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Measles outbreak continues to grow, with cases surpassing 700 in U.S.

April 29, 2019

By Mary Beth Versaci

Measles cases on the rise infografic

New York is experiencing its worst measles epidemic in decades, and the state dental association is urging dentists to continue to follow universal precautions as the number of cases climbs.

New York is among 22 states with confirmed measles cases in the largest outbreak since the disease was declared eliminated in 2000. As of April 26, there were 624 cases in New York, accounting for most of the more than 700 cases reported across the country, according to health departments in the state.

“Measles is highly contagious and easily transmitted,” the New York State Dental Association states in its response to the outbreak. “In their clinical practice, dentists should handle the measles outbreak like any other highly infectious disease. The dentist’s primary responsibility is to make sensible clinical decisions for patients in all situations.”

The association advises dentists to properly sterilize instruments and surfaces and use personal protective wear. However, even if dentists follow these protocols, patients with a fever may not be the best candidates for nonemergency treatment until they are medically cleared by their physicians. If a patient has an emergency, the emergency may contraindicate the need for medical clearance, according to the association.

“The dentist’s emphasis should remain facilitating patient treatment, not ‘refusal to treat certain patients,’” the association states.

The Centers for Disease Control and Prevention recommends that dentists prevent the spread of infectious diseases by having an infection control program that addresses staff safety, complies with the Occupational Safety and Health Administration’s bloodborne pathogens standard and includes occupational health needs such as vaccinations, exposure management, post-exposure protocols and work restrictions for staff members who are ill. Dentists should provide education and training to personnel and follow standard precautions as well.

Another step dentists can take to address respiratory hygiene within their practices is to post signs that instruct patients to use tissues, cover their mouths and noses when they cough or sneeze, and disinfect their hands, the CDC advises. Offices should provide tissues and no-touch receptacles for tissue disposal, as well as a way for patients to sanitize their hands.

The most important thing a dentist can do is to stress to parents that the measles-mumps-rubella vaccine is “extremely safe and highly effective” in the prevention of measles, which can be life threatening to a child, said Dr. Angelo J. Mariotti, chair of the American Dental Association Council on Scientific Affairs.

“This is a significant public health issue that can be ameliorated by parents vaccinating their children,” Dr. Mariotti said. “Parents are concerned that vaccines can cause autism, but that’s been shown by numerous studies not to be true.”

As of April 26, the CDC reported there were 704 measles cases in 2019 in Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Tennessee, Texas and Washington. This surpasses the 667 reported in 2014, which previously had the most cases since the disease was considered eliminated in 2000.

In response to the outbreak, New York City leaders declared a public health emergency April 9 in certain zip codes within the Williamsburg neighborhood of Brooklyn. Unvaccinated residents who may have been exposed to measles will be required to receive the MMR vaccine or potentially face a $1,000 fine.

Symptoms of measles include tiny white spots inside the mouth, high fever, cough, runny nose, rash and red, watery eyes. The virus can be spread to others through coughing and sneezing, living for as long as two hours in an airspace, according to the CDC. Others can become infected if they breathe the air or touch a contaminated surface and then touch their eyes, nose or mouth.

The CDC recommends that health care providers ensure their patients are current on the MMR vaccine. Health care professionals also should have documented evidence of immunity themselves, and if they do not, they should get two doses of the MMR vaccine, separated by at least 28 days.

One dose of the vaccine is 93% effective against the measles, while two doses are 97% effective, according to the CDC.

Adults born before 1957 are assumed to be protected against the measles because they likely were infected naturally, the CDC states. However, even if health care personnel were born before 1957, they should still consider getting two doses of the vaccine if they do not have laboratory evidence of immunity or disease.
Those who received a live measles vaccine in the 1960s do not need to be revaccinated, but people who were vaccinated prior to 1968 with an inactivated measles vaccine should be revaccinated with at least one dose of the live version, the CDC advises.
In April 2017, the ADA sent a letter to the White House, emphasizing how “vaccinations have saved countless lives and billions of dollars in medical costs.”

“Administering vaccines to stimulate a person’s immune system is one of the most effective methods of preventing infectious diseases,” ADA Executive Director Kathleen T. O’Loughlin and former President Gary L. Roberts said in the letter. "In fact, the widespread use of vaccines has eradicated smallpox and significantly reduced the incidence of polio, measles, mumps, rubella, tetanus and a host of other preventable diseases.”