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Measles is on the rise - what you should know

Ontario has recently experienced an increase in cases of measles.  Dr. Kieran Moore, the province’s Chief Medical Officer of Health, is urging all healthcare providers, including dentists, to consider measles in their differential diagnoses, particularly in patients who show respiratory symptoms and have returned from recent travel.

Diagnosis

Measles is usually diagnosed based on medical history and physical examination.  Serology tests are sometimes used to confirm the diagnosis.

Symptoms

Symptoms typically develop 8 to 12 days after exposure and include:

  • High fever
  • A maculopapular rash starting on the face and spreading from head to toe
  • Cough
  • Runny nose
  • Conjunctivitis 

Early oral signs:

Koplik spots, tiny blue-gray spots on the buccal mucosa, are often present during the prodromal period and are pathognomonic for measles.

Transmission

Measles is highly contagious and can be transmitted by coughing, sneezing or talking. Infectious droplets may stay airborne for about an hour. Transmission can also occur after contacting infected surfaces. Infected individuals are considered contagious from four days before to four days after the rash appears.

Treatment

There is no specific medical treatment for measles.  The best way to prevent the disease is to obtain the measles vaccine.

Important Considerations for Dental Management of Patients with Measles:

Prevention and Identification:

  • The College’s IPAC Standard requires dental offices to have a written policy for managing patients with suspected febrile respiratory infections, rash, and eye infections. 

  • Patients should be reminded when confirming appointments that if they are ill, they should reschedule. If there is a measles outbreak in your area, ask all patients when confirming appointments or on arrival at the office whether they have had any contact with a person infected with measles.
  • Dentists should consider measles in patients presenting with the above signs and symptoms, especially if they have recently traveled or come into contact with a known case of measles.

  • A symptomatic patient should either be rescheduled or, in case of emergency, promptly isolated in a room with the door closed and treated using universal precautions.

  • A sign should be posted at the office entrance requesting that patients who may be ill identify themselves to the receptionist. The reception area must have 70-90% alcohol-based hand rub and masks available.
  • The dentist should advise the patient to isolate themselves until they can be further evaluated by a physician.  If the patient is referred for further assessment, the dentist should contact the receiving facility to allow IPAC measures to be implemented to prevent exposures.

  • Follow the College’s IPAC standards for disinfecting non-clinical and clinical surfaces for all patients.

  • Ensure proper hand hygiene to minimize the spread of the virus.

Reporting:  

If measles is suspected, the dentist must contact their local public health unit immediately to report the suspected case.  To find your local public health unit, click here: Public Health Unit Locator (gov.on.ca)

 

For further information, please visit: Measles | Public Health Ontario