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If Measles Walks Into Your Clinic...

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As a dental student I often forget about what is going on in the world around me, mostly due to the demanding course schedule and studying that I am sure we are all familiar with.  The recent measles outbreak is one of those things that was not really at the forefront of my mind until I started wondering what to do if someone came to our school clinic with symptoms of measles.  For that reason, I decided to do a short overview of measles targeted towards the dental student for this blog. 

 

First, what is measles?  

Measles is a highly contagious respiratory virus associated with a moderate to high fever and eventually a generalized itchy rash. Approximately 90% of susceptible individuals who come into contact with the virus will become infected. Other symptoms of measles can include nasal congestion, runny nose, cough, and conjunctivitis. Of particular interest to oral healthcare providers are the pathognomonic Koplik’s spots. These are clustered white lesions that often present on the buccal mucosa opposite the molars approximately 2-3 days before the measles rash appears.  


How is measles transmitted? 

The measles virus is transmitted via airborne transmission or direct contact with infectious droplets, which can remain infectious for up to 2 hours after the infected individual leaves the area.  The incubation period for measles is about 7-21 days. People are considered to be contagious from 4 days before to 4 days after the measles rash appears.  

 

Who is susceptible? 

All healthcare workers should be immunized against measles and have documented proof of immunity. There is no defined treatment of measles other than supportive care, therefore the best way to prevent transmission of the virus is vaccination. Two doses of the vaccine are 97% effective at preventing measles. Anyone without the vaccine, immunocompromised individuals, individuals with chronic underlying disease, and small children, especially under age 1, are most susceptible.  

 

What should I do if someone presents in my clinic with symptoms of measles? 

The best way to discern if the patient is not fit for elective dental care due to the measles virus is a thorough medical history and good observation skills. Specifically, ask about common symptoms of measles virus, whether or not the patient has been exposed to someone with the measles virus, whether or not the patient has been immunized against measles, and whether or not the patient has traveled internationally to areas where the measles virus is more common.   

 

If you suspect a patient of having the measles virus, you should present the patient with mask and gown to prevent further contamination of your operatory and refer the patient to emergency care so that they may be placed in airborne isolation.  Your school may have different guidelines for control of infectious disease, so be sure to familiarize yourself with them in order to protect yourself and others.  

 

Finally, I hope this update has been helpful, especially for those of you in areas where there is a current outbreak of measles or a high population of people who do not vaccinate for various reasons.  

 

http://www.cdc.gov/measles/