Sixth measles case confirmed at Broward elementary school. Here’s how to protect yourself from the highly contagious virus
On Tuesday evening, health officials confirmed a sixth case of measles at Manatee Bay Elementary School in Weston, just hours after Broward County Public Schools Superintendent Dr. Peter Licata visited the school to ease fears.
Licata assured faculty that the school had been deep-cleaned, air filters had been changed over the holiday weekend, and anyone who has been vaccinated has no need for concern. Buses that take students to and from Manatee Bay also have been cleaned and the air filters have been changed. On Tuesday, more than 200 of the 1,067 Manatee Bay students were absent.
It’s unclear whether all six children with measles were unvaccinated for the disease that was once thought to be eradicated in the United States. The first reported case last Thursday was a third-grade student at the elementary school. About 11% of the Manatee Bay students — roughly 117 students — are unvaccinated, using a medical or religious exemption from the mandatory vaccine requirements.
On Friday, Broward County Public School District in cooperation with local health officials held a vaccination event at Manatee Bay and on Sunday, a second vaccination event was held off-site for students throughout the same school zone. On Wednesday, the school district is holding another vaccination event from 2 to 6 p.m. for Manatee Bay Elementary students, staff and family.
While the health department has not linked the first reported case to travel, infectous disease experts say it is likely he or she was in contact with someone who visited an area where measles is spreading. The U.S. Census shows nearly half the population in Weston is foreign-born and many travel internationally.
“DOH-Broward is continuously working with all partners including Broward County Public Schools and local hospitals to identify close contacts that are at highest risk of transmission and severe illness,” the health department said in a statement.
Late Tuesday, the school district shared a Department of Health letter that had been given to parents and guardians of students at Manatee Bay. The letter signed by Florida Surgeon General Joseph Ladapo noted, “When measles is detected in a school, it is normally recommended that individuals without history of prior infection or vaccination stay home for up to 21 days. This is the period of time that the virus can be transmitted.”
The letter also referenced the number of reportedly healthy children who are being kept home from school, and indicated that remote lessons may become necessary.
“Due to the high immunity rate in the community, as well as the burden on families and educational cost of healthy children missing school, DOH is deferring to parents or guardians to make decisions about school attendance,” the letter reads. “… Broward County School District is prepared to provide continuous learning to all children at Manatee Bay Elementary School whose parents/guardians choose to keep them at home. If someone in your household contracts measles, all members of the household should consider themselves exposed and monitor symptoms.”
Even before the new South Florida cases, a total of 23 measles cases were reported to the Centers for Disease Control and Prevention between Dec. 1 and Jan. 23, according to a recent health alert. In addition, the World Health Organization has been warning of an “alarming rise” in measles cases throughout Europe.
How does measles spread?
Measles is highly contagious, spread through the air when an infected person coughs or sneezes. If one person has it, about 90% of people around them will also become infected if they are not protected by the vaccine or masks, according to the U.S. Centers for Disease Control and Prevention.
The disease can live on a surface or in an airspace for up to two hours where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. If you are unvaccinated for measles, your risk is much higher.
“Certainly if you’re in a typical-sized classroom with a patient that’s infected, who’s coughing or sneezing, then you’re at risk,” said Dr. Ronald Ford, chief medical officer at Joe DiMaggio Children’s Hospital in Hollywood.
If my child gets vaccinated now, how long does it take until he has immunity?
The measles-mumps-rubella vaccine, or MMR, is required for students attending public schools in Florida, according to the state Department of Health. The vaccine is two doses, the first dose at 12 to 15 months and the second dose at 4 to 6 years old. One dose of MMR vaccine is 93% effective in preventing measles. Two doses of MMR vaccine are 97% effective against measles.
But parents increasingly have foregone the vaccine for their children in recent years, and as immunization rates have dropped, vaccine-preventable illness rates are on the rise.
If a child gets vaccinated now, he will have some antibodies within just a few days after vaccination. It takes about two weeks to be fully protected, according to the CDC.
If I am exposed, can I still transmit it even if I have been vaccinated?
You can infect someone only if you have the disease. Transmission after vaccination is extremely rare, especially if you don’t have symptoms.
You are considered contagious four days before the measles rash appears, and for four days after the rash erupts.
“Usually the first thing that you’re going to see is a fever, and it’s generally a fever that’s pretty high, around 104 degrees,” Ford said. “Then comes respiratory symptoms such as cough, congestion, sore throat, and then comes red eyes and the rash, which typically appears the fourth or fifth day after symptoms start.”
Ford said the rash spreads in a unique way. “It almost always starts around the hairline and behind the ears and on the face; it spreads to the trunk and then it spreads to the extremities. Not a lot of rashes spread like that.”
Infectous disease expert Dr. Tina Tan said measles outbreaks, particularly in school settings, are challenging to contain, particularly when there’s a population of unvaccinated children. “There is a 90% transmission rate in a close contact setting,” said Tan, who is president-elect of the Infectious Diseases Society of America.
If I am unvaccinated and exposed to measles, is it too late to get a shot?
The MMR vaccine can be effective in preventing measles if it’s given within 72 hours of exposure, said Dr. Ford of Joe DiMaggio.
Children typically don’t get vaccinated with the first shot until they are older than 1. The second dose comes after age 4.
If someone in the household gets infected, a baby can be given a shot as a precaution.
The vast majority of moms transfer antibodies of all three — measles, mumps, and rubella — to fetuses. Once born, antibodies wane really quickly and are almost all gone at 6-12 months of age.
If you are traveling to an area where measles outbreaks are occurring and don’t know your vaccine history, there is no harm in getting a dose of the MMR vaccine, says Tan, an attending physisian at the Ann & Robert H. Lurie Children’s Hospital of Chicago.
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If I was vaccinated, or had measles many decades ago, can I still get the disease?
If you have had the MMR vaccine developed in 1971, you’re 35 times less likely to get measles than someone with no immunity, according to Katelyn Jetelina, an epidemiologist and author of a health newsletter.
But nothing is perfect. A breakthrough case is rare but possible (3 out of 100 fully vaccinated people will get infected), she notes. For the vaccinated who do get infected, the disease does tend to be milder.
The CDC says if you received a live measles vaccine in the 1960s you likely still have immunity. The majority of people born before 1957 are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella, the CDC says.
“If you had clinical measles and you’re certain that it was rubeola, which is the the measles virus, and you should have lifelong immunity,” said Dr. Ford of Joe DiMaggio. “We do know that there’s going to be a very small number of patients who get the vaccine and can still get measles, but it’s generally very, very mild and you may not have all the symptoms like a full-blown case of measles.”
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If we are protected from measles for life, why are there booster rumors?
Measles antibodies are incredibly durable, but they do wane over time, Jetelina points out in her newsletter. “This isn’t too concerning because we have T cell protection, too. Studies that followed people for 17 years showed the vast majority (91%) remained above the threshold needed for protection. currently, outbreaks are occurring among unvaccinated people,” she says.
Some countries such as Korea are discussing the possibility of a measles booster. Studies show a booster provides benefits, but they are short-lived. There has not been discussion of this type in the U.S.
If I get measles, how dangerous is it?
Measles most often can be treated at home with over-the-counter medications for the symptoms. However, there are several groups that are more likely to suffer from measles complications:
Children younger than 5 years of age.
Adults older than 20 years of age.
Pregnant women.
People with compromised immune systems, such as from leukemia or HIV infection.
“Measles can make you feel pretty lousy,” Ford said. “The good news is that most of the cases resolve on their own.”
Adults can get more of the complications, said Dr. Tan, the infectious disease expert. “This is not a benign illness.”
About 1 in 5 people in the U.S. who get measles will be hospitalized, and there have been deaths from the disease. Complications can include ear infections, pneumonia, deafness and encephalitis.
When is okay to sent my child back to school if he gets measles?
Ford says children are contagous for four days after the rash clears. Measles comes with a rash rather than the small bumps associated with chicken pox.
What do I do if I think I or my child has measles?
Hold off on going to the emergency department, unless you or your child has a complication.
“We have really been emphasizing to parents that the emergency department is not the place to come for measles unless you need emergency type of care because it’s so contagious,” Ford said. “The majority of these kids can be cared for at home and given comfort measures. We discourage parents from bringing them to the hospital for testing or for confirmation of the diagnosis because that increases the risk of spread in the community.”
Because measles was eradicated more than 20 years ago, medical students and even some doctors never have seen the disease. Early symptoms easily can be mistaken for another illness. The CDC and the Florida Department of Health have alerted providers that the disese is spreading again.
How do you actually confirm that you have measles? Is it just a visual?
A lab test officially can confirm measles. But Ford says most doctors rely on a clinical diagnosis. “You can diagnose measles pretty conclusively based on the signs and symptoms,” he said. “If there is an exposure history and if the child has not been vaccinated, you can really make that diagnosis.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
