number of years and the number of cases of measles that we've had in the United States. So, as was mentioned earlier, that we really thought it was eradicated in 2000, actually. And we only had maybe about 60 cases in a year, and that seemed to be a lot. But we had a very interesting outbreak in California. We fondly call it the Disney outbreak. And this is where in 2015, 176 people from 17 states, with most of the cases that were part of this Disney outbreak, 100 145 people. And it was assumed that this measles virus came to Disney on a visitor to the park, someone from another country where measles is probably more uh common. And that person had close proximity to people who were not vaccinated. And so when I think about this, I think about all those lines you stand in at Disney. And here's someone that that came here to California from another country to have a good time at Disneyland and didn't want to give up their date just simply because they weren't feeling well. But meanwhile, they're standing next to other people, passing people back and forth through these zigzag lines. I think about the little boat ride and it's a small world and this person coughing and sneezing and probably leaving virus in the air. So my mind goes into all these different scenarios of how this virus may have been passed to these 176 people. And there were also characters from they call them characters, but employees at the Disney park who became infected as well. So it's not something we can write off altogether.
SPEAKER_02Totally agree, Leslie. Thank you for reminding us of that outbreak in Disneymore.
SPEAKER_01Mary? Thank you, Leslie, for again reminding us about that. I just, oh my goodness, Cinderella with measles is not a good thought. Two challenges that we have right now. One is that there has been, I think, a lot of highlighted information about vaccine risks recently. And also most people are aware that not everything that we're used to seeing is available on the CDC website. So you have to rely on your state and your local health department. Right now, the CDC isn't issuing health alerts through the health alert network, but the states and local county health departments are. So that's where you need to go to get the information. The background information, there's great resources on measles on the CDC website, but we don't see data about outbreaks. That's where you go to your state.
SPEAKER_02Mary, thank you so much for that reminder. That's really important that everyone, doesn't matter what part of the country that you're in, rely on your state health department for the most recent up-to-date information in your location. Leslie?
SPEAKER_03There was another thing I wanted to add was that most pediatricians had never seen a case of measles, probably in their whole career. And a pediatrician described to me that the way that you can diagnose and detect someone may have measles over just the common rash is he said it's like you take a bucket of red dots and you pour it over a person's head. And the red dots are starting to go down from the top of their hairline down to their extremities, down to their feet. So that's something else to look for in dentistry, as well as those couplet spots that you might find in the oral cavity.
SPEAKER_02Another great tip. Thank you so much, Leslie. So I hope that our listeners take back some great information just to be aware of measles and what's going on in our country as far as the recent outbreaks so they can continue to protect themselves and their patients from day to day. As a compliance divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Any resources that we mentioned today will be in our show notes. And then we invite you to submit any questions to support at thecompliancedevas.com. And also don't forget to scroll down and leave us a comment or a like. Thanks for joining us. We'll see you next time.