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As a Florida elementary school tries to contain a growing measles outbreak, the state’s top health official is giving advice that runs counter to science and may leave unvaccinated children at risk of contracting one of the most contagious pathogens on Earth, clinicians and public health experts said.

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Florida surgeon general Joseph A. Ladapo failed to urge parents to vaccinate their children or keep unvaccinated students home from school as a precaution in a letter to parents at the Fort Lauderdale-area school this week following six confirmed measles cases.

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Instead of following what he acknowledged was the “normal” recommendation that parents keep unvaccinated children home for up to 21 days – the incubation period for measles – Ladapo said the state health department “is deferring to parents or guardians to make decisions about school attendance.”

The controversial move by Ladapo follows a pattern of bucking public health norms, particularly when it comes to vaccines. Last month, he called for halting the use of mRNA coronavirus vaccines, in a move decried by the public health community.

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Ben Hoffman, president of the American Academy of Pediatrics, said Florida’s guidance flies in the face of long-standing and widely accepted public health guidance for measles, which can result in severe complications, including death.

“It runs counter to everything I have ever heard and everything that I have read,” Hoffman said. “It runs counter to our policy. It runs counter to what the [Centers for Disease Control and Prevention] would recommend.”

Measles outbreaks have been on the rise in recent years. So far in 2024, at least 26 cases in at least 12 states have been reported to the CDC, about double the number at this point last year. In addition to the six cases confirmed in the Florida school, cases have been reported in Arizona, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, New York City, Ohio, Pennsylvania and Virginia.

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Experts say the outbreaks are linked to the growing number of parents seeking exemptions from childhood vaccinations in recent years following political backlash to coronavirus pandemic mandates and rampant misinformation about the safety of vaccines.

In January, the CDC issued a warning to health providers to be on alert for more measles cases. Infected people are contagious starting four days before a rash develops and until four days afterward.

Because measles virus particles can linger in the air and on surfaces for up to two hours after an infected person leaves the area, up to 90 percent of people without immunity will contract measles if exposed. People who have been infected or received the full two doses of the MMR vaccine are 98 percent protected and very unlikely to contract the disease. That is why public health officials typically advocate for vaccination amid outbreaks.

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“The reason why there is a measles outbreak in Florida schools is because too many parents have not had their children protected by the safe and effective measles vaccine,” said John P. Moore, a professor of microbiology and immunology at Weill Cornell Medical College. “And why is that? It’s because anti-vaccine sentiment in Florida comes from the top of the public health food-chain: Joseph Ladapo.”

When asked to comment, the Florida health department responded with a link to Ladapo’s letter.

Ladapo’s unwillingness to use public health tools echoes the movement by conservative and libertarian forces to defang public health’s ability to contain diseases like the highly infectious measles. In a measles outbreak in Ohio that began in late 2022, most of the 85 children infected were old enough to get the shots, but their parents chose not to do so, officials said. The state legislature in 2021 had stripped health officials’ abilities to order someone suspected of having an infectious disease to quarantine.

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Ladapo’s letter to parents comes at a time of heightened worry about the public health consequences of anti-vaccine sentiment, a long-standing problem that has led to drops in child immunization rates in pockets across the United States. The percentage of kindergartners whose parents opted them out of at least one state-required childhood vaccinations rose to the highest level yet during the 2022-2023 school year – 3 percent – according to federal data released last year.

Paul Offit, a pediatric infectious diseases expert at Children’s Hospital of Philadelphia, said Ladapo’s failure to urge vaccination endangers children.

“Is he trying to prove that measles isn’t a contagious disease when the data are clear that it is the most contagious vaccine-preventable disease, far more contagious than influenza or covid?” Offit wrote in an email.

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The measles virus is extremely contagious, and infections spread rapidly. Young children are especially vulnerable because the first dose is not given until a child is 12 to 15 months old. The CDC recommends two doses of MMR vaccine, with the second dose at 4 through 6 years old.

A drop below 95 percent vaccination coverage for measles can compromise herd immunity and allow a virus to spread more quickly. Florida’s state vaccination coverage is 90.6 percent, but statewide vaccination coverage does not identify pockets where there may be lower coverage.

The outbreak will explode exponentially, becoming a much bigger community threat, if unvaccinated people exposed to the virus don’t follow public health recommendations and stay home from school during the potentially contagious period, said Patsy Stinchfield, president of the National Foundation for Infectious Diseases and a nurse practitioner in Minneapolis. She has been involved in controlling three measles outbreaks, including the 2017 outbreak in Minnesota that affected 75 people, most of them unvaccinated, and most of them children.

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About 1 in 5 unvaccinated people in the United States who contract measles is hospitalized, according to the CDC. As many as 1 out of 20 children develop pneumonia, the most common cause of death from measles in young children. About 1 child out of every 1,000 with measles will develop swelling of the brain that can lead to convulsions and leave the child deaf or with an intellectual disability. For unvaccinated babies who contract measles, 1 in 600 can develop a fatal neurological complication that can lie dormant for years.

Manatee Bay Elementary School, about 20 miles west of Fort Lauderdale, has six confirmed measles cases, school officials said this week. Of the school’s 1,067 students, 33 have not received the MMR vaccine, Broward County Schools Superintendent Peter B. Licata said Wednesday during a school board meeting. A school district official said the district has held “four vaccination opportunities,” including two at the school and two at other locations in the community.

The first case was reported Friday in a third-grade child who had no history of travel abroad, Florida health officials said.

School officials referred questions to Broward County school district, which said it is following guidance from the state health department.

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