Measles Has Come Back in Force. Is Your School Ready?

The United States has recorded

more measles cases this year than in any year in more than three decades.

As of this month, the Centers for Disease Control and Prevention had confirmed 4,080 cases, far more than in all of last year.

Measles was declared eliminated in the United States in 2000, thanks largely to school-entry vaccine requirements, said William Moss, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Today some states are loosening nonmedical exemptions while others are tightening them. The CDC sent states $100 million in two installments this summer to support vaccination, testing, and surveillance, The New York Times reported

.

“There’s no doubt that this is an unusually large set of outbreaks of measles here in the United States,” said Moss.

Similar numbers, he said, were last reported during a national outbreak that occurred between 1989 and 1992.

For schools, the surge poses real risks. Measles is one of the most contagious known diseases, and it spreads fastest where vaccination rates are low. Experts say principals need to know which students in their buildings are unprotected, and have a plan before a case shows up.

The younger a child is, “the more likely you’re going to get severe measles,” said Dr. James Campbell, interim head of pediatric infectious disease at the University of Maryland School of Medicine.

Babies can’t be vaccinated before 6 months old, and there is no antiviral treatment for measles, he said.

Even healthy school-age children who catch measlescan end up with ear infections or in the hospital for IV fluids, Campbell said. In Pennsylvania, 128 children under 5 have caught measles this year, according to the state health department.

States are attempting to keep cases under control

Pennsylvania has been hit hardest. The state had 1,078 confirmed cases across all age groups as of early October, and its health department has reported five measles-associated deaths this year.

Children make up about a third of the state’s cases. That includes 128 children under age 5, according to the state’s department of health.

“Thus far, there have been very few exposures reported from schools or childcare programs,” department spokesperson Stephanie Nojiri said in a statement to Education Week. Under state law, enforcing school vaccine requirements is the job of superintendents, principals, and other school leaders, she said, not that of the health and education departments.

In New York, Gov. Kathy Hochul responded to the rising measles cases by declaring a state disaster emergency

this month. The state health department has reported 93 cases since mid-July in rural communities with low rates of immunization in 18 counties.

Slipping vaccination rates are fueling the outbreak

The root causes of the surge in cases is clear, public health officials have said.

“What is driving the measles epidemic is the lack of measles vaccination,” Campbell said.

Measles is so contagious that one sick person can infect 12 to 18 people who aren’t vaccinated, he said.

That is why health experts want at least 95% of children to have both MMR doses by kindergarten. At that level, Campbell said, people who can’t be vaccinated, such as infants and children with weakened immune systems, are shielded because nearly everyone around them is immune. Below that rate of vaccination, measles can keep spreading.

If vaccination rates don’t climb back above that line, Campbell said, then outbreaks “will be the new normal.”

Pennsylvania state officials say that more than 93% of its K-12 students are fully vaccinated.

“It’s good, but it’s not quite good enough,” said Campbell.

Nationally, 92.4% of kindergartners had completed their MMR shots last school year, down from the year before, according to the CDC. That left about 280,000 kindergartners without records showing they had finished the series.

State averages can also hide schools where many children are unprotected, Campbell said. “It’s local rates that are the most important.”

About two-thirds of Pennsylvania’s cases are adults. Moss said the surge of so many adults getting sick“reflects really long-standing under-vaccination in these communities that are hardest hit.”

That worries Campbell. Unvaccinated adults “are able to just as easily pass it to children as children are to pass it to children,” he said.

For instance, children could catch measles from unvaccinated teachers or cafeteria workers.

Pennsylvania communities have been hit hard by the illness

Lancaster County’s Amish and Mennonite communities, which have historically had low vaccine coverage, have been especially hard hit by the measles outbreak, Moss said.

Amish schools are private and usually have one teacher and about two dozen students in grades 1-8, all in one room, said Mark Dewalt, a Winthrop University professor emeritus who studies Amish education. He is a fellow this fall at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College in Pennsylvania. Each school answers to its own small board, not a superintendent.

“No one’s checking vaccination status,” he said.

Families in Amish communities do keep sick children home, Dewalt said. “If one family has the measles, they’re not sending their kids to school. If three families have the measles, they’re gonna close until everybody’s done with it.”

Access to health care is also a challenge. Many Amish families travel by horse and buggy, so a distant clinic can mean paying for a ride. A clinic used by Amish families in Lancaster nearly ran out of vaccines, while another, harder-to-reach site drew few people, he said. “More Amish are getting vaccinated than you think.”

Since 2019, New York has let children skip school vaccines only for medical reasons, not religious beliefs, even at private religious schools. The passage of the law followed an outbreak in the state of more than 1,000 cases.

Moss said people vaccinated with one or two doses “really don’t have to worry very much.”

But unvaccinated people in affected communities are at a real risk, and “there are serious adverse consequences associated with measles, even in those who are otherwise healthy.”

Some of those consequences appear years later. A rare brain disease called SSPE can develop long after a child seems to recover, Campbell said.

“It’s invariably fatal, and it’s due to measles,” he said, adding that it is “completely preventable by vaccination.” Measles can also weaken the immune system for a time, Moss said, though the health effects of that tend to be minor.

How one Ohio school district attempts to stay ready

The leaders of the Springfield, Ohio, school system have protocols in place to prepare for an influx of measles cases.

The state of Ohio, which has reported 160 measles cases this year, requires school systems to report their immunization records each October. The nurses on staff in Springfield, located in the southwestern part of the state, keep lists of which of the district’s more than 6,000 students are full vaccinated, partially vaccinated, or unvaccinated against measles, said district nurse Bronwyn Patterson.

If the county health department passed on information to the district about a child with measles, Patterson said she could pull the names of unprotected students in a particular classroom within an hour.

Speed matters. Under health department guidance, exposed students who aren’t vaccinated have 72 hours to get an MMR shot, Patterson said. Otherwise, they could be kept out of school for 21 days.

Tracing contacts outside the classroom is hard, she said. “There are thousands of potential touch points that students could cross every day that we aren’t even aware of.”

One bit of advice offered by doctors is to keep an exam room empty for about two hours after a suspected case, because the virus can linger in the air. Patterson said that isn’t realistic. “I don’t know of any school in Ohio that’s going to have a space that could be isolated for two hours,” she said.

Springboro High School Principal Clayton Lavercombe said in the case of an outbreak, decisions about away athletic events or school trips would come from the county health department.

“We wouldn’t make a decision like that unilaterally,” he said.

Experts point to steps schools can take now to prevent a measles outbreak. Staff unsure of their immunity can check their records, get a blood test, or get an MMR shot, Campbell said. For students who can’t be vaccinated, such as organ transplant recipients, “the school should do everything it can to ensure that the adults and children around that child are immunized,” Moss said.

If a nurse suspects measles, Moss said, isolate the child, call the health department, and warn the hospital. “The last thing you want to have is a child with measles in a busy, crowded emergency room,” he said.

He also urged principals to follow the American Academy of Pediatrics’ vaccine recommendation

. The AAP recommends two MMR doses for every child, the first at 12 to 15 months and the second at 4 to 6 years.

Patterson says her district’s obligation is to be ready to stem any potential outbreak.

“It’s not a matter of if, it’s when,” she said, “and how prepared are we.”