#231 What's Going Around? The Surge in Respiratory Ilnesses

In this episode, Mary and Leslie discuss the data behind the record number of influenza cases, the continuing outbreaks of measles, and other respiratory illnesses that threaten dental team members and patients.  The Divas also discuss the causes of these increases and tips for prevention of these infections.

Resources:

• CDC FluView https://www.cdc.gov/fluview/index.html
• CDC Respiratory Illnesses https://www.cdc.gov/respiratory-viruses/index.html
• CDC Respiratory Virus Activity Levels  https://www.cdc.gov/respiratory-viruses/data/activity-levels.html
• CDC Measles https://www.cdc.gov/measles/index.html

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:05

Welcome! I'm Leslie Cannum. I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Wan.

SPEAKER_01 0:11

And together we are the Compliance Divas.

SPEAKER_00 0:23

Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I'll be the moderator for this episode along with Leslie Canum. As the busy holiday travel season is winding down, respiratory viruses are ramping up and in a big way. In this episode, we'll review recent data from the CDC on the increasing number and severity of flu infections and why these numbers are so alarming. We'll also discuss the continuing increases in measles outbreaks and the risks to dental teams. And we'll review protocols for screening patients and team members for respiratory symptoms when patients should be rescheduled and when employees should stay home from work. And Leslie, I feel like this is kind of same stuff, different day. We've been talking about this for so long and still needing to beat the drum about respiratory infections, and primarily because we work in such close proximity with our patients in their face, literally, and so many of these infections are easily transmitted through droplets or aerosols. So our first topic is going to be influenza. The news stories that we've seen recently talk about the superflu, a new flu variant called the Clade variant. And it is spreading like wildfire. And there actually have been five pediatric deaths around the country in the last week from influenza complications. So the CDC estimates that there have been over seven and a half million cases, 81,000 hospitalizations, and 3,100 deaths from flu so far this season, which started actually in 2024 and goes through the end of 2025. So, as always, because flu is a vaccine-preventable illness, the recommendation is for anyone six months and older to get a flu vaccine. It's not the best match, according to the CDC this year, with the prevailing variants that are out there, the prevailing viruses, but it's better than no vaccine at all. And the other thing to remember is that there are prescription antiviral drugs that can treat the flu illness to help decrease the symptoms, decrease the duration of the illness, but they have to be started within two or three days of the start of symptoms. So if you're starting to feel achy and having some respiratory symptoms, contact your physician and see if it makes sense for you to take one of these prescription medications like Tamaflu to help prevent it from becoming very serious and probably stay home, especially from work if you're a dental team member, and take good care of yourself, stay hydrated and so forth. So there's not a whole lot we can do to completely prevent the flu. It's kind of everywhere, and many people were exposed, no doubt, during the holiday travel season. But flu vaccines, antivirals, those things can certainly help. And Leslie, I'm gonna ask you to update us on what's happening with measles outbreaks around the country.

SPEAKER_01 4:12

Well, Mary, you know, measles, just a quick little history of measles. It it was officially considered to be eliminated from the United States in 2000. So for the last 25 years, really it's almost been eradicated, meaning that there were no measles spreading in the country, and new cases were only found when someone contracts measles abroad and then returns to the country. So achieving measles elimination status in the United States was a historic public health achievement. And now we're starting to see these outbreaks cropping up. And just to give you an idea, as of yesterday, December 30th, 2025, there were a total of 2,065 confirmed cases of measles reported in the United States. And of these 2,000, most of them, 2041, were measles that were reported in four different states or jurisdictions. 24, a total of 24 measles cases were reported among international visitors to the United States. So there have been 49 outbreaks reported in 2025. 88% of the confirmed cases are outbreak associated. For comparison, there were 16 outbreaks reported in 2024, and 69 of those cases were outbreak related. Now, CDC is aware of probable cases of measles being reported, but there's no real way to know because the data at CDC only includes the confirmed cases. So really what we're looking at is that there's maybe many more cases of measles than what we actually are hearing about. So, and just to give a little bit more context to what's going on with regards to the outbreaks, we've had some outbreaks in California. South Carolina has reported outbreaks too. Let's take a look, just a quick look at some of the information that we're seeing. And you know, CDC is not actually getting all the information as quickly as we're hearing it from some of the news media stations.

SPEAKER_00 6:20

It seems like there were a hundred and some cases in South Carolina in a very short amount of time. You know what, Mary, that's right.

SPEAKER_01 6:28

There's been quite a few cases there. I'm looking in California cases, and what I'm seeing here is that we have picked up several cases that that were uh actually spread in shopping malls. I know that in Newark, New Jersey, they had uh airport passengers that yesterday they indicated that there were people who were exposed. A person in one of the terminals had been there all day long, and there were other people who were nearby that individual who may have been exposed. And and here's the problem is that if you don't have immunity to measles, you have a very high likelihood of acquiring that virus. So, Mary, just to give you an idea of vaccination coverage, the MMR, which is the Measles Mumps Rubella vaccine, is very safe and effective. And when more than 95% of people in a community are vaccinated, most people are protected, which's called herd immunity. But that number of vaccinations has actually decreased over the last few years. And instead of being at 95%, those rates have dropped down to 92% in 2023 and 2024 school year. So that leaves approximately 280,000 kindergartners at risk during that period, 2023-2024 school year. So in other cases of outbreaks that we're hearing about in California, I just wanted to mention we had a measles exposure that was confirmed in what they call the Contra Costa County area. And they actually had identified that the individuals had had visited the shopping malls, you know, right around this time of year where people you have a large number of people in close proximity. So is that a Macy's and in a mall and an Apple store where they were known to have been with a known measles case? So anybody in those areas shopping have been warned by the news media to notice if they have symptoms. And so let's talk a little bit about what symptoms would look like if someone was actually exposed to the measles. What would it look like? What would it feel like? And so the information is that mostly with measles, you don't have symptoms until you're about four days into the virus. So you can still be exposing other people before you start to see, for example, a rash or or have other symptoms. And then you're infectious uh to about four days after the rash and the other symptoms disappear. So, symptoms of measles, if you go to the CDC website, you can get a very clear picture of measles. Measles is a highly contagious disease that can lead to very serious complications. Symptoms usually begin seven to fourte days after initial infection, and measles can be very dangerous, especially for babies and young children. So what we would see seven to fourteen days after a measles infection would be possibly a high fever, which could be as high as 104. Cough, runny nose, runny nose is also known as chriza, and then red and watery eyes. They they call it sometimes in the medical world, they call it the three C's cough, choriza, and red watery eyes would be conjunctivitis. Two to three days after symptoms begin, that's when the coplic spots appear. And this is where dental professionals can be very aware of what they may be seeing in some of their patients. These are tiny white spots that appear inside the mouth two to three days after symptoms begin. Now, three to five days after symptoms begin, then we have the measles rash. And it usually begins as a flat red spot that appears on the face, at the hairline, and then spreads downward to the neck, the trunk, the arms, the legs, and the feet. These are small raised bumps that may also appear on the top or of these flat red spots. And the spots may actually become joined together as they spread from the head to the rest of the body. When a rash appears, a person's fever may spike to more than 104 degrees. Now, a funny thing about, not funny, but something that I thought was funny when I heard about how pediatricians are learn about measles. You know, most pediatricians in the United States had never even seen a case of the measles, and they were told how to recognize would be to imagine that you're holding a bucket of red dots, and we'll call that a bucket of rash. And you pour that bucket of rash over the head of a person, and those little red dots go from the head to the to the cheeks, down to the shoulders, the lower extremities. There's other complications that can also occur. You know, there could be ear infections, diarrhea. Uh, children are at risk, younger than five years old, and adults older than 20 years old, pregnant women, of course, and people with weakened immune systems. So you have a pretty big risk of uh getting severely ill with measles if you don't have immunity. And so another thing I wanted to point out is that there are ways that we can protect ourselves when it comes to the measles. And the first thing is, of course, to have awareness. We want to make sure that we're we're screening our patients and that we are screening in California, we have to screen for aerosol transmissible diseases anyway. And measles is one of the viruses that's identified as something that we are supposed to be screening for. So the best way to protect yourself, of course, is to be vaccinated. But you know, to if you start to feel ill, there is a list of what's called suggested work restrictions in the CDC website. Now, this is a the MMWR report that is dental infection control in dental health care settings, where in this report on one of the documents, it shows a table what's called suggested work restrictions for health care personnel infected or exposed to major infectious diseases in healthcare settings. So when there's not state or local regulations or public health orders, then we sort of have to monitor ourselves. And and when it comes to measles, we should not go to work, of course, so we see exclude from duty, both when it's active and uh post-exposure, until seven days after the rash appears. Now, post-exposure from the fifth day after the first exposure to the 21st day of the last exposure, or four days after the rash appears, is the duration. So we can be infectious to others who who may not be vaccinated. And today I think we're finding a bigger trend of individuals who are not vaccinating for one reason or another. And so, of course, the best practice is to stay home if we're not feeling well.

SPEAKER_00 13:30

Thank you, Leslie, for that review of all that great information about measles. The one thing for our listeners to keep in mind is that the measles virus, once it's aerosolized, either from dental procedures or from coughing or sneezing or even talking or singing, can stay in the air for up to two hours. And so that's what makes it so incredibly infectious. And we probably aren't going to see patients in our practices, even in a pediatric practice, that have already broken out with the rash. That's kind of the cardinal sign and a signal to the parents: don't bring your kids into the office if they've got this rash. But they're infectious before that rash appears, and there are signs in the oral cavity. If you remember your oral pathology, coplic spots on the buccal mucosa or the junction between the heart and soft palate could be indicators that that person has measles and is already infectious. And that's why we keep hammering this point about being careful and screening patients so that we don't have an outbreak traced to a dental practice. Not good for the Newark airport right now, that anybody who is there in that concourse may start seeing symptoms as soon as the New York and New Jersey public health departments are saying is as soon as Friday. So the other thing we want to talk about a little bit is whooping cough, the pertussis infection, which is part of the TDAP, tetanus, diphtheria, and pertussis vaccination. As Leslie said earlier, vaccine rates tend to be kind of dwindling as there's been a lot of controversy about the safety and efficacy of vaccines. TDAP boosters are given typically every 10 years. And it's only been in the last 10 or 15 years that adults got boosters of pertussis when they got a tetanus booster. It was typically given to children because they're the most vulnerable. But whooping cough is actually a bacterial infection. It can cause a very serious cough that can last for several months. And you may think that the cough is due to a cold, or maybe it's influenza, you may have a fever. But the signature symptom of whooping cough is that there's a whooping sound that's made. Patients will cough very violently almost, and it almost takes your breath away. And so while influenza and measles are not treated with antibiotics, whooping cough or pertussis infection is it is treated with azithromycin or commonly known as a ZPAC to clear up that infection, but it can lead to pneumonia, it can lead to some very serious complications, especially if a patient also has asthma. So we need to be extremely careful about differentiating between all of these different respiratory diseases. There are home tests for influenza. There is a combo test now for COVID and influenza. There is not home testing for measles. If you need to be tested, typically that's done in your primary care practice, but trying to differentiate symptoms and what's wrong, you can partake in those home testing kits. And we need to be, again, recognizing that respiratory infections easily spread in a dental practice to the patients and the team, and we need to protect ourselves. COVID is still out there, it's not spreading in huge numbers right now, but we're also seeing the RSV, respiratory sensitial virus, that's spreading as well, can develop into pneumonia and hospitalization, especially in older people or infants and young children. So we need to be on the alert. So, Leslie, will you kind of wrap up this podcast for us in talking a little bit about what we should be doing in terms of screening patients and screening team members?

SPEAKER_01 18:00

Well, Mary, first of all, in screening our patients, it's very simple to screen our patients with the confirmation phone call, or whether it's a confirmation text, to include something like we saw when we were facing the COVID pandemic. Are you experiencing any signs or symptoms of respiratory illness? I remember getting text messages when I had an appointment and you had to answer yes or no. And uh after two or three questions, I was cleared to come in for my appointment. So if we're confirming verbally, then we should be asking our patients if they're feeling well or if they're experiencing any signs or symptoms of respiratory illness. And if they're not, then of course, we've confirmed their appointment, they can come in. Another thing we want to do is be mindful of visual observation. Someone comes to the appointment and they don't look like they're feeling well, they're coughing, they're sneezing. And with measles, that's the three C's, the cough, choriza, and conjunctivitis. So that we can have visual observation. Again, another simple question: are you experiencing any signs or symptoms of respiratory illness? Someone may answer with, no, I'm just it's hay fever or the allergies are driving me crazy today. So they're not necessarily infectious. But if they are, if they are experiencing signs or symptoms of respiratory illness, then we want to postpone their treatment so that they're not infectious to others. In California, the aerosol transmissible disease standard requires it. It's been in effect since 2009. So it's not only screening patients, but uh having written plans on how to screen patients. Part of your OSHA manual should include a section in your injury and illness prevention plan on how to screen patients and some policies if you have patients that do present with illness or with fever. We also want to make sure that we are ourselves healthy and we should have the work restrictions policy discussion at our dental practices using the CDC guidelines and the table. And we certainly don't want to discriminate against anybody and say, well, no, you can't come into work today. We need to have firm policies in place that describe that if we are infectious to others and then we should not be at work. I have to share a funny story. My own veterinarian today had took my horses in to have their dental work done and something you do on an annual basis, and his vet tech wasn't there. So I said, Oh boy, I get to, you know, I haven't assisted in dentistry in many years. I'm so excited about this. But you know, she was smart enough not to come in when she was not feeling well. So we need to make sure that that's a good open conversation, open communication with our employers, employees, co-workers, so that we we have a way of being able to stay home when we need to stay home. And that's what is the advice is today is that if you are not well, for heaven's sake, stay home. Don't spread it to others.

SPEAKER_00 20:52

You're so right, Leslie. And that is especially true if you have a fever. It's one thing to have some minor respiratory symptoms that are not associated with a fever. And so, as we found out during COVID and after, that we may want to wear a face mask as source protection. So we protect ourselves. But if you've got serious respiratory symptoms, you cannot stop coughing and you have a fever, you should not be in the office working. It's disrespectful to the team members and it's disrespectful to your patients. So we just need to think about the implications of that. And I know people are struggling with being short-staffed and so forth, but the problem is if somebody comes in to work sick and then makes everybody else sick, then you're really gonna have to cancel patients or shut the office down. And I've actually seen that happen in some practices in the last several years. So that's kind of a scary thing. So, to sort of recap what we've talked about today, first of all, remember that influenza cases are surging. Flu season typically goes through about mid to end of March. So we may continue to see these cases. And again, ask those questions when you're confirming patients. Make sure you are appropriately wearing your respiratory protection, not putting your mask down underneath your nose. Make sure you are changing your face mask after every patient visit and not reusing face masks from one patient to a next, to the next. We talked about the measles outbreaks, and so you need to be diligent, especially checking with your local health department to see what are the outbreaks that may be happening in your local area, whether it's flu or measles or whooping cough. Make sure that if you are a dental team member, that you are up to date on your flu vaccine, on your measles immunity, that you have an updated tetanus diphtheria protussis, a TDAP vaccine so that you have protection. And again, be diligent about screening employees and screening patients for symptoms. So we thank you for joining us for this episode. The compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You may submit questions by email to support at thecompliancedivas.com. The resources that we mentioned today from the CDC in particular will be listed in the show notes section of your podcast app. And we also invite you to subscribe to our podcast so that you never miss an episode and leave us some feedback on the podcast app. Thanks for listening.