What should parents do about school during a measles outbreak? Here is the guidance
Florida parents and kids are getting conflicting advice when it comes to a measles outbreak at a Broward County school in Florida.
On one side: public health experts who recommend that unvaccinated children stay home for 21 days after exposure.
On the other side: the state’s surgeon general, who says it’s up to parents whether to send their kids to school.
Joseph Ladapo’s guidance breaks away from federal quarantine recommendations and has led to criticism by other public health experts and politicians, with Democratic U.S. Rep. Debbie Wasserman Schultz, whose district covers much of southern Broward County, on Tuesday calling for his resignation.
Measles can spread through coughing, sneezing and touching contaminated objects and then touching your mouth.
Here’s what to know about what the experts are saying:
What do public health experts recommend?
Public health experts from Florida International University, Florida State University and the University of Pittsburgh told the Miami Herald that while they recognize that Ladapo’s guidance tries to address the challenges of keeping kids out of school for up to three weeks, it also increases the risk of measles spreading to those who don’t have immunity.
Public health officials recommend that unvaccinated kids stay home for 21 days after exposure to the contagious disease. At the Weston school, there are 33 kids who are not vaccinated.
“What would happen if you had an unvaccinated person continuing to be in a school and potentially incubating this virus, they’re putting the other children at risk, even the vaccinated children, particularly those vaccinated children that may have an underlying health condition,” said Dr. Mary Jo Trepka, an epidemiologist at Florida International University in Miami-Dade County. “Those parents making decisions are making a decision that’s not only about their child, it has ramifications for the other children in that school.”
What does the Florida surgeon general recommend?
Last week, in response to the measles outbreak at Manatee Bay Elementary in Weston, Ladapo issued the following guidance to parents whose children were exposed but do not have symptoms:
For children who are not vaccinated and have not previously had measles: Parents can decide whether to keep their child at home or send them to school. Kids with symptoms or who have measles should stay home until symptoms subside without medication.
Ladapo acknowledged in his letter that the normal recommendation for people who are not vaccinated and have not had a previous measles infection is to stay home up to 21 days after measles exposure in a school. “This is the period of time that the virus can be transmitted,” he wrote.
At the Weston school, the quarantine would be through March 7. However, Ladapo said his recommendation — to let parents decide — is based on the “high immunity rate in the community” and “the burden on families and educational cost of healthy children missing school.” He said the date, as well as his recommendation, could change as the epidemiological investigation continues.
What do we know about the measles outbreak and reaction?
▪ As of Tuesday, seven cases have been confirmed at Manatee Bay Elementary in Weston, among 10 total in Florida.
▪ Also on Tuesday, 82 students of the nearly 1,100 population at Manatee Bay were absent from school, Broward Superintendent Peter Licata said while announcing a seventh confirmed measles case at the school. At the school, 33 children, or 3% of its students, aren’t vaccinated. Thirty-four children are learning remotely.
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What about vaccination rates?
The World Health Organization says there needs to be at least 95% of vaccination in a population for herd immunity. At the Weston elementary school where the outbreak occurred, 97% of its students are vaccinated and 3% are not vaccinated.
However, not every school in the county has the same vaccination rate, and as experts noted, people move around, visiting grocery stores, restaurants and other places throughout their daily lives. Measles can be transmitted four days before the start of symptoms, according to the state health department.
While county-level data for the 2023-2024 and 2022-2023 school year wasn’t immediately available, in the 2021-2022 school year, about 92% of public and private kindergarten students in Broward and Miami-Dade met their immunization requirements, including two MRR doses, state data shows.
Vaccination rules at Florida schools
In Florida, the measles, mumps and rubella vaccine, or MMR, is required to attend public and private childcare and K-12 schools. But some students can avoid the vaccine by getting a medical or religious exemption.
And while infection is rare for those vaccinated, up to 90% of people who aren’t vaccinated will get measles if exposed to someone with the disease, according to the U.S. Centers for Disease Control and Prevention. One in five will be hospitalized. Those most at risk for severe illness include infants, and people who are immunocompromised, pregnant or have underlying health conditions.
What the CDC says about quarantining after measles exposure at school
Ladapo’s recommendation clashes with the guidance of the CDC, the country’s top public health agency. The CDC says children who are not vaccinated against measles, including those who have a medical or religious exemptions, should stay away from school through 21 days after their most recent exposure.
An exception: The CDC says children who get the first dose of the MMR vaccine within 72 hours after their initial measles exposure can remain in school. The CDC says one MMR dose could help people avoid falling ill or reduce the risk of severe illness. Ladapo’s letter doesn’t mention this.
READ MORE: Should you worry about measles in South Florida? What to know as school cases found
“Not going to school causes problems. There’s no question about it. I understand that. But if you really want to know the things you can do to stop a measles outbreak, it’s be vaccinated and avoid contact with kids who have measles,” said Dr. Mark Roberts, a distinguished professor of health policy and management and director of the Public Health Dynamics Lab at University of Pittsburgh School of Public Health.
He added: “The CDC recommendations are designed to protect everybody not just the child who does or does not go to school, but everybody. And a recommendation that says you can do this based on your own decision, in my opinion, it’s scientifically flawed from what the data says, but it also means that somebody else — only parents of kids who can’t be vaccinated should be responsible for the safety of those kids.”
While the MMR vaccine is recommended for most people, some groups can’t get the shot, including infants younger then 12 months and people who have a weaker immune system due to certain conditions, such as cancer and HIV/AIDS. This is why it’s important to have herd immunity in a community, according to Roberts and Trepka, the FIU epidemiologist.
What to do after measles exposure
All of the public health experts the Herald spoke with said vaccination is the most effective tool to reduce the spread of measles. For those who are vaccinated, it’s rare to get sick — one dose of the MMR vaccine is about 93% effective and two doses is about 97% effective, according to the CDC.
Kids should get the first dose at 12 through 15 months of age and the second dose at 4 to 6 years of age, according to the CDC.
Those exposed to measles who were vaccinated should monitor for symptoms. Anyone who is not vaccinated should contact their doctor for guidance, which may include getting the MMR vaccine.
What should parents do if their child was exposed to measles?
“From the public health point of view, the answer is quite clear,” even if it can sometimes be a difficult decision for government and school officials to enforce, said Dr. George Rust, director of the Center for Medicine and Public Health at Florida State University in Tallahassee who also serves as medical director of Leon County’s health department.
Rust, Trepka and Roberts all referred parents to the CDC’s guidance and encouraged vaccination to reduce the spread.
