Florida measles threat grows as more young children go unvaccinated

As measles outbreaks are popping up across the country and the number of unvaccinated children in Florida is climbing, state health officials and parents worry that one of the most infectious diseases that was practically eliminated in the United States two decades ago could have a resurgence.

"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 Susie Gilden, a Davie mother of a second-grader and a preschooler. "It is not fair that my children's health should be endangered."

In Central Florida, more than 2,400 kindergartners in public and private schools weren't vaccinated because of a religious or medical exemption during the 2017-2018 school year. That's about 7.5 percent of the student population.

For longtime pediatricians who had seen the number of measles cases dwindle over the years, the upward trend is alarming.

"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."

Throughout Florida, about 11,500 children—almost 6 percent of the state's 200,000 students—started public school in kindergarten this school year with some form of exemption from required vaccinations. The numbers for private schools are even higher.

The increase in exemptions comes as 465 measles cases have been confirmed this year 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 measles since October.

More concerning, in the first week of April, 78 new cases of measles were reported in the United States, more than in any other week this year, according to the Centers for Disease Control and Prevention.

In Florida, children must be vaccinated to attend public or private schools, but there are exemptions that excuse them. 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. Students in public elementary schools with religious exemptions rose by about 35 percent over the last five years.

When accounting for all children up to 18 years old, including those in private schools and preschools, between 2013 and 2018, the total religious exemptions in Florida climbed each year 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 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.

"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."

Nationally, the overall number of vaccine exemptions is increasing, too. During the 2017-18 school year, 2.2 percent of kindergartners across the country were exempted from vaccination,

"Although the overall percentage of children with an exemption was low, this was the third consecutive school year that a slight increase was observed," according to a 2018 report from the CDC.

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.

"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 not even half of its counties have achieved that goal.

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.

Orange County, with a 91 percent immunization rate among kindergartners, ranked next to last among the state's 67 counties during the 2017-2018 school year. Broward County ranked slightly better with an almost 94 percent immunization rate. Both lag well behind Franklin County in the Panhandle, which ranked first at 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. 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.

"The time to vaccinate your child is not at the last minute, when all of a sudden there's a case in the community and you're panicking and rethinking," said Dr. Alix Casler, chief of pediatrics for Orlando Health Physician Associates.

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.

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. 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.

Silver 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 rather than permanent. Last year, students in Florida's public and private schools had more temporary medical exemptions than religious. But with the strengthening anti-vaccine movement, some pediatricians are refusing to care for unvaccinated children

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.

©2019 The Orlando Sentinel (Orlando, Fla.)
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