Brushing your teeth while being treated in hospital can significantly reduce your chances of falling ill with pneumonia.

Many hospitalised patients don’t brush their teeth during their stay, probably for a variety of reasons. Some may have forgotten to bring a toothbrush, while others don’t think about it, feel unmotivated or are physically incapable of doing so. Medical staff often do not include routine oral hygiene care as part of their services to patients.

But in the largest randomised controlled trial of its kind, patients equipped with a toothbrush, toothpaste and dental care advice in hospitals were 60 per cent less likely to develop a common form of hospital-acquired pneumonia, says at Avondale University in Australia.

“This just really enforces the need for communication with patients about pneumonia risk, and the importance of oral care and brushing their teeth whilst in hospital,” he says.

It’s widely understood that patients on often develop pneumonia, due, in part, to the medical equipment interfering with the natural respiratory system. But many non-ventilated hospitalised patients also acquire pneumonia at least 48 hours after hospital admission. Researchers are still trying to understand why this happens and how to prevent it – particularly since hospital-acquired pneumonia is linked to .

“It’s an important problem,” says at Harvard University, who was not involved in the study. “Hospital-acquired pneumonia is one of the most common and deadly healthcare-associated infections, and rigorous data on how best to prevent it are sparse.”

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Mitchell suspected the disease might be linked to the bacteria in people’s mouths. The oral microbiome can affect respiratory health, as people breathe bacteria-laden droplets into their lungs. And the oral microbiome changes when people are hospitalised, says Mitchell. “I felt it was important that we try to do something to address this.”

So, he and his colleagues developed a year-long randomised controlled trial involving 8870 patients in three Australian hospitals to test the effects of oral care on pneumonia risks. He presents the results of this part of the team’s Hospital-Acquired Pneumonia Prevention (“HAPPEN”) study today at the in Munich, Germany.

Each participating hospital divided its study participants into three groups. None of the groups received any intervention for the first three months of the study. After three months, the patients in one group were provided with toothpaste and a toothbrush, labelled “Brushing teeth helps prevent pneumonia” on one side and “Brush away pneumonia!” on the other. The brushes were designed with a special handle for people with reduced dexterity. Patients also received a QR code linking them to educational materials on the .

After six months, the second group also received the toothbrushes, and the third group was given toothbrushes after nine months – meaning all study participants had the option of brushing their teeth for the final three months of the study.

As for the healthcare staff, the research team organised oral care training for ward nurses and provided them with links to professional advice on their website. They also encouraged the nurses to remind patients to brush and floss their teeth and to help those who had difficulty doing so themselves.

Outside of the intervention periods, only 15.9 per cent of the patients brushed their teeth once a day. During the intervention periods, 61.5 per cent of the patients attended to their oral care at least once per day – with patients doing so 1.5 times per day on average. Web statistics revealed that both patients and nurses frequently accessed the information on the HAPPEN pages during the intervention periods, says Mitchell.

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That coincided with a dramatic drop in the number of cases of non-ventilator-associated hospital-acquired pneumonia, says Mitchell. Specifically, the incidence fell from 1 case per 100 admission days in the control group to 0.41 in the intervention group.

“This study is intriguing,” says Klompas, who highlights the large study size and randomised design. “The message is that brushing teeth while in hospital is not only good for one’s oral hygiene and sense of well-being, but it may also literally be life-saving.”

at the University of Helsinki, Finland, says he appreciates the importance of such a significant risk improvement based on such a simple intervention. “Basically the patients were just provided with toothbrushes, toothpaste and advice,” he says. Even so, results might vary depending on reasons for hospitalisation and the patients’ usual oral hygiene habits.

The US is currently facing its most severe measles resurgence in years. On 26 March, Ohio became the fifth state to declare a this year, joining Texas, Oklahoma, New Mexico and Kansas.

How many measles cases are there in the US?

As of 27 March, the US (CDC) has confirmed 483 measles cases in the US this year. This is the highest number of infections since 2019, when there were more than 1200 confirmed cases. The CDC is aware of more potential measles cases but is waiting for confirmation before including them in the case count.

Which states are affected by measles?

So far, 19 states have confirmed at least one measles case this year: Alaska, California, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont and Washington. Fourteen of these states have reported only isolated incidences, meaning the infection didn’t spread to more than one other person.

However, five states declared a measles outbreak, defined as at least three related measles cases. As of 28 March, confirmed measles cases totalled in Texas and in New Mexico. There were as of 25 March. and have confirmed 23 and 10 measles cases, respectively, as of 26 March.

Has anyone been hospitalised or died?

The CDC reports that 70 people have been hospitalised for measles so far this year. One unvaccinated child also died from the virus on 26 February in Texas – the country’s first recorded measles death in a decade. A second possible measles-related death is under investigation in New Mexico.

When did the outbreak start?

Texas was the first state to declare a measles outbreak. The Texas Department of State Health Services issued an alert on after identifying measles in two unvaccinated adults who lived together in Houston and had recently travelled abroad. A week later, the state confirmed an additional in unvaccinated children on the other side of the state in Gaines county. It isn’t clear if these two incidents were related.

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Since then, measles has rapidly spread through Gaines county, located in western Texas, infecting at least 270 individuals. Gaines county has a large rural population and low vaccination rate: just under 82 per cent of children in kindergarten – which usually starts at age 5 – were vaccinated against measles. The real rate may be lower, as the data doesn’t include home-schooled children.

The outbreak has since spilled into neighbouring communities, including those across the state border in New Mexico, which announced its first case on , and Oklahoma, which announced its first two cases on . reported that state health officials also believe the Kansas outbreak, which began on , is related to those in New Mexico and Texas.

The latest outbreak in Ohio is unrelated to those in other states. The Ohio Department of Health declared the first case on in an unvaccinated man who had contact with someone who had recently travelled abroad. All nine of the other confirmed cases are related to this first unvaccinated man.

Who is most affected by measles?

Nearly all of the confirmed measles cases – 97 per cent – have occurred in people who are unvaccinated or whose vaccination status is unknown. Only 2 per cent of cases are in people who have received two doses of the measles, mumps and rubella (MMR) vaccine. Two doses of the vaccine is against measles while one dose is only 93 per cent effective.

Children and adolescents are particularly susceptible to measles. The majority of cases – 75 per cent – are in people 19 years old and younger. Children are also at risk of developing serious complications from measles. About children with measles develops pneumonia and about 1 out of every 1000 with the illness experiences brain swelling, which can lead to hearing loss, intellectual disability and death.

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Why are there so many measles cases?

The US declared measles eliminated in 2000. However, occasional outbreaks still occur due to waning vaccination rates. Measles is a highly contagious virus. Each case can lead to an additional 12 to 18 cases if people aren’t protected against the disease. When more than 95 per cent of people in a community are fully vaccinated against measles, most people in the area are protected through herd immunity.

In the 2019 to 2020 school year, more than 95 per cent of US kindergarteners were vaccinated against measles. Yet that number fell to less than 93 per cent in the 2023 to 2024 school year, leaving roughly 280,000 kindergarteners at risk of infection.

What is the US doing to contain the outbreak?

Vaccination is the best protection against measles. “The fact that we now have a measles case in Ohio adds emphasis to the importance of being fully vaccinated,” Bruce Vanderhoff at the Ohio Department of Public Health said in a announcing the state’s first case. “This disease can be very serious, but it is preventable. I strongly encourage you to protect yourselves and your children by getting vaccinated.”

However, the US secretary of health, Robert F Kennedy Jr, has stopped short of calling on people to get vaccinated. “The decision to vaccinate is a personal one,” he wrote in a article on 2 March. “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”