Post by kittylady on Feb 24, 2024 2:07:48 GMT
Florida defies CDC in measles outbreak, telling parents it's fine to send unvaccinated kids to school
With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public health standard that's long kept measles outbreaks under control.
On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.
The Department of Health "is deferring to parents or guardians to make decisions about school attendance," wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo's in the letterhead.
Ladapo's move contradicts advice from the Centers for Disease Control and Prevention.
"This is not a parental rights issue," said Scott Rivkees, Florida's former surgeon general who is now a professor at Brown University. "It's about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness."
Most people who aren't protected by a vaccine will get measles if they're exposed to the virus. This vulnerable group includes children whose parents don't get them vaccinated, infants too young for the vaccine, those who can't be vaccinated for medical reasons, and others who don't mount a strong, lasting immune response to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.
The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious measles virus spreads on tiny droplets through the air and on surfaces, students are considered exposed simply by sitting in the same cafeteria or classroom as someone infected. And a person with measles can pass along an infection before they develop a fever, cough, rash, or other signs of the illness. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop ear infections that can lead to permanent hearing loss, and about 1 in 1,000 die from respiratory and neurological complications.
"I don't know why the health department wouldn't follow the CDC recommendations," said Thresia Gambon, president of the Florida chapter of the American Academy of Pediatrics and a pediatrician who practices in Miami and Broward, the county affected by the current measles outbreak. "Measles is so contagious. It is very worrisome."
Considering the dangers of the disease, the vaccine is incredibly safe. A person is about four times as likely to die from being struck by lightning during their lifetime in the United States as to have a potentially life-threatening allergic reaction to the measles, mumps, and rubella vaccine.
Nonetheless, last year a record number of parents filed for exemptions from school vaccine requirements on religious or philosophical grounds across the United States. The CDC reported that childhood immunization rates hit a 10-year low.
In addition to Florida, measles cases have been reported in 11 other states this year, including Arizona, Georgia, Minnesota, and Virginia.
Only about a quarter of Florida's counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent data posted by the Florida Department of Health in 2022. In Broward County, where six cases of measles have been reported over the past week, about 92% of children in kindergarten had received routine immunizations against measles, chickenpox, polio, and other diseases. The remaining 8% included more than 1,500 kids who had vaccine exemptions, as of 2022.
Broward's local health department has been offering measles vaccines at Manatee Bay Elementary since the outbreak began, according to the county school superintendent. If an unvaccinated person gets a dose within three days of exposure to the virus, they're far less likely to get measles and spread it to others.
For this reason, government officials have occasionally mandated vaccines in emergencies in the past. For example, Philadelphia's deputy health commissioner in 1991 ordered children to get vaccinated against their parents' wishes during outbreaks traced to their faith-healing churches. And during a large measles outbreak among Orthodox Jewish communities in Brooklyn in 2019, the New York City health commissioner mandated that anyone who lived, worked, or went to school in hard-hit neighborhoods get vaccinated or face a fine of $1,000. In that ordinance, the commissioner wrote that the presence of anyone lacking the vaccine in those areas, unless it was medically contraindicated, "creates an unnecessary and avoidable risk of continuing the outbreak."
Ladapo moved in the opposite direction with his letter, deferring to parents because of the "high immunity rate in the community," which data contradicts, and because of the "burden on families and educational cost of healthy children missing school."
Yet the burden of an outbreak only grows larger as cases of measles spread, requiring more emergency care, more testing, and broader quarantines as illness and hospitalizations mount. Curbing a 2018 outbreak in southern Washington with 72 cases cost about $2.3 million, in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving. If numbers soar, death becomes a burden, too. An outbreak among a largely unvaccinated population in Samoa caused more than 5,700 cases and 83 deaths, mainly among children.
Ladapo's letter to parents also marks a departure from the norm because local health departments tend to take the lead on containing measles outbreaks, rather than state or federal authorities. In response to queries from KFF Health News, Broward County's health department deferred to Florida's state health department, which Ladapo oversees.
"The county doesn't have the power to disagree with the state health department," said Rebekah Jones, a data scientist who was removed from her post at the Florida health department in 2020, over a rift regarding coronavirus data.
DeSantis, a Republican, appointed Ladapo as head of the state health department in late 2021, as DeSantis integrated skepticism about COVID vaccines into his political platform. In the months that followed, Florida's health department removed information on COVID vaccines from its homepage, and reprimanded a county health director for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo's call to halt vaccination with COVID mRNA vaccines entirely, based on notions that scientists call implausible.
Jones was not surprised to see Ladapo pivot to measles. "I think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government," she said. Although his latest decision runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.
In an email to KFF Health News, the Florida health department said it was working with others to identify the contacts of people with measles, but that details on cases and places of exposure were confidential. It repeated Ladapo's decision, adding, "The surgeon general's recommendation may change as epidemiological investigations continue."
For Gambon, the outbreak is already disconcerting. "I would like to see the surgeon general promote what is safest for children and for school staff," she said, "since I am sure there are many who might not have as strong immunity as we would hope."
CBS News
And we're seeing a rise in cases in the UK too.
England now seeing clusters of measles cases
England is now seeing clusters of measles cases across a number of regions including London, the North West, Yorkshire, The Humber and the East Midlands, as well as the West Midlands.
There have been 166 cases in the last month, with 56 of those in the last week, latest figures reveal.
Measles is highly contagious and is likely to keep spreading unless more people are vaccinated, experts warn.
Symptoms include a rash and fever.
The West Midlands accounted for about half of the 166 cases seen since 15 January, mostly in Birmingham. Case numbers in that region now appear to be stabilising.
Elsewhere:
12% (20/166) of cases have been in London
10% (17/166) in the North West
10% (16/166) in Yorkshire and The Humber
9% (15/166) in the East Midlands
Many of the infections have been in children and young people.
Measles is almost entirely preventable with vaccination using the MMR (measles, mumps and rubella) jab.
Dr Vanessa Saliba, from the UK Health Security Agency, said: "As expected, due to worryingly low MMR vaccine uptake in some areas across the country, we are now starting to see clusters of cases in other regions.
"While parents are coming forward to take up the offer of the MMR vaccine for their children, there are still hundreds of thousands of children who remain unprotected, and therefore remain at risk of serious complications or lifelong disability.
"I strongly urge parents to take up the offer of the MMR vaccine now to make sure their child is protected."
What is measles and what are the symptoms?
Measles is caused by a virus that is spread by coughs and sneezes.
Common symptoms include:
high fever
sore, red and watery eyes
coughing
sneezing
Small white spots may appear inside the mouth
A blotchy red or brown rash usually appears after a few days, typically on the face and behind the ears, before spreading to the rest of the body.
It can be harder to see on brown and black skin.
You can catch it any age if you have not been vaccinated.
After both MMR vaccine doses, 99% of people are protected against measles and rubella, and 88% are protected against mumps.
The first MMR dose is usually given at 12 months old, while the second jab is administered at about three years and four months.
The number of young primary school children who have had both doses of the MMR vaccine is below World Health Organization targets.
Approximately 85% of children in England in 2022-23 had received two MMR doses by their fifth birthday, the lowest level since 2010-11. The recommended figure is 95%.
That means a few million children under the age of 16 have not had both doses and are potentially at risk.
Measles normally clears up within seven to 10 days. However, complications can include pneumonia, meningitis, blindness and seizures. For some people, it is deadly.
BBC News (15 Feb 2024)
With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public health standard that's long kept measles outbreaks under control.
On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.
The Department of Health "is deferring to parents or guardians to make decisions about school attendance," wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo's in the letterhead.
Ladapo's move contradicts advice from the Centers for Disease Control and Prevention.
"This is not a parental rights issue," said Scott Rivkees, Florida's former surgeon general who is now a professor at Brown University. "It's about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness."
Most people who aren't protected by a vaccine will get measles if they're exposed to the virus. This vulnerable group includes children whose parents don't get them vaccinated, infants too young for the vaccine, those who can't be vaccinated for medical reasons, and others who don't mount a strong, lasting immune response to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.
The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious measles virus spreads on tiny droplets through the air and on surfaces, students are considered exposed simply by sitting in the same cafeteria or classroom as someone infected. And a person with measles can pass along an infection before they develop a fever, cough, rash, or other signs of the illness. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop ear infections that can lead to permanent hearing loss, and about 1 in 1,000 die from respiratory and neurological complications.
"I don't know why the health department wouldn't follow the CDC recommendations," said Thresia Gambon, president of the Florida chapter of the American Academy of Pediatrics and a pediatrician who practices in Miami and Broward, the county affected by the current measles outbreak. "Measles is so contagious. It is very worrisome."
Considering the dangers of the disease, the vaccine is incredibly safe. A person is about four times as likely to die from being struck by lightning during their lifetime in the United States as to have a potentially life-threatening allergic reaction to the measles, mumps, and rubella vaccine.
Nonetheless, last year a record number of parents filed for exemptions from school vaccine requirements on religious or philosophical grounds across the United States. The CDC reported that childhood immunization rates hit a 10-year low.
In addition to Florida, measles cases have been reported in 11 other states this year, including Arizona, Georgia, Minnesota, and Virginia.
Only about a quarter of Florida's counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent data posted by the Florida Department of Health in 2022. In Broward County, where six cases of measles have been reported over the past week, about 92% of children in kindergarten had received routine immunizations against measles, chickenpox, polio, and other diseases. The remaining 8% included more than 1,500 kids who had vaccine exemptions, as of 2022.
Broward's local health department has been offering measles vaccines at Manatee Bay Elementary since the outbreak began, according to the county school superintendent. If an unvaccinated person gets a dose within three days of exposure to the virus, they're far less likely to get measles and spread it to others.
For this reason, government officials have occasionally mandated vaccines in emergencies in the past. For example, Philadelphia's deputy health commissioner in 1991 ordered children to get vaccinated against their parents' wishes during outbreaks traced to their faith-healing churches. And during a large measles outbreak among Orthodox Jewish communities in Brooklyn in 2019, the New York City health commissioner mandated that anyone who lived, worked, or went to school in hard-hit neighborhoods get vaccinated or face a fine of $1,000. In that ordinance, the commissioner wrote that the presence of anyone lacking the vaccine in those areas, unless it was medically contraindicated, "creates an unnecessary and avoidable risk of continuing the outbreak."
Ladapo moved in the opposite direction with his letter, deferring to parents because of the "high immunity rate in the community," which data contradicts, and because of the "burden on families and educational cost of healthy children missing school."
Yet the burden of an outbreak only grows larger as cases of measles spread, requiring more emergency care, more testing, and broader quarantines as illness and hospitalizations mount. Curbing a 2018 outbreak in southern Washington with 72 cases cost about $2.3 million, in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving. If numbers soar, death becomes a burden, too. An outbreak among a largely unvaccinated population in Samoa caused more than 5,700 cases and 83 deaths, mainly among children.
Ladapo's letter to parents also marks a departure from the norm because local health departments tend to take the lead on containing measles outbreaks, rather than state or federal authorities. In response to queries from KFF Health News, Broward County's health department deferred to Florida's state health department, which Ladapo oversees.
"The county doesn't have the power to disagree with the state health department," said Rebekah Jones, a data scientist who was removed from her post at the Florida health department in 2020, over a rift regarding coronavirus data.
DeSantis, a Republican, appointed Ladapo as head of the state health department in late 2021, as DeSantis integrated skepticism about COVID vaccines into his political platform. In the months that followed, Florida's health department removed information on COVID vaccines from its homepage, and reprimanded a county health director for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo's call to halt vaccination with COVID mRNA vaccines entirely, based on notions that scientists call implausible.
Jones was not surprised to see Ladapo pivot to measles. "I think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government," she said. Although his latest decision runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.
In an email to KFF Health News, the Florida health department said it was working with others to identify the contacts of people with measles, but that details on cases and places of exposure were confidential. It repeated Ladapo's decision, adding, "The surgeon general's recommendation may change as epidemiological investigations continue."
For Gambon, the outbreak is already disconcerting. "I would like to see the surgeon general promote what is safest for children and for school staff," she said, "since I am sure there are many who might not have as strong immunity as we would hope."
CBS News
And we're seeing a rise in cases in the UK too.
England now seeing clusters of measles cases
England is now seeing clusters of measles cases across a number of regions including London, the North West, Yorkshire, The Humber and the East Midlands, as well as the West Midlands.
There have been 166 cases in the last month, with 56 of those in the last week, latest figures reveal.
Measles is highly contagious and is likely to keep spreading unless more people are vaccinated, experts warn.
Symptoms include a rash and fever.
The West Midlands accounted for about half of the 166 cases seen since 15 January, mostly in Birmingham. Case numbers in that region now appear to be stabilising.
Elsewhere:
12% (20/166) of cases have been in London
10% (17/166) in the North West
10% (16/166) in Yorkshire and The Humber
9% (15/166) in the East Midlands
Many of the infections have been in children and young people.
Measles is almost entirely preventable with vaccination using the MMR (measles, mumps and rubella) jab.
Dr Vanessa Saliba, from the UK Health Security Agency, said: "As expected, due to worryingly low MMR vaccine uptake in some areas across the country, we are now starting to see clusters of cases in other regions.
"While parents are coming forward to take up the offer of the MMR vaccine for their children, there are still hundreds of thousands of children who remain unprotected, and therefore remain at risk of serious complications or lifelong disability.
"I strongly urge parents to take up the offer of the MMR vaccine now to make sure their child is protected."
What is measles and what are the symptoms?
Measles is caused by a virus that is spread by coughs and sneezes.
Common symptoms include:
high fever
sore, red and watery eyes
coughing
sneezing
Small white spots may appear inside the mouth
A blotchy red or brown rash usually appears after a few days, typically on the face and behind the ears, before spreading to the rest of the body.
It can be harder to see on brown and black skin.
You can catch it any age if you have not been vaccinated.
After both MMR vaccine doses, 99% of people are protected against measles and rubella, and 88% are protected against mumps.
The first MMR dose is usually given at 12 months old, while the second jab is administered at about three years and four months.
The number of young primary school children who have had both doses of the MMR vaccine is below World Health Organization targets.
Approximately 85% of children in England in 2022-23 had received two MMR doses by their fifth birthday, the lowest level since 2010-11. The recommended figure is 95%.
That means a few million children under the age of 16 have not had both doses and are potentially at risk.
Measles normally clears up within seven to 10 days. However, complications can include pneumonia, meningitis, blindness and seizures. For some people, it is deadly.
BBC News (15 Feb 2024)
