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Infection Control Supporting Your Practice

Measles: Spotting Signs of Infection in the Mouth

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According to the Public Health Agency of Canada’s weekly Measles and Rubella Reports, there are presently five active cases of measles in Canada with a total of eight having been reported in 2019. A number of confirmed cases of measles were reported in mid-February in British Columbia. Most of these cases were associated with a cluster of related school-based outbreaks in Vancouver linked to importation from outside of North America.

Measles is a highly contagious and serious disease with no antiviral treatment. Measles is highly contagious because transmission is airborne causing it to infect 90% of contacts unless the contact is vaccinated. It can cause can cause encephalitis and pneumonitis and results in 1-3 deaths out of every 1,000 infections.

An infected child or adult visiting your practice can incubate the virus and infect others nearby who are not immune.

Are Measles Making a Comeback?

  • In August of 2011, 198 cases of measles and 15 outbreaks were reported in the US—the largest number of cases since 1996.
  • In 2012, Measles were considered endemic in the United Kingdom after previous being reported as eliminated.
  • During a 2008 outbreak of measles in California, 75% of cases were children who were intentionally unvaccinated due to parent refusal to vaccinate.
  • Developed countries with widespread vaccine availability and well-established public health infrastructure are being challenged to maintain measles control.
  • Many parents are disconnected from the impact of measles because the disease has controlled due to vaccination throughout their lifetime.

Some of the First Signs and Symptoms Appear in the Mouth

Most parents and even some pediatricians and physicians have never seen or treated measles before, making it difficult for them to recognize signs and symptoms. This lack of experience and familiarity also means parents and caregivers underestimate the severity of the disease, are more likely to consider their child to be at a low risk, and may not appreciate how easy it is for measles outbreaks to occur.

Early signs of infection can be seen orally in some including blue-grey Kolpik spots on the soft palate and oropharynx, and bright red spots on the buccal mucosa resembling grains of sand.

For up to four days before these symptoms appear, an infected person will feel normal. They are highly infectious at this time and will remain infectious for up to four additional days after symptoms appear.

Other signs and symptoms of measles include a non-itchy macular-papular skin rash, fever, cold-like symptoms, and light sensitivity.

What is Causing New Cases?

Health professionals know that measles is effectively prevented by the measles, mumps, rubella (MMR) vaccine.

While endemic transmission was declared to be eliminated in the United States and the Americas in 2000, measles is now making a comeback due to three factors.

  1. The highly transmittable nature of measles.
  2. Increasing parental refusal to vaccinate.
  3. Globalization and immigration from regions where vaccines are not available.

When less than 90% to 95% of the population has immunization, the community loses its protection putting people who cannot receive the vaccine like those with, cancer, congenital immune deficiencies, transplants, at risk (these conditions do not respond to vaccination). While some are not vaccinated due to pre-existing health conditions, limited access to health care in their home country prior to immigration, most children are not vaccinated because their parents have “vaccine hesitancy” and lack confidence in the safety and efficacy of vaccines despite scientific evidence.

Managing Measles in the Dental Office

  • Ask patients about their vaccination status and include records of vaccination in their dental charts.
  • If a patient may have active measles or may be incubating the disease, it is appropriate to delay their visit to your office.
  • Patients who may be infectious should be sent home from your office and their primary care physician contacted.
  • If an infectious patient has been confirmed in your office, contact your local public health group as well as other patients who may have been exposed.
  • If a measles outbreak occurs in your area, ask patients if they may have come in to contact with the disease or if they are vaccinated during the appointment reminder call.

Talking to Patients About Measles and Vaccinations

  • Educate your patients about measles and the importance of vaccination by placing educational posters like this Don’t Wait, Vaccinate information poster from Canada.ca around your office.
  • Help parents and care givers understand that measles is more than just a rash it can be very serious and harmful to a child’s health.
  • Educate yourself about measles and be prepared to talk to patients about vaccine efficacy, safety, and research to help them make informed choices.

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