As more children go without vaccinations, risk of a measles outbreak in Florida increases

The number of students entering Florida schools without vaccines is on the rise, and health officials worry that the highly infectious measles virus — once eradicated across the United States — could get another chance to cause an outbreak.

“Measles is like that shark that’s always looking for the hole in the net,” said Dr. Kenneth Alexander, chief of the division of infectious diseases at Nemours Children’s Hospital in Orlando. “It’s one of the most infectious diseases there is.”

In Dade, Broward and Palm Beach counties, more than 4,000 students entered public kindergartens this school year with some form of exemptions from required vaccinations — that’s almost 7 percent of the 54,000 students. The numbers for private schools are even higher.

Across the state, about 11,500 children started public school in kindergarten this school year with some form of exemption from required vaccinations — that’s almost 6 percent of Florida’s 200,000 students.

The increase in exemptions comes as measles cases are cropping up across the country, confirmed in 19 states including Florida. Last week, New York City declared a public health emergency in four Brooklyn ZIP codes after seeing more than 285 cases of the measles since October. More concerning, in the first week of April, 78 new cases of measles were reported in the U.S., more than in any other week this year, according to the Centers for Disease Control and Prevention.

On April 15, the CDC reported 90 more cases, bringing the total so far in 2019 to 555.

And the increase in the number of unvaccinated children in schools at a time when measles has resurfaced — with Florida’s first case in 2019 confirmed in Broward County — has parents like Susie Gilden concerned.

“I respect the right of parents to choose what they want for their child, but I do not want their choice to affect my kid,” said Gilden, a Davie mother of a second-grader and a preschooler. “It is not fair that my children’s health should be endangered.”

For longtime pediatricians who had seen the number of measles cases dwindle over the years, the recent spread of measles in the United State is alarming too. Even the fully vaccinated still have a 3 percent chance of infection.

The increase in the number of unvaccinated children stems from a greater frequency of easy-to-obtain religious exemptions, which some parents believe anti-vaccine advocates are using to avoid state requirements to attend school.

Parents can get a doctor to say vaccines present a medical problem or they can opt out of vaccines on religious grounds. Religious exemptions require only a parent’s signature on a county health department form.

Each year more Florida parents are using religious exemptions to send their children to school without some or all vaccines, according to data from the state health department. The number of students in public elementary schools with religious exemptions rose by about 35 percent over the last five years.

The numbers are even more jarring when private schools and preschools are included: Between 2013 and 2018 for children up to 18 years old, total religious exemptions in Florida climbed from about 12,200 students to nearly 25,000 — an increase of about 105 percent over that span of time, according to data provided by the Florida Department of Health.

The biggest jump happened in the 2018 school year when the state granted an additional 5,300 religious exemptions, almost 25 percent more than it had in 2017.

“So something is going on here with these exemptions,” said Dr. Karen Liller, professor at University of South Florida’s College of Public Health. “Of course, we have the whole anti-vaccination movement that is strong. And that has been part of this issue. But we know in public health that vaccinations are safe. And vaccinations are needed.”

Measles, which is one of the most infectious viruses known to man, can spread through the air, or by contact with a surface up to two hours later. Worse, people can be contagious days before symptoms develop.

While medical practitioners encourage parents to vaccinate their children with two doses of the MMR (measles, mumps, rubella) vaccine, a growing and vocal group of people — empowered by social media — oppose vaccinations, convinced the measles vaccine has or could harm their children’s development or lead to autism.

Numerous scientific and medical studies have shown no link between vaccines — or any of their ingredients — and autism.

Christina Sullivan of Tampa said her oldest child, now 10, had a vaccine reaction as a baby that included high fever and a decline in developmental progression. She has obtained a medical exemption for him and his younger brother to attend public school without required vaccinations.

“I think there’s a scare factor around the disease. If a child has gotten vaccines and if it’s as effective as parents say, their kids should be protected.”

To vaccinate, or not

Nationally, the overall number of vaccine exemptions are increasing, too. During the 2017-18 school year, 2.2 percent of kindergartners across the country were exempted from vaccination, according to researchers at Syracuse University. The CDC said “although the overall percentage of children with an exemption was low, this was the third consecutive school year that a slight increase was observed.”

Amid measles outbreaks across the country, lawmakers in states such as New York, New Jersey, Vermont, Maine, Iowa, Oregon and Washington are considering ending the practice of exempting students from vaccines for religious beliefs.

Measles can be stopped from spreading when a high percentage of the population is vaccinated against it. It’s called herd immunity. When the immunization rates drop below 91 percent to 95 percent, the odds increase for a measles outbreak.

“The worry is that anti-vaccination is going to get stronger and stronger and we’re going to see the vaccination rates go down. And that’s the concern,” Liller said. “The state of Florida has a lot of visitors. We have people out and about and if we don’t have herd immunity, if we lose that immunity, that virus is going to spread.”

Florida’s goal is to have 95 percent of the kids immunized by the time they enter kindergarten, according to the Florida Department of Health. But fewer than half of its counties have achieved that goal.

Broward County came the closest in South Florida to meeting that goal, with an almost 94 percent immunization rate. Palm Beach County has a 93.1 percent rate, and Miami-Dade a 92.8 percent rate. All lag well behind Franklin County in the Panhandle, which ranked first in the state at a 99.2 percent immunization rate.

Meanwhile, there are neighborhoods within each county where the rate of religious exemptions — the number of unvaccinated children — is higher than average, making it easier for a virus like measles to spread.

“If you look at the exemption rates nationally, or at the state level, it’s quite low, but they tend to cluster geographically and they tend to cluster socially,” said Dr. Daniel Salmon, professor and director of the Institute for Vaccine Safety at Johns Hopkins School of Public Health.

“So if you have a child in that school or in that community, it doesn’t really matter what the national rate is even at the state level. The question is, what is the likelihood of your child coming into contact with an unvaccinated child?” Salmon said.

Any likelihood concerns Province Zamek, a Miami mother of two teenage daughters.

“It bothers me for two reasons. First, measles is so contagious and second, because I feel like if you do your homework, you will end up vaccinating,” she said. “Getting vaccinated is less dangerous than not, and you’re putting other people’s kids at risk.”

Florida parents are able to learn the number of unvaccinated children in a specific school — public and private — but not in an individual classroom.

An interactive map, compiled by the state health department and based on county subdivisions, further highlights where clusters of families in Florida with religious exemption live. While the overall rate of schoolchildren in Florida with religious exemptions averages 3 percent, in certain pockets of each county the exemption rates can be as high as 30 percent.

For instance, several clusters in Pinellas County, which had a measles outbreak last year, especially in the coastal areas near Clearwater, have exemption rates as high as 33 percent.

There is no cure for measles, just treatment of the symptoms.

Dr. Maria Pilar Gutierrez, a pediatric infectious diseases specialist with Joe DiMaggio Children’s Hospital urges parents to get their children vaccinated.

“It is unforgivable to have a child contract a disease that could have been preventable,” she said.

Before a measles vaccine became available in the early 1960s, 400 to 500 people died each year, according to the Centers for Disease Control and Prevention. By 2000, the disease was eliminated in the United States.

Diseases crop up more frequently

Meanwhile, measles isn’t the only vaccine-preventable disease surfacing in the state. Florida’s children have experienced the spread of other diseases in the last few years such chicken pox and pertussis (known as whooping cough). So far, Florida has been spared from mumps cases although the disease has hit colleges in the Northeast.

With preventable diseases cropping up more often, Amy Silver said it hasn’t swayed her decision not to vaccinate her two children in the Hillsborough County Public Schools and one in private preschool. Silver said her family has a history of autoimmune weakness, which influenced her decision.

“I felt like if I vaccinated them, I would be playing Russian roulette,” she said. Silver has secured temporary medical exemptions for her children that need to be renewed annually.

She said she doesn’t keep it secret that her children are unvaccinated. With clean water and sanitation, Silver said she considers diseases like measles less serious than previous times in history.

“I don’t feel there’s any harm to others being around my kids.”

Pediatricians, who find themselves being asked to give medical exemptions, tend to give more temporary than permanent. Last year, students in Florida’s public and private schools were granted more temporary medical exemptions than religious. But with the strengthening anti-vaccine movement, some pediatricians are refusing to care for unvaccinated children. Large practices like Pediatric Associates in South Florida no longer accept unvaccinated patients.

But Dr. Thomas Lacy, division chief for primary care and urgent care at Nemours, said he treats unvaccinated children, although he continues counseling the parents about the benefits of vaccination every visit.

“To not immunize is basically going back to the pre-modern times when kids got sick and died. I mean, it’s just a step backwards,” he said.

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