With 10 measles cases in Florida, state health officials fail to provide information

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FORT LAUDERDALE, Fla. — Criticism mounted Tuesday of the Florida surgeon general’s response to the measles outbreak, as the number of cases rose to 10 in the state — nine of them in Broward County.

Florida Surgeon General Joseph Ladapo, the state’s top health official, shared a letter on Feb. 20 telling parents at Manatee Bay in Weston that the decision whether to keep their children home was up to them, a move that has received widespread criticism from public health experts and political leaders across the country.

Ladapo’s letter has drawn scrutiny from doctors, epidemiologists and infectious disease specialists. And at a news conference Tuesday, Congresswoman Debbie Wasserman Schultz said Ladapo, in his letter, wrongly left the decision of keeping kids home up to their parents, and should have recommended vaccinating them. She also decried Ladapo’s failure to declare a public health emergency.

She called him a “super spreader of misinformation.”

“I’m calling for his immediate termination and demanding Gov. DeSantis replace him with a public health expert that will place Floridians’ health safety and well-being first,” said the congresswoman, a Democrat who grew up in Weston, where Manatee Bay Elementary — the school that has had students with measles — is located. Ladapo was appointed for his role by Republican Gov. Ron DeSantis.

Broward County now is up to nine cases of measles, two of them in children younger than 4 years old. Seven of the nine are students at Manatee Bay Elementary. It’s unclear whether the two cases younger than 4 are siblings of students at the elementary school. A tenth case has been reported in a Polk County resident age 20-24.

Meanwhile, Florida health officials have not been forthcoming with information about the disease’s spread.

When Floridians learned of an outbreak in measles at a Weston elementary school, it was the public school district that provided information to the public, not health officials.

The health department has held vaccination events at the school and in the community, however, it has not provided information on how many adults and students in Broward County have been vaccinated for measles since the outbreak began last week. At the time the first case was reported, more than 100 of the 1,067 students at the school were unvaccinated.

The outbreak in Florida started with four cases reported on the state’s disease surveillance website. Outside of Broward County, Polk County was reported over the weekend, bringing the total in Florida to 10 cases. Florida’s outbreak is the largest in the U.S. right now.

Gone unanswered by Florida’s health officials have been questions about whether these cases are in the unvaccinated, whether the younger children with measles are siblings of infected at Manatee Bay and whether the newest case is in a college student.

They also haven’t answered questions the public wants to know: How did measles get to Florida? How exactly is this once-eradicated disease spreading in South Florida? How many people in Broward County have been vaccinated at the recent events?

Local health officials in Broward County and Polk County have redirected reporters’ inquiries to the Florida Department of Health’s main communications office in Tallahassee. That office has not respond to multiple inquires from the South Florida Sun Sentinel and the Orlando Sentinel.

John Sullivan, a spokesman for Broward County Public Schools, has provided information on cases in Manatee Bay and the school district’s response informing the public about cleaning measures at the elementary school. On Tuesday, 82 students were absent at the school, an improvement from the more than 200 absent last week.

Ladapo’s letter draws criticism

The only communication thus far from the Florida Department of Health has been a letter sent to parents at Manatee Bay from Ladapo, Florida’s top health official.

Ladapo, nationally known for his outspoken skepticism toward the COVID-19 vaccine, recently sent a letter to parents at Manatee Bay Elementary School.

“Due to the high immunity rate in the community, as well as the burden on families and educational cost of healthy children missing school, (the state health department) is deferring to parents or guardians to make decisions about school attendance,” Ladapo wrote.

His letter states that when a school has a measles outbreak, it is “normally recommended” that unvaccinated students who haven’t previously had the disease be kept home for three weeks “because of the high likelihood” they will be infected.

But the letter then says the state won’t turn that recommendation into a mandate.

“This is unprecedented. Those with no prior immunity need to isolate for 21 days,” epidemiologist Katelyn Jetelina wrote in her popular public health science newsletter. Jetelina says “measles is one of the most contagious diseases on earth.”

On Tuesday, Wasserman Schultz was joined by Dr. Mary Jo Trepka, an infectious disease epidemiologist at Florida International University, and Latha Krishnaiyer, the legislative chair of the Broward Parent Teacher Association.

Measles was declared eradicated in 2000, thanks to a highly effective vaccination program. But the disease has emerged again as more Americans forgo vaccination, which the COVID pandemic further politicized.

“Sadly, frustratingly, Florida’s Surgeon General stands in stark contrast to America’s proud legacy of bipartisan public health success,” said Wasserman Schulz. “Ladapo instead politicizes public health and peddles risky freedom-of-choice rhetoric that fuels vaccine hesitancy and downplays the public and personal health necessity of vaccination.”

Wasserman Schultz likened Ladapo’s approach to measles to his treatment of the COVID vaccine, saying he omitted data from a COVID vaccine study that would have shown the risk of catching the virus was greater than the risk of getting vaccinated, as reported by the Tampa Bay Times.

“It’s one thing if he was concerned about what was then considered a relatively new vaccine, with COVID,” Wasserman Schultz said. “But now he didn’t even recommend in the letter he released that people get their children vaccinated for measles. I mean, never mind not declare an emergency, never mind leaving the decision on whether to send their child to school if they were unvaccinated to the parents. That’s dangerous. And it’s clearly getting more and more kids sick.”

Even those who have not been vaccinated could drastically reduce their chances of getting sick or having severe illness, experts say.

Children who have been exposed should vaccinate before symptoms appear, Trepka said; the vaccine lessens the severity of symptoms. Adults who are not vaccinated are at risk of more serious disease than children.

It is unclear how many children at the school have been vaccinated since the outbreak. No one had that information at the news conference.

In response to questions on whether Florida has reported how many measles shots have been given out since the state’s outbreak began and whether the reported cases are in the unvaccinated, Centers for Disease Control and Prevention spokesperson Lisa George said Florida health officials would be who could provide that information.

“State and local health departments have the lead in investigating measles cases and outbreaks when they occur,” a written statement from the CDC said. “The CDC will continue to closely monitor reported cases.”

Jetelina, the epidemiologist, also pointed out that Ladapo’s letter failed to recommend kids without immunity get vaccinated. “Many parents don’t know that unvaccinated kids can still get protection from a vaccine within 72 hours of exposure. (Also, the standard of care is that if they get vaccinated within 72 hours, they can return to school as long as they don’t develop symptoms.)”

She believes Ladapo’s recommendations put more children at risk. “Measles has a long incubation period. It takes 5-21 days from exposure for symptoms to develop. So even if a child, especially an unvaccinated one, doesn’t have symptoms, they may be contagious and spread it to others, including in the community,” she said.

Krishnaiyer also voiced support for the vaccine on behalf of the PTA, which she said has a “strong history of advocating for universal measles vaccinations for children, as it has proven to be an effective tool in preventing the disease.”

She commended the Broward school district for its approach, saying that “all information should be disseminated to parents, families: the protocols, the suggestions, all of the medical information must be accessible to all parents in the community, and also be available to parents with disabilities and other languages.”

Wasserman Schultz made it clear that Ladapo was the focus of her criticism. Krishnaiyer said that state health officials had recently visited the school with the superintendent.

Vaccination rates are low

The absence of information comes as Florida falls short of the national 95% vaccination goal with only 91.7% of the state’s kindergartners immunized with the measles, mumps and rubella vaccine. Florida allows students to opt out of required vaccinations with medical or religious exemptions.

Measles, which is identified by fever, cough and a rash that starts near the hairline and spreads, often can be treated at home with over-the-counter medication. However, it does bring serious health risks. For people without immunity, 1 in 5 will be hospitalized, 1 in 20 will develop pneumonia (the most common way measles kills young kids), 1 in 1,000 will develop encephalitis (infection of the brain, sometimes causing permanent brain damage), and 1 to 3 in 1,000 will die.

The Centers for Disease Control and Prevention reported that as of Friday there have been at least 35 measles cases in 15 states in 2024 — most related to international travel.

The National Foundation for Infectious Diseases (NFID) and the Centers for Disease Control and Prevention (CDC) recommend that adults born in 1957 or later who do not have evidence of immunity should receive at least one dose of the Measles-Mumps-Rubella vaccine, also known as the MMR vaccine. Many insurance plans cover the cost of MMR immunization.

On Monday, the Association of State and Territorial Health Officials put out this statement:

“Vaccination is the best and safest way to protect children. Two doses of measles vaccine are more than 97% effective in preventing the disease entirely, and vaccinated people may continue to engage in routine activities even if they are exposed to someone with the disease. When community vaccination rates drop below 95%, however, outbreaks become more common because the disease can spread from one vulnerable person to another.”

The association’s recommendation is the opposite of what Ladapo advised parents: “Because of the risk of severe disease from measles and the high likelihood of transmission to others even before symptoms are evident, well-established public health practice recommends that unvaccinated persons exposed to measles stay home for at least 21 days to prevent further growth of the outbreak.”