As Summertime Travel Heats Up, so Do Measles Outbreaks

By Genni Burkhart

In 1978, the Centers for Disease Control and Prevention (CDC) began a campaign to eliminate measles in the United States by 1982. However, it wasn't until 2000 that the disease was officially declared eradicated. This effort was made possible by widespread immunization with a second dose of the vaccine for all children, which resulted in the absence of continuous transmission for over 12 months.

Unfortunately, due to recent decreases in “herd immunity” measles is returning in the U.S. In 2022, this disease claimed the lives of over 136,000 people worldwide, primarily children.

According to the World Health Organization (WHO), confirmed measles cases rose 79% in 2023. Travel season also increases this time of year, so dentists should stay observant of any outbreaks in their community and diligently screen all patients for aerosol-transmissible diseases before providing care.

CDC Issues Warning

The CDC issued a health alert on March 18th to head off the busy spring and summer travel season and warn against increasing global and domestic measles cases and outbreaks.

On April 4th of this year, the CDC issued a statement on the rise of measles in the U.S. This outbreak is caused by a decrease in measles-mumps-rubella (MMR) vaccination rates, which have declined since the COVID-19 pandemic.

When vaccination rates drop below 95%, outbreaks can occur. As some communities have much lower vaccination rates, the risk of a measles outbreak becomes more likely.

To combat these outbreaks, the CDC provides clinical guidance to healthcare providers, technical and communications support, and vaccine supplies for health departments. They’re also monitoring the global epidemic and creating models of how this can impact infection rates in the U.S. These models have a variety of uses including managing healthcare resources and identifying communities and the highest risk.

Confirmed Cases

With measles poised to come back in the U.S. and two different outbreaks at California college campuses, the California Dental Association (CDA) recently posted an article recommending dentists to screen for measles and other ATDs (Aerosol Transmissible Diseases).

The CDA reports that as of March 13th, the state had four confirmed cases.

The Atlantic recently reported three confirmed cases in Michigan and seven more cases, all from the same elementary school.

For the most recent snapshot of confirmed measles cases, the CDC updated stats on May 16th. Here’s the most recent data showing a slight increase since the data was previously updated on May 10th.

• One hundred thirty-nine total confirmed cases across the U.S.
• 45% of confirmed cases are under five years old.
• 82% of cases are unvaccinated,13% in one MMR dose and 6% in two MMR doses.
• 54% of cases are hospitalized for complications or isolation (75 of 139 cases).
• Of those hospitalized, 63% are under five years old.

Source: CDC (https://www.cdc.gov/measles/data-research/?CDC_AAref_Val=https://www.cdc.gov/measles/cases-outbreaks.html)

Measles Prevention in Your Practice

According to the American Dental Association (ADA), universal precautions are the most effective way to reduce the spread of measles to staff and patients.

The ADA’s Advisory Committee on Immunization Practices (ACIP) recommends that healthcare workers have “documented” evidence of measles immunity. Furthermore, they suggest that dental practices’ infection control protocols confirm that all staff are current on immunizations. This proactive step is to aid the practice should an outbreak occur. If staff are exposed to measles and cannot show immunity evidence, they can be offered post-exposure PEP (prophylaxis) or be “excluded” from the practice setting.

Suspected Case?

The CDA recommends using a patient history form specific to measles and other ATDs. Staff should also be aware of the signs and symptoms of the disease and ask questions if the infection is suspected.

Measles is marked by a rash that spreads from the head to the trunk and lower extremities. Infection can also include a rash of ‘tiny white spots’ inside the mouth, malaise, high fever, cough, runny nose, and conjunctivitis.

In general, most practices are still asking patients about recent international travel. This precaution is due to COVID-19 exposure and increasing cases of measles. The ADA also suggests asking patients about the following:

• Vaccination status.
• Domestic travel.
• Contact with those who have traveled internationally.
• Known exposure to measles in their community.

A review of potential symptoms is warranted if a patient’s ATD exposure is considered high risk due to recent travel or exposure. If a case of measles is suspected the patients should be rescheduled. As with any infectious disease, immediately report suspected measles cases to your local health department.

In Conclusion

Despite the significant strides made in the fight against COVID-19, it’s essential to recognize the battle against one disease doesn’t mean the end of infectious disease challenges. Dental professionals must remain vigilant.

As healthcare professionals, dentists are often at the forefront of airborne diseases. With increased travel expected in the coming months, the risk of measles transmission is also likely to rise. Therefore, dentists should discuss this issue openly with their staff, stay updated with the latest CDC and ADA guidelines, and review infection control measures to minimize the spread of illness among patients and team members.

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Author: With over 14 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.