Are you checking for Koplik Spots?

The U.S. is currently in the midst of a large-scale measles outbreak. Considered an eliminated disease by the United States in 2000, the measles virus has recently reemerged, infecting 141 people across 17 states and Washington DC in the first one and a half months of 2015 (CDC 2015).

Measles, otherwise known as rubeola, is a highly contagious disease that can lead to pneumonia, brain damage, deafness and even death, particularly in young, malnourished children.

Travel spreads the virus from countries where measles remains a common disease. In fact, the recent outbreak is likely due to a traveler who got infected with the measles virus in the Philippines and then visited an amusement park in Southern California.

The alarming come-back of the measles virus is explained by growing vaccination paranoia and the subsequent decline in vaccination rates. Because measles is airborne and highly contagious, coughing or sneezing can easily spread the virus to unvaccinated individuals even hours after the person with the disease has left the room. People who haven’t been vaccinated are at great risk of contracting the virus. The CDC estimates that 90% of unvaccinated individuals exposed to the disease will become infected (CDC 2014).

Early detection of early on-set measles symptoms can significantly reduce the spread of this highly contagious disease. While rash and fever are classic indications of a measles infection, identifying these symptoms may be too late to effectively limit the spread of the disease because an infected individual is most contagious when the rash has already erupted.

Koplik spots, on the other hand, develop inside the mouth two to three days earlier, before the measles rash appears. These spots are small and white and are often found on a reddened background on the inside of the cheeks. Recognizing these spots early on can assist in a quicker adoption of preventive measures such as isolation, curbing any person-to-person spread.

Because of the historic rarity of the disease, today’s healthcare professionals have likely seen Koplik spots only in textbooks and not in the clinical setting. However, the recent reemergence of the disease requires that all healthcare professionals recognize oral manifestations of the virus. By transitioning the standard physical examination from the traditional HEENT to the HEENOT examination (head, eyes, ears, nose, oral cavity and throat), healthcare professionals will always include the mouth as part of their patients’ overall health assessment, whether children or adults,and be more likely to detect the early symptoms of measles infection.

The number one protection against measles remains vaccination. It is recommended that children, unless immunocompromised, get vaccinated, and that adults check with their healthcare providers to ensure that they have received the required immunizations. The first dose should be received 12-15 months and the 2nd dose at 4-6 years. As long as their mothers have been immunized, babies under 6 months of age are protected against measles by the antibodies from their mothers.

Have you seen Kopliks spots in your practice?

References:

Center for Disease Control. Measles Cases and Outbreaks. (2015). Retrieved from http://www.cdc.gov/measles/cases-outbreaks.html

Center for Disease Control. Measles Transmission. (2014). Retrieved from http://www.cdc.gov/measles/about/transmission.html

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