Measles: How To Keep Staff and Patients Safe From Infection

Measles is in this news. With the recent outbreak reported in Florida and new cases in Michigan, Orthodontic Products podcast host Alison Werner spoke to infection prevention expert Jackie Dorst, RDH, BS, about what you need to know to keep the staff and patients safe. 

In this episode, Jackie provides: 

• a backgrounder on measles,
• a list of symptoms, including the one orthodontic staff are uniquely positioned to spot, 
• a breakdown of who is at risk,
• a reminder of the steps you can take to protect staff and patients from airborne diseases, 
• guidance on what to do if you have an exposure in your office, and 
• information on where to learn more. 

Resources mentioned in this episode: 

• CDC Measles Main Page: https://www.cdc.gov/measles/index.html
• CDC Measles Healthcare Providers page: https://www.cdc.gov/measles/hcp/index.html
• CDC COCA Call - We Must Maintain Measles Elimination in the United States: Measles Clinical Presentation, Diagnosis, and Prevention: https://emergency.cdc.gov/coca/calls/2023/callinfo_081723.asp
• CDC COCA Call PowerPoint Slide Presentation: https://emergency.cdc.gov/coca/ppt/2023/081723_slides.pdf

Creators and Guests

Host

Alison Werner

Editor-in-Chief, Orthodontic Products

What is Orthodontic Products Podcast?

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Alison Werner: Hello and welcome
to the Orthodontic Products

podcast. I'm your host Alison
Werner. We have a special

episode this week touching on a
timely issue that may be

affecting your community and
your practice. Specifically the

rise in measles cases in certain
parts of the United States. To

break down the current situation
and what the orthodontic team

needs to know to protect staff
and patients is infection

prevention expert Jackie Dorst.
Jackie, thanks for joining me

today.

Jackie Dorst: Thanks, Alison.
It's always good to share

information with your viewers.

Alison Werner: Great. Well, so I
know this is a topic that came

up recently on the AAO Staff
Club Facebook group. So some of

our listeners may be aware of
the outbreak in Florida and more

recently, they there have been
some cases in Michigan. Can you

talk about what's currently
going on?

Jackie Dorst: Yes, the Michelle
Ritterscamp with AAO, who

manages the AAO staff club, had
read about increasing numbers of

measles cases in the United
States. And she contacted me and

she said, Is this a concern for
ortho offices? And if so, is

there some information that we
should be sharing? And so I put

together a short informational
posting to include on the staff

club webpage or a Facebook page
with them about the current

status of measles infections in
the United States, and concerns

for the orthodontic office and
how we can manage these

potential infections if they had
an outbreak in their community.

So it's very timely information
as this, it seems like daily

that I'm getting updates from
both CDC and in the news media

about measles cases in different
communities.

Alison Werner: Okay, so let's
talk about measles. It actually

was declared eradicated in the
US in 2000. But there have of

course, been outbreaks since
then they are increasing. So

what do we need to know about
measles?

Jackie Dorst: Well, measles is
caused by a virus. It is an

airborne transmission of the
virus. And it is the most highly

infectious of airborne
transmitted diseases. You know,

we learned about R-naughts the
infectivity during the pandemic,

and it has an R naught of that
estimated between between 15 and

18, and is used as the standard
really for how infectious are

airborne diseases. Measles is a
childhood disease that is

vaccine preventable. The vaccine
is very effective, over 90%

protection from it. But we have
to have vaccination of 95% of

the population to provide that
herd immunity. So with the

pandemic, interrupting socially
and healthcare wise vaccination

rates, we've seen a drop in the
vaccinations and even prior to

that, for whatever reason, there
have been communities where

vaccination levels have dropped
below that 95%. And since 2000,

there have been a few years
where there was an incidence of

measles back diseases with it,
and believe the year was 2014.

Just to give you an example,
Alison, that there was one child

who visited Disneyland in
California that was infected

with measles. And within 14
days, there were over 800 cases

of measles that cropped up
because of that one child, the

zero patient, if you will, being
at Disneyland. So we've seen,

you know, just a few cases,
again of this vaccine

preventable diseases until 2019.
And then in 2019, it was is if

the herd immunity was lost, we
dip down in enough communities

that there was a peak in
infections. And in 2019, there

were actually 1,274 infections
and the health the public

health, you know, was concerned.
And then what happened? We had

the pandemic and all of the
respiratory protections that was

implemented with wearing masks,
hand hygiene, fresh air in the

office and air filtration to
prevent COVID transmission

prevented respiratory diseases
in general, both influenza,

colds, RSV, and potentially
measles with it, and we didn't

see another incident. Now, as
we've exited the pandemic, we're

in our new normal with it now.
People have dropped precautions,

right. And we're getting out
socially and we're going to

sporting events and
entertainment events where

there's crowds of people and
traveling a lot more

internationally. And yes,
measles was supposed to have

been eradicated from the United
States in 2000, but not

globally. And that's where we've
seen, there are other countries

where there are higher rates,
such as in India and in England,

that we're seeing higher rates
of measles transmission. And

with travel, then you can have
patients come back to the United

States that acquire an
infection. Unvaccinated people,

even adults are at risk of an
infection, but especially

infants. An infant under one
year old, they don't receive

their, their measles vaccine,
their MMR vaccines, measles,

mumps, and rubella. All three
vaccines are given when the

baby's one year old. Younger
than that they have their

mother's protection with it, and
their immune system hasn't

developed enough for them to
produce antibodies with it. So

that's why that vaccinate
vaccination is scheduled for the

one year mark on it. And babies
could get infected during that

international travel with it. So
highly infectious airborne

disease.

Alison Werner: So what are some
of the symptoms that people

should be looking out for?

Jackie Dorst: Well, like all
virus, respiratory diseases,

that cough, you can have a cough
with it, runny nose, oh my gosh,

that is one of the first
symptoms that you'll see. And

high fever, fever will run up to
104, possibly 105 with a measles

infection. But for us in the
orthodontic world, in oral

health, one of the first
symptoms will be lesions inside

the mouth. Before they might
even develop the cough or the

fever, there is a unique oral
lesion called a Koplik spot. And

I think you've got some photos
of it that you can bring up with

us for our viewers to see with
it. And they'll usually be on

the inside of the buccal mucosa,
or on the soft palate. So that's

one of the things that I would
encourage ortho offices, if you

hear of a one or two cases, even
in your community, start doing

that oral exam, you know, when
we look at a patient's mouth,

the first thing they're going to
look at is the alignment of the

teeth. And are there any
brackets off? And you know, are

we changing archwires today? Or
are you due for a new aligner

with it? But look on the inside
of the cheek, look at the soft

palate, do that quick oral soft
tissue exam. And if you see any

of those Koplik dots, then
definitely that's an alert. I

would segregate the patient into
another room even not even in

the open bay area. Because this
virus with it being an airborne

disease, it can stay suspended
in the air for up to two hours

after an infected patient is
even sitting in the reception

room for 15 minutes or in the
open bay. So you would want to

segregate them immediately. And
then dismiss them and reschedule

them for another appointment and
just say, you know, we are

suspicious of this, looks like
we're not definite, please go

see your doctor. And because we
don't have I airborne isolation

rooms in our ortho office. So
you don't want to put the rest

of the team or other patients at
risk.

Alison Werner: Okay. And then
what are the complications with

measles?

Jackie Dorst: Well, a measles
infection, we think of it is a

childhood disease and you know
you're sick for a week or so

stay out of school. I was born
before 1957, which is the year

that the measles vaccine was
introduced in it and we saw mass

vaccination starting in the 60s
with it. And CDC says that

anyone born before 1957 is
assumed to have acquired

immunity having had that
infection. And I remember when I

had it, and one of the things is
having ear complications with

it. The infection can actually
affect the ear and cause hearing

loss that is a lifelong hearing
loss or affects the eyes. I

remember both with chickenpox
and measles, my mom said, Hey,

I've got to stay in a dark room,
you're not gonna play outside in

the bright sunshine, while you
have that ocular eye infection.

And of course, it's the rash
over the full body. The high

temperature can be a risk with
it. And it can be there are

fatalities with it. Not a lot.
It's you know, maybe one in 1000

and it's usually from
complications such as developing

pneumonia. So initially, the
cough, runny nose with it and

the high fever and of course,
like any viral infection, the

aches and pains, the fatigue
with it, but those oral lesions

are a real early symptom that we
can identify in our orthodontic

practices.

Alison Werner: Okay, so you
talked about the oral exam and

those are only And so what can
staff do? What can the ortho

team be doing to protect staff
and patients?

Jackie Dorst: Well, let's go
back to what we learned during

the pandemic. And it's about
protecting against all of those

airborne diseases. And I'm going
to call in CDC refers to them as

ILI, influenza like illnesses.
So flu, RSV, colds, all of those

diseases that can be transmitted
in the air, then we want to take

precautions. So number one, how
is your heating and air

conditioning system working is
it at its maximum efficiency,

you want to have at least six
air changes per hour. When have

you change your your filter on
the heating and air conditioning

system. We learned that a MERV
13, minimum efficiency reporting

value, provides at least 50%
filtration of point three micron

size particles. And that should
be changed on a regular basis. I

can't give you how often, it
depends on how busy your ortho

practice is. If you're working
four days a week, and you're

seeing 200 patients a day, you
probably need to change your

filter more frequently than an
office that works three days a

week and maybe sees 40 to 60
patients. So what's the traffic

in your office how you know that
you need to change that filter.

And I would suggest at least
once a quarter if not once a

month, depending on the traffic
with it, and then you want as

much fresh air coming into the
building as possible. And we use

an indirect way of measuring
that looking at the carbon

dioxide. Because the more
densely populated we have the

office, more patients the team
members in the office. If that

carbon dioxide where we're
exhaling each time gets above

800 parts per million, then the
risk of acquiring an airborne

infectious disease is greater
normal outdoor carbon dioxide

levels are at 400 parts per
million. So keeping a simple co2

monitor that you can buy online,
in the reception room and in the

open bay area is a good way to
monitor, Do we have enough fresh

air in our office. And then I
would definitely check with the

vaccination status of all your
employees. I think that's

important. We've had new team
members join our offices as we

had some maybe early retirements
during the pandemic, if you have

a team member who was not
vaccinated as a child, then

they're going to be at high risk
of acquiring infection, and

especially for say, young women
in their 20s and 30s who could

possibly be pregnant. If they
were not vaccinated and acquire

a measles infection, then it
could affect their developing

fetus. So again, recommending
they go get that vaccine. It's

one of the vaccines recommended
for all healthcare providers by

CDC in the US. And even if they
haven't been previously

vaccinated, if you had an
outbreak in your community and a

patient was identified as
infectious, then go get that

vaccine right now because even
you having that vaccine before

you develop signs or symptoms
can help reduce symptoms or even

prevent an infection. So it
wouldn't be too late to say, oh,

I've already been exposed. The
vaccine won't do me any good.

Alison Werner: Okay. And then
what should offices do if there

is an exposure in their office?

Jackie Dorst: Because the
disease is so highly infectious,

let's say you do have that
patient come in, and you do the

oral exam and you see the
lesions and you go, I would go

ahead and notify patients that,
you know, there has been a

measles outbreak in the
community, and it's been

identified in within your office
because of the risk. You want to

notify patients. And if those
patients have any unvaccinated

family members or patients that
were in your office within the

last five days or so, because
again, patients can be

infectious before they show
signs or symptoms, and then

they're highly infectious for
that three to five days

afterwards. I would say, Please
watch for symptoms. And if you

do observe symptoms, please
immediately go for a measles

vaccine, see your physician and
go from measles vaccination. And

I would say watch for symptoms
for 14 days, because the

incubation period can be
anywhere from 10 to 14 days with

measles.

Alison Werner: Okay. And then
just to go back to keeping the

ortho team and patients say,
what are the masking what what

do you recommend in terms of
masking just to keep the

practice safe?

Jackie Dorst: Well, I've had a
there's a debate and it's just

going to be an office policy at
this time. Ortho offices need to

watch for postings on their
local health department about

airborne diseases especially
such as measles, and we're going

to see other emerging and
reemerging diseases in the

future. So you just need to stay
aware of community transmission

and your office, verify that you
are current with your infection

control standards with your know
what your disinfectants are, are

they effective against
healthcare acquired infections.

And speaking of that, EPA, which
regulates disinfectants, now

just published a new blood borne
pathogens list that is called

the EPA List S. And it combined
about five different lists that

EPA had. So you want to make
sure that your, your

disinfectant that you're using
is on that List S, you know, as

a health care disinfect
disinfectant. Review your

airborne disease transmission
precautions, and then screening

patients with it. Wearing a mask
is always from the respiratory

disease system from October
until April a wise precaution.

It is a prevention with it. And
it doesn't have to be that N95

respirator mask. It can be a
level two, or a level three.

Both of those procedure masks
provide the same level of

particle filtration. With them,
the only difference is a slight

fluid increase with the level
three on there. So it would be

wise to wear that mask as a
prevention for both the front

desk team and the clinical team.
Because this disease is not one

that's just transmitted in blood
or saliva, it's airborne. So the

entire team needs to be
protected. And many hospitals

during the season are
reimplementing mas protocols for

both visitors, patients and
staff during this time,

especially during the community
outbreak, so you have to use

good professional judgment and
keep up with community

transmission of diseases in your
area.

Alison Werner: Right. And they
can find that information

through their their local health
department.

Jackie Dorst: The their local
health department. And I have in

my Google Alerts. That's what I
go through every morning what

pops up in the entire United
States and even globally on

safety and infectious diseases.
But the health department in

both the media, the media has
been good to alert about the

outbreaks that are in Florida
now. I know this morning, I saw

three new cases that were just
in Michigan. And when you have

an outbreak there, it can spread
like fire through a community

because of the high infectivity
and the airborne disease. So

keeping up with your your local
health department is one of the

best ways to stay informed.

Alison Werner: Okay. And I know
you wanted to make a

recommendation to doctors to
visit the CDC website page

focused on measles. Should they
Well,

Jackie Dorst: as the case has
started reemerging. I thought I

need to review what are signs
and symptoms complications. And

the CDC are this is another
improvement that we're seeing

post pandemic with it. CDC is
updating their website. I didn't

realize it but there are over
220,000 web pages in the CDC

website. And if you've been
looking for information, and

especially during the pandemic,
we will all spend maybe two or

three hours trying to find a
specific page with it. They are

in the beta test. Now I was
privileged to sit in on the

initial introductory meeting for
that last week. And it's going

to be a huge improvement. Much,
much more user friendly, easy to

locate information with it. And
we won't lose information as the

CDC is revamping their website.
Some of it that's not that's it

will be archived. And it will
still be available if you want

to do a deep search on it. But
it's going to bring up the more

relevant information and as
things change that there'll be

posted with it. So I looked up
measles on the CDC website,

you'll go to the main page, then
go down to what health care

professionals need to know.
Click on that. And there is an

educational video. And the same
PowerPoint slides that were used

in the video that came were
posted in last fall. And it was

from what's called COCA and it's
the communication on for

communities on issues of health
for CDC that they put out and

they do COCA calls routinely
with emerging issues such as

measles with it. And just
reviewing those the PowerPoint

slides, it took me about maybe
five to 10 minutes to click

through about 40 of those
relevant slides. How the disease

is transmitted, what are the
symptoms? What's the prevention

with it? And what are the risks
or complications with the

disease? I think it's wise for
every doctor and for the

clinical team to quickly review
those slides. If they prefer to

listen to the video, they have
the option of listening to the

video just to update themselves
on measles, and the measles

complications with it and how it
could affect the orthodontic

practice.

Alison Werner: Okay, well, we
will provide a link to that

measles website, as well as the
direct page for the video and

then a direct page or direct
link for the for the PowerPoint

slide, Jackie, as always, it's
great to see you and thank you

so much for all this
information.

Jackie Dorst: Well, thank you
for sharing this information. I

think it's very timely Alison.
And my hope is that this measles

infection will just be a little
blip. But it's wise for us to

share the information in case
there are is a bigger spread

with communities. And the
orthodontic team knows how to

care for patients safely and to
prevent transmissions in their

office. So thank you for sharing
the information about the AAO's

orthodontic staff club and the
AAO being proactive and sharing

this information and for getting
the information out. There are

always emerging issues that we
can do to be the best in our

orthodontic practices.

Alison Werner: Exactly. All
right. Well, thank you so much.

As always, thank you for joining
us. Be sure to subscribe to the

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online.com to keep up with the
latest industry news. Until next

time, take care