Dealing with the Measles Outbreak

Krysia GabenskiFeatured News

By Judith H Holmes, J.D.
From the Spring 2015 Journal of the Colorado Dental Association

Question:  We have a general dentistry practice, and we see patients of all ages.  We are concerned about the effects of the recent measles outbreak on our patients and employees.  Are there some guidelines on how to address this issue in our practice?

In December of last year, many visitors to Disneyland (“The Happiest Place on Earth”) contracted measles, and the outbreak has spread to several states, including Colorado.  According to the Centers for Disease Control and Prevention (CDC), measles is highly contagious and can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. In fact, if other people breathe the contaminated air or touch the infected surface, and then touch their eyes, noses, or mouths, they can become infected.

According to the CDC, measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.  Infected people can spread measles to others from four days before to four days after the rash appears.

Making matters worse, Colorado has a dismal vaccination rate.  A recent CDC report found that Colorado children of kindergarten age had the lowest vaccination rates in the country for measles, mumps and rubella.  Colorado is one of several states with a “personal belief exemption,” allowing parents to exempt their child from immunization requirements.

Although you aren’t likely to encounter a measles case in your patients or staff members, you may be faced with situations involving a pandemic or an outbreak of a disease similar to measles. You should prepare your practice in advance to address the issues that typically arise.  The following is a response to frequently asked questions:

Can we require our employees to be vaccinated? There is no magic answer to this question.  The federal and state immunization mandates for hospitals do not apply to private dental offices. It is risky to demand that your current employees get vaccinated, or to threaten to terminate them if they refuse to get vaccinated.  However, as a healthcare provider, you have a legitimate business reason for providing a safe, healthy work environment, and making sure your staff does not contract or spread the measles or other similar diseases to patients or other staff members.

The U.S. Equal Employment Opportunity Commission (EEOC) has not issued guidelines with respect to mandatory measles vaccinations, but it has taken the position that an employee may be entitled to an exemption from a mandatory vaccination requirement based on an ADA disability that prevents him/her from taking the influenza vaccine as a “reasonable accommodation barring undue hardship (significant difficulty or expense).”

Significantly, the EEOC has taken the position that ADA-covered employers should consider simply encouraging employees to get the influenza vaccine rather than requiring them to take it. Employers may consider applying this EEOC approach.  Although there is no applicable statute prohibiting mandatory immunization of employees, if you adopt such a policy, do so with the help of your employment counsel.   Any mandatory immunization policy should include an “opt-out” for those employees with religious objections or medical concerns.

What should we do if we suspect a patient has exposed our employees?  If a staff member who has not been immunized has been exposed to a patient who has contracted measles, according to the CDC, that staff member is very likely to contract the virus. That staff member should be required to take leave immediately for the period of time required to be certain the staff member returns virus-free.

Does the dental practice have to provide paid leave?  If a staff member does contract a disease such as measles from a patient, review your leave policies to determine whether some or all of the employee’s time off should be considered paid leave.  Review your insurance policies to determine whether there is short-term disability coverage available. In addition, the Colorado’s Workers’ Compensation Act covers all injuries, diseases or conditions that are caused by on-the-job activities, so if an employee can prove he/she has been exposed to an infectious disease such as measles in the course of their employment, a claim may be valid.

Protect your practice.  Here are some suggestions to consider:

  • Establish a written policy regarding immunization.  If you require employees to be immunized, the policy should take into consideration the medical, disability, religious, and personal belief issues discussed above.
  • If you require your employees to be immunized against certain diseases, consider advising job applicants about that requirement, but avoid questioning regarding the applicant’s medical history or religious beliefs.
  • Do not automatically reject applicants who are not immunized, since their decision may involve religion or disability.  If this issue arises during the hiring process, ask for guidance from your employment counsel.
  • Adopt written protocols for pandemic outbreak situations.
  • Adopt comprehensive leave and illness policies, and enforce them uniformly.
  • When employees report to work when they are ill, send them home.  Your leave policy should be specific as to what is paid leave and what is not.
  • Consider making certain vaccinations available in the office for convenience or offer to reimburse employees for the vaccinations if they get them somewhere else.  Insurance plans generally cover the cost.
  • For those who have reservations about the health effects of immunizations, provide current information about the benefits and risks of being vaccinated.  Many people have rejected the MMR vaccine because they relied on a study that was later debunked.   By providing up-to-date information on the safety of the drugs, some people may reconsider their earlier refusal.
  • Don’t pressure or retaliate against an employee if they elect not to get immunized.
  • Keep all information regarding employees’ health records, immunizations, and illnesses as confidential as possible.

This article is for informational purposes and does not constitute legal advice.

Judith H. Holmes, J.D., is a practicing attorney with law firm of Judith Holmes & Associates, LLC. Contact her at 303-781-6858 or Visit her Website at