Amid Measles Outbreak, School Nurses Promote Vaccinations

As a measles outbreak rages in the southwest and cases pop up around the country, public school nurses have a clear, simple message: get the facts and get vaccinated.

“You have to be educated to be healthy and healthy to be educated,” says Rachel Leathers, a school nurse in Aurora, Illinois.

The outbreak has raised alarm among school nurses and the larger medical community.

“The reason it keeps me up at night, the thing that distinguishes measles from most other diseases out there, is that it is the most contagious disease that we know. It spreads with unbelievable efficiency,” Adam Ratner, director of the Division of Pediatric Infectious Diseases at New York University, said in a recent episode of the Big Brains podcast.

A quarter of a century after it was eliminated in the United States, one of most contagious diseases on Earth is back, killing two people so far this year. 

The reason for the comeback is declining vaccination rates.

“Some parents ask, why get a vaccine for a disease you never hear about anymore?” says Leathers. “I explain that the reason we didn’t hear about it for years is because of the vaccine.” 

Before the vaccine was made available in 1963, about 3 million people contracted measles every year, and between 400 and 500 died from it, many of them school children, according to the CDC. Major epidemics occurred every two to three years, causing about 2.6 million deaths worldwide.

Today, very few people remember what it was like before the measles vaccine. And now, with increased worry about possible side effects of vaccines and a growing suspicion of vaccinations in general, public health is in jeopardy. 

When parents express hesitancy about the vaccinations because they’ve heard about possible side effects, Leather explains that the vaccines are safe and effective while also sharing information about the risks that come with getting measles and how gravely ill their child can become.

“They don’t know how severe it can get,” she says. “I provide them with the facts so they can make informed decisions about the risks of vaccinating versus not vaccinating."

What is Measles?

Measles is a viral infection that is highly contagious and is spread through the air when an infected person breathes, coughs or sneezes. The virus can remain infectious in the air up to two hours after an infected person leaves an area.[GU2] 

If one person has it, up to 9 out of 10 people nearby will become infected if they’re not protected by a vaccine. 

Symptoms of measles appear seven to 14 days after exposure, though the virus can be spread to others for approximately four days before symptoms appear. Onset of the illness brings high fever, cough, runny nose and red, watery eyes. A few days later, a rash breaks out as flat, red spots on the face, which spreads down the neck and torso to the rest of the body. 

Measles can lead to pneumonia, swelling of the brain, deafness, intellectual disability, and death.

The good news is that measles is prevented with vaccination – they are 99 percent effective after the second dose.

The American Association of Pediatrics (AAP) and CDC recommend children receive the measles-mumps-rubella (MMR) vaccine at age 12-15 months and again at 4-6 years. Each dose of MMR lowers the risk of infection and severity of illness, if infected.

Medical experts agree that a high rate of vaccination can lead to what is called “herd immunity,” which can protect everyone, especially those who can’t be vaccinated because of their age, if they’re immunocompromised, undergoing cancer treatment, or will experience severe allergic reactions to the vaccine, among other reasons. 

To achieve herd immunity for measles, 95 percent of a community needs to be vaccinated. (For polio, the threshold is 80 percent.) 

In Gaines County, the west Texas farming community where the current outbreak started, the vaccination rate for kindergarten students who received the MMR vaccine last year was 82 percent.

Nationwide, the rate of kindergartners with the measles vaccine declined from around 95 percent before the pandemic to under 93 percent last year, according to the CDC. A few percentage points below the threshold can cause outbreaks.

Vaccine Misinformation Versus Science

“We know that immunizations are the safest and most efficient way to prevent disease, disability, and death from communicable disease like measles. That is the science,” says Kate King, a school nurse in Columbus, Ohio, and president of the National Association of School Nurses.

The goal of school nurses, she says, is to help educate parents about the science and to dispel misinformation.

“People aren’t always aware of the research and evidence-backed science,” King says. “So many parents depend on social media and friends to talk about immunizations, and misinformation can be spread.”

School nurses understand that there are parents who have vaccine hesitancy, she says, and the best way to handle that is through one-on-one conversations.

“We ask them, ‘what is your thinking about this? What are your concerns’,” she explains.

Some parents have heard misinformation about vaccines causing autism, others think there are terrible side effects, and some may believe vaccines are no longer important or necessary.

“We address every issue with accurate information that shows how important childhood immunizations are for the health of families and communities,” King says. “We want parents to protect their kids and help them understand we have the responsibility of protecting those unable to get vaccinated because it would put them in medical danger.”

Vaccine Exemptions

All 50 states and Washington D.C. have laws requiring certain vaccines for students to attend school, and all states allow exemptions for children who are unable to receive vaccines for medical reasons. But state laws vary regarding non-medical exemptions for religious or personal reasons, sometimes referred to as "philosophical exemptions." 

After the COVID-19 pandemic, childhood vaccination rates began to fall as some Americans became suspicious of public health vaccine requirements and sought exemptions. 

Now, even amid a measles outbreak, state lawmakers around the country are trying to resurrect or create new religous or personal exemptions from vaccine requirements.

In Illinois, religious exemptions make up the majority of exemptions for vaccines in school-aged children, according to the Illinois Department of Public Health. 

Gloria E. Barrera is school nurse at a high school in DuPage Country outside of Chicago. She says her district has a high level of adherence to vaccination requirements, but she still works hard at educating families about the effectiveness of vaccines in preventing disease.

“We kind of tiptoe around it, but the politicization of the COVID vaccine created widespread doubts about vaccine mandates,” Barrera says. “What we do as school nurses is partner with organizations like AAP and state health departments to promote a unified, clear message about what is needed to protect public health.” 

That unified message was muddied by recent comments made by Health and Human Services Secretary Robert F. Kennedy Jr. While acknowledging that vaccinations protect children from measles, he didn’t strongly encourage parents to vaccinate their children. He called it a “personal choice” and touted the benefits of Vitamin A and cod liver oil.

Unfortunately, the choice not to vaccinate is sometimes made before parents have all the information, says Rachel Leathers.

“I have rights,” a parent who bristled at the vaccination requirement, told Leathers. 

“Yes, you have rights, and you also have the right to accurate information from a health professional to make an informed decision,” she explained to the individual. “I emailed the information about vaccines and went over the research and really helped them understand the research.” 

School nurses, Leather says, understand that all parents have concerns about what they are putting in their children’s bodies, and that they need to trust in the safety of vaccines.

“We are the source of trust for families,” she says. “We are the bridge between health care and education.”