It often starts with a cough. Red, watery eyes. A high fever. You might think it’s a normal cold. Perhaps it’s the flu.
But then days later, a rash sets in. Red spots and bumps appear on your face and begin to spread downward, to your neck, chest, legs, arms and feet.
Measles.
“Most physicians that have been practicing in the last 20 years or so have never seen it,” said Dr. Otto Ramos, director of pediatric infectious diseases and virus laboratory at Nicklaus Children’s Hospital near South Miami. Ramos, who has practiced medicine for over 40 years, cared for patients in South Florida during a resurgence of measles outbreaks in the country from 1989 through 1991.
Now, measles are back in South Florida, with at least six confirmed cases of measles linked to a Broward elementary school. It’s not the first time cases have popped up in the state.
What to know about measles and how it spreads
The highly contagious disease was eliminated from the U.S. in 2000 following an effective and strong vaccination program. The vaccine is required to attend K-12 school in the U.S. And while the disease is now uncommon in the country, outbreaks can sometimes still occur, usually when an unvaccinated traveler falls ill in another country and comes into the U.S., spreading the virus to other unvaccinated people.
Measles can spread through coughing, sneezing and by touching infected surfaces. For those who are vaccinated, infection is rare. For those who previously had measles, you can’t get the infection again.
For Ramos and Ronald Ford, chief medical officer at Joe DiMaggio Children’s Hospital in Hollywood, their main concern are for those who don’t have immunity. That includes newborns who aren’t eligible for the shot yet, anyone who is not vaccinated against measles and has not had the infection previously and anyone who is immunocompromised.
“Any parent who suspects that their child has been exposed and especially if that child is not immune should contact their pediatrician and the department of health immediately for guidance,” said Ford, noting that most people can recover at home.
However, measles can be dangerous and lead to severe complications in certain at-risk groups who do not have immunity, including children younger then 5, adults older then 20, people who are pregnant or who are immunocompromised, according to the U.S. Centers for Disease Control and Prevention. Complications can include pneumonia, brain swelling and premature birth. Some people might get seriously ill and die.
Measles cases confirmed at Broward elementary school
The newest cluster of cases in Florida is linked to Manatee Bay Elementary School, a K-5 school at 19200 Manatee Isles Dr. in Weston. Broward’s school district and the state health department didn’t answer questions from the Miami Herald on whether the sick people at the school were vaccinated and if any had recently traveled.
Those infected are between the ages of 5 and 14, according to preliminary data from Florida’s web-based reportable disease surveillance system. The cases are listed as “acquired in Florida,” though this information is preliminary and may change as the state conducts its epidemiological investigation. It’s worth noting that cases are classified based on the county where the person lives and does not necessarily mean that the person fell ill in the county.
“Since Friday that we heard about the first case, we have been getting ready,” said Ramos of Nicklaus Children’s. “We have been trying to get ahead of this and if we do, we will defeat it. ... We do have the tools to fight this.”
At Nicklaus, for example, Ramos said the hospital is promoting vaccination and is asking patient questions about their vaccination status and if they were exposed or not before admitting them into the hospital for elective surgery and other care to reduce the risk of the disease spreading.
Both doctors recommend people frequently wash their hands and avoid people who are sick to reduce their risk of infection. They say the best prevention is vaccination.
One dose of the measles, mumps and rubella vaccine, or MMR, is about 93% effective, with two doses about 97% effective, according to the U.S. Centers for Disease Control and Prevention. Kids should get the first dose at 12 through 15 months of age and the second dose at 4 to 6 years of age. About 3 of 100 people vaccinated with two doses will fall ill if exposed to the virus, the CDC says.
Florida has seen 40 confirmed cases of measles in the last decade, including some in Miami-Dade and Broward counties, state data shows. The six Broward elementary school cases are the only ones recorded for 2024. Miami-Dade had one confirmed measles case recorded in September, the data shows. The data doesn’t provide vaccination information.
Florida Surgeon General Joseph Ladapo on Tuesday said it’s normally recommended people who are not vaccinated for measles and have not had a previous measles infection to stay home for up to 21 days after measles exposure in a school. At the moment, the end of the infectious period is considered to be March 7, though that date could change as the epidemiologist investigation continues.
However, Ladapo said he will let parents and guardians decide whether their children should continue attending classes at the Weston school. Kids who have symptoms should stay home. Ladapo said his recommendation is based on the “high immunity rate in the community” and “the burden on families and educational cost of healthy children missing school.”
While the MMR vaccine is mandatory to attend all public and private childcare and K-12 schools in Florida, some students may be eligible for medical or religious exemptions.
At Manatee Bay Elementary, 3 percent of its students are unvaccinated, Broward County Public Schools Superintendent Peter Licata said Wednesday during a Broward School Board meeting. Licata told board members that 33 of the 1,067 students at the K-5 school in Weston don’t have the MMR vaccine for “various reasons” that he didn’t mention.
READ MORE: 3% of students are unvaccinated at Broward school with measles cases, superintendent says
While statewide immunization data for the 2023-2024 school year wasn’t immediately available, in the 2022-2023 school year, about 91% of kindergarten students in Florida had the two MRR doses, according to a CDC report.
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. About 7.5% kindergarten students in Broward and nearly 8% of kindergarten students in Miami-Dade had a medical or religious exemption.
That is below the 95% vaccination threshold health experts say is needed for herd immunity against measles.
And it’s not just happening in Florida. The U.S. has seen a nationwide decline in childhood vaccinations since the COVID pandemic, an alarming trend that could increase the “risk of outbreaks of vaccine-preventable diseases,” according to the CDC.
Last school year, vaccination coverage among kindergarten students nationwide remained below pre-pandemic levels, while exemptions increased, according to the CDC.
“It is not clear whether this reflects a true increase in opposition to vaccination, or if parents are opting for nonmedical exemptions because of barriers to vaccination or out of convenience,” the CDC noted in its report.
What to do if exposed or diagnosed with measles
Measles can be transmitted four days before the start of symptoms, according to the state health department. Symptoms can appear 7 to 14 days after contact with the virus and can include a cough, runny nose, red and watery eyes, a high fever up to 105 degrees and a rash. The rash can appear three to five days after the first symptoms.
While people previously infected with measles or who are fully vaccinated are unlikely to get the disease, up to 90% of people without immunity could fall ill if exposed.
Here’s what to do if you were exposed or diagnosed with measles:
▪ If you’re vaccinated for measles, it’s rare that you’ll fall ill but you should still notify your doctor and monitor for symptoms. However, if you’re not vaccinated or have never previously had measles, speak with your doctor about getting the MMR vaccine. If you get the vaccine within 72 hours after initial exposure, it could provide some protection against the disease or help you have a milder illness, the CDC says. Your doctor might also opt to give you a medicine called immunoglobulin within six days of exposure to reduce your risk of severe illness.
▪ Ramos, Ford and Ladapo recommend people contact their doctor for guidance if they were exposed to measles. Don’t show up to the doctor without notifying the office beforehand to reduce the risk of exposing others. Telehealth appointments are another option. Both Ramos and Ford are also asking people to avoid visiting the ER for a diagnosis unless they have another medical emergency to reduce the risk of spreading the disease to other high-risk people.
▪ If you have measles, the CDC recommends staying home for four days after developing the rash to reduce your risk of spreading the virus to others. And follow the COVID protocols: Wash your hands frequently, cover your mouth and nose with a tissue when you cough or sneeze, don’t share drinks or eating utensils and disinfect frequently touched surfaces.
▪ Because measles is a virus, the body needs to fight it off. If you’re caring for someone with measles, Ford recommends ensuring that the person stays hydrated and giving them fever reducers as needed to help them feel better. And make sure to wash your hands frequently.
This story has been updated to reflect Dr. Ramos experience caring for measles patients.
