Chalkbeat

School vaccine data can expose hidden outbreak risks. But access depends on where you live.

2026-09-09T14:08:00+00:00

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As Pennsylvania’s growing measles outbreak gets closer to her community on the west side of the state, Amanda Clear is taking actions to assess the risks to her son Dylan.

One of her first stops: A new state website that lets anyone look up the student vaccination rates at individual Pennsylvania schools. That’s how she learned that about 86% of the students at Dylan’s school are vaccinated against measles. That’s well below the 95% that’s considered necessary to prevent an outbreak of the highly contagious virus.

“Having that data point is very informative to help parents decide what they need to do,” Clear told me. Even though Dylan, 9, is vaccinated, he has an immune disorder that makes her worry he could be at increased risk for a breakthrough infection.

But across the country, not all parents can easily get access to this information. In some states, even public health officials don’t routinely know the vaccination rates at individual schools.

That’s despite research highlighting the importance of this data nationally in assessing the risks of outbreaks of measles and other vaccine-preventable diseases within local communities.

Here’s what I found.

What the research shows

Since measles was declared eliminated in the United States in 2000, CDC scientists have found that outbreaks involving more than 50 people have largely involved close-knit communities that for varying reasons have chosen not to get vaccinated. In the past few years, declining vaccination rates have contributed to these outbreaks spreading further within communities.

A prime example was the recent record-setting measles outbreak in South Carolina, which centered on a vaccine-hesitant Ukrainian- and Russian-speaking community in Spartanburg County and resulted in 997 documented infections by the time it ended in April. Most of those infected were school-age children and teens, and measles exposures that occurred at 33 schools resulted in 874 students being asked to quarantine at home for up to 21 days.

Yet across the country, data about childhood vaccination rates is often reported at a county or state level – averaging the vaccination status of kids over a broad geographic area.

It’s an approach that obscures localized pockets of unvaccinated people who live near each other, send their children to the same schools, and often share the same cultures, traditions, and beliefs, including about whether to vaccinate their children. In some cases these clusters may indicate shared barriers to accessing healthcare, such as transportation or language.

By analyzing South Carolina’s school-level immunization data, Clemson University researchers have identified clusters of undervaccinated students and their geographic relationship to measles exposures during the state’s recent outbreak.

As Clemson research associate Emily Serman mapped the data, it revealed that the risk from measles wasn’t spread evenly across Spartanburg County, which has one of the state’s lowest childhood vaccination rates.

Inside the largest U.S. measles outbreak in decades: Records reveal spread in vaccine-hesitant community

“It’s really concentrated in the northern half of Spartanburg County,” she told Healthbeat. The Clemson team’s findings suggest that the geographic clustering of undervaccinated students may pave the way for outbreaks.

At the national level, researchers from Cornell University warned in the journal Nature Medicine last month that county-level vaccination averages can appear high enough to protect against measles spreading, yet still hide dense clusters of unvaccinated children that can fuel outbreaks.

How states compare

Knowing how many children are — and are not — vaccinated at individual schools is a powerful indicator of local outbreak risks, these researchers say. Yet whether parents, researchers, or even health departments have routine access to that information varies significantly by state.

Some states post easily accessible, up-to-date maps and data. Others require a public records request or suggest the public seek the information from school districts, which might also require a public records request. Some don’t collect it until an outbreak strikes.

Texas: Neither the public nor the state’s health department have routine access to school-level vaccination data. State law only requires school districts to report student vaccination rates at an aggregated district-wide level, said Chris Van Deusen, spokesperson for the Texas Department of State Health Services, which posts an annual report of the information it receives. The report includes some information about individual private schools. Legislation to require reporting at the individual school level failed amid concerns from some legislators that it could result in students and families being harassed.

“In the event of an outbreak in a particular school or area, public health can get campus-level data from schools,” Van Deusen said.

Minnesota: The state’s health department has posted vaccination rates for individual schools and school districts since 2014, said Ben Christianson, senior epidemiologist in the department’s vaccine preventable disease section. The department uses the data to identify at-risk areas and its public availability has helped make school and childcare leaders better aware of immunization coverage in their local areas, Christianson said. It’s also reduced the department’s workload responding to data requests, he said.

Florida: Obtaining school-level data doesn’t appear to be easy. The Florida Department of Health — which last month announced a proposed rule that would reduce the number of required school vaccines — only posts aggregated county-level data for the state’s kindergartners and seventh graders on its website.

Isabella White, the department’s press secretary, said by email that “school-specific rates are not publicly available unless requested directly from the relevant health department or school district.” Does the state collect school-level data so it can prepare for and respond to outbreaks? White wouldn’t say. Two school districts — Broward County Public Schools and Miami-Dade County Public Schools — told Healthbeat they only submit aggregated district-wide data to the state health department. Neither district makes its school-level data public without a public records request.

South Carolina: During the state’s recent measles outbreak, the state health department began posting school-level data on its website that shows the percentage of children who were up-to-date on all of their required school shots, but not by individual vaccines. The department told Healthbeat that the data helps it prioritize outreach to schools with low vaccine coverage and that it plans to continue posting updated data online each winter. Previously the state had only published school vaccination data at the county and regional level.

During South Carolina’s recent measles outbreak, exposures occurred at 33 schools, including Boiling Springs Elementary School in Spartanburg County.

California: While the state health department posts school-level vaccination data on its website, it’s outdated — in some cases by several years, Healthbeat found. The most recent data displayed by the state’s interactive database and map is from the 2021-2022 school year. Elsewhere, the department posts some more recent, but still outdated, spreadsheets with school-level data for kindergarteners during the 2024-25 school year, plus some older data for seventh graders. Health officials have access to current data, the department told Healthbeat, and the 2025-26 school reports and data will be posted online over the next year.

“In the meantime, parents and members of the public may check with their school or local health department about coverage,” a department spokesperson said by email. School-level data can be found on at least some county health department websites, such as these for Los Angeles County and San Diego County.

Pennsylvania: This summer, the state’s health and education departments launched a new interactive website that details vaccination rates in key grades at individual schools. “Pennsylvania parents deserve clear, accessible data about the health of their children’s schools,” Dr. Debra Bogen, the state’s secretary of health, said in announcing the tool. The data will help families and local leaders work to reduce vaccine-preventable diseases, such as measles and whooping cough, she said.

Why it matters

Knowing the percentage of children immunized in individual schools can inform where and how health officials focus their resources, whether that’s for deploying staff to do contact tracing during an outbreak, assessing barriers to immunization, or conducting focused communication campaigns, the Clemson research team told Healthbeat.

“What the analysis did was it took a massive state-level problem and broke it down into several big, but more manageable, areas,” said Lior Rennert, a professor and director at the Clemson Center for Public Health Modeling and Response. “If you want to do an intervention, you now have targeted areas where you could do that.”

S.C. measles cases surged after holiday school closures delayed outbreak investigations

For the public, the data can provide a way to gauge outbreak risks in their immediate area. This can be especially useful for people at higher risk from certain diseases, such as pregnant women, infants, and young children who have not been vaccinated, and people with compromised immune systems, such as Dylan Clear.

After looking up Dylan’s school and learning not enough students were fully vaccinated against measles to prevent the virus spreading, his mother has begun working with school officials on a specialized plan in case he needs to miss school should Pennsylvania’s measles outbreak reach their area.

“If you have the knowledge,” Amanda Clear said, “you know how to respond appropriately rather than out of fear.”

What to watch

With the U.S. experiencing another record-breaking year for measles and outbreaks becoming a new norm, Pennsylvania and South Carolina this year made school-level vaccination data more transparent. We’re watching whether:

The resurgence in measles prompts other states to reconsider what information they make visible about vaccination coverage in local schools.
Parents and communities push for greater access to information about the outbreak risks at individual schools.

Alison Young is Healthbeat’s senior national reporter. Sign up to receive her free national newsletter here. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

One measles case could upend a campus for weeks. Colleges urge faculty to locate proof of immunity now.

2026-09-02T09:53:00+00:00

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While reporting a recent story on the surge in older adults seeking measles immunity tests, I kept coming across something I hadn’t expected. Colleges and universities were encouraging faculty and staff to gather proof of their immunity to measles before an exposure ever occurred on campus.

The more universities I spoke with, I realized there was another story unfolding. It wasn’t just that individuals were taking a personal interest in knowing their immunity. Some educational institutions also were preparing for the growing threat of measles, including looking for ways to prevent the disruption a single case could bring.

Here’s what I learned.

The lead signal

When a measles outbreak hit a suburban Denver school district earlier this year, it sent 80 exposed students and employees into home quarantine for weeks. It also spurred officials at the University of Northern Colorado to start preparing for the disease to arrive on their campus.

“This is going to be a problem that more and more educational entities are dealing with, both K-12 and higher ed, so we’re trying to be proactive about it,” Blaine Nickeson, the university’s associate vice president for administration, told Healthbeat.

The university has begun alerting students, faculty, and staff about the importance of having documentation of measles vaccination or immunity.

The push is not only to protect against the disease, but to help individuals avoid the significant disruptions that could result from just a single case of measles on campus — even for those who aren’t known to be infected.

“If even a single measles case is confirmed at UNC, state and county public health officials will collaborate with the university to orchestrate a significant public health response. This may include exclusion from campus for 21 days or more … Having a vaccine exemption on file will not prevent exclusion,” the university’s new measles awareness web page warns.

Students and their parents might not fully realize how a decision not to get vaccinated against measles could result in their exclusion from campus — including campus housing — during an extended quarantine period, Nickeson said.

Faculty and staff might not have thought about their measles immunization status in many years, but would face missing work if they are exposed to measles and lacked proof of vaccination or immunity, he said.

Unlike students, faculty and staff at colleges and universities generally don’t have campus vaccination requirements unless they work in certain hospital or health sciences settings.

The university highlights that measles shots and titer tests to check for immunity are available at the campus health center. The vaccine is typically covered by insurance, and the out-of-pocket cost of the titer test at the center is about $20 if insurance won’t cover it.

Where else we’re seeing this

University of Colorado Boulder: The university’s measles web page says: “To prevent unnecessary absences, faculty and staff are encouraged to have their immunization records or other evidence of immunity readily available for review if requested.” Faculty and staff can receive walk-up measles immunity testing on the Boulder campus for an out-of-pocket cost of $5.

University of Tennessee Chattanooga: The school’s measles preparedness efforts and recommendations for having proof of immunity were spurred in part by watching South Carolina’s Clemson University deal with measles earlier this year, said Jordan Jacobs, a UTC infectious disease nurse practitioner.

“For the majority of our faculty and staff, it is a new concept,” Jordan said. Their main question: How do they find their old immunization records? If their shots aren’t in state immunization registries, Jordan advises checking with past healthcare providers and schools. “Some staff do ask about titers and vaccinations,” she said.

University of Massachusetts Amherst: “Knowing and documenting your immunity status is critical as it determines whether you may continue working in the event of a confirmed exposure,” says the university’s measles web page, which was launched last year in response to the West Texas measles outbreak and continues to be updated. Dr. Khama Ennis, associate medical director for university health services, said there has been little feedback from faculty and staff, but the campus plans to do additional outreach this fall.

The national playbook

On the national level, the Centers for Disease Control and Prevention has created a checklist for higher education institutions to help prepare to respond to measles cases on campus.

The checklist notes the importance of maintaining records in accordance with legal requirements for privacy and confidentiality. Some university officials told Healthbeat that navigating privacy issues and the continued fallout from COVID vaccine mandates are among the reasons they are only advising faculty and staff to have their measles immunity documentation readily available, but not asking them to turn it in.

Some state health departments also are providing guidance: Among the proactive steps recommended by the North Carolina Department of Health and Human Services, colleges and universities should create a list of students who do not have appropriate documentation of immunity and recommend that faculty and staff have their evidence of immunity readily available.

“Obviously quarantining can have a significant impact,” said Dr. Emma Doran, medical director of the department’s Vaccine Preventable and Respiratory Diseases Medical Consultation Unit.

“Health systems and local health departments and the state health department have been preparing for this for a while, but I think we’re getting a little bit more traction in terms of preparing school systems and universities to think about it.”

How we got here

Historically, school vaccination laws and requirements were created as conditions of student enrollment as a way to combat childhood diseases — not usually as conditions for employment. So faculty and staff pose different challenges.

Many older faculty and staff don’t have easy access to records from shots given decades ago, before the creation of electronic medical records and state immunization registries. Unless they work in healthcare or laboratory settings, universities don’t generally require or track employee immunizations.

And in fact, the American College Health Association’s vaccination recommendations are specific to students and do not provide guidance related to faculty and staff.

JoLynn Montgomery, chair of the ACHA’s vaccine-preventable diseases committee, said the focus is on students because of their unique risk factors. “Many are navigating the healthcare system on their own for the first time,” she said.

But with measles cases at high levels, Montgomery said that generally it’s a good idea for all individuals, including faculty and staff, to be ready.

“Personally, I don’t have documentation for my doses, and I just went and got revaccinated,” said Montgomery, who is the senior manager for applied public health at the University of Michigan. She said her husband decided to get a measles titer test to check his immunity.

Why it matters

A single measles infection on campus can impact far more people than just the person who becomes sick.

As the infected person moves about campus, hundreds more can be exposed — and required to quarantine for up to 21 days — if they don’t have proof of vaccination or immunity.

“It’s not only disruptive to the patient, to the person who’s quarantined, but it’s disruptive to the school, the university. It’s very disruptive to have people out of work,” said Dr. Alan Melnick, the public health director in Clark County, Washington, and a board member of the National Association of County and City Health Officials.

The virus is highly contagious and spreads through the air. It can linger in a room for up to two hours. People can spread the disease in lecture halls, cafeterias, and communal housing beginning four days before the telltale measles rash appears.

What to watch

With U.S. measles cases so far this year already surpassing last year’s record number — the worst since 1991 — we’re watching whether:

More colleges and universities take measles preparedness actions.
Faculty and staff become a larger focus of campus communications, and how they respond.
More health departments and public health organizations issue guidance about having readily available documentation of measles immunity to avoid quarantine.

The bottom line

By urging faculty, staff, and students to gather proof of measles immunity before an exposure occurs, some colleges and universities hope to reduce weeks of disruption if measles reaches their campuses. It’s another example of how the return of measles across the United States is changing how we live.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

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Spring break is coming. South Carolina wants schools’ help to avoid a measles surge.

2026-03-13T17:23:21+00:00

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Amid concerns that spring break could reignite South Carolina’s measles outbreak, state health officials are trying to avoid a repeat of the communication gaps that delayed measles exposure investigations when schools were closed for winter break.

Healthbeat revealed last month that the South Carolina Department of Public Health was hamstrung in late December in its efforts to quickly warn and quarantine students and staff who had been exposed to measles. The problem: Schools were closed over winter break and they had nobody available to provide contact information to outbreak investigators.

The result was that people who were unaware they were infectious continued to interact with others in the community during the busy winter holiday season. In the weeks that followed, cases of measles surged dramatically and the South Carolina outbreak became one of the largest in decades.

“We are concerned that we may see another surge in cases,” Dr. Linda Bell, South Carolina’s state epidemiologist said. “So we have actually been in contact with schools to work with them more closely, to make sure that we have points of contact.”

Bell said Thursday that the department has sent letters to schools in South Carolina’s 11-county Upstate region asking them to identify a person who will be available during the spring break vacation period – when schools and administrative offices are closed – who can provide school attendance and contact information if it is needed for measles exposure investigations.

Here's how the S.C. measles outbreak grew after the holidays

“We’ve been receiving steady responses from the schools for those points of contact,” she said.

The health department said late Thursday that the letters, which requested contact information by March 10, were sent to all public school superintendents in the Upstate region. Only 11 of the 23 superintendents had supplied contacts as of Thursday. “DPH has previously established contacts at private and charter schools that have been impacted by the outbreak,” the department said.

Of the 993 measles cases recorded since the outbreak was identified in October, 936 have been in Spartanburg County and most of the others in nearby Upstate counties, according to state data. Almost all of those who have been infected were unvaccinated and most have been school-age children and teens.

In recent weeks, the number of new measles cases being reported to the department has slowed to a trickle. On Monday, the health department said just two new cases had been identified since Friday.

In Spartanburg County, spring break is scheduled for April 6-10 for many schools, but dates vary throughout the state.

“We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said. School holiday break periods pose an increased risk for the spread of measles because they often involve people traveling and socializing more.

The winter holiday break was a time of significant spreading of measles in the Spartanburg area.

Between early October – when the outbreak began – and Dec. 22, when Spartanburg County schools closed for winter break, there had been a total of 144 measles cases during the nearly three-month period. Then, in just the three weeks after schools reopened in January, there were more than 500 new cases of measles, state data show.

When Healthbeat asked South Carolina’s health department last month why it hadn’t reached out to schools to have contacts in place before winter break, the department said: “DPH cannot direct school employees to come to work to assist with outbreak investigations.”

Bell on Thursday said the new outreach to schools is an example of the department incorporating lessons learned into its outbreak response. “DPH has made the ability to communicate with school officials who have access to the information needed for case investigation a priority ahead of the upcoming spring break,” she said.

Measles is highly contagious and spreads through the air when an infected person breathes, coughs, or sneezes. The virus can linger in a room for up to two hours after an infectious person has left. Because a person is infectious for four days before the telltale measles rash appears, and initial symptoms may seem like a cold, many people spread the disease before they know they have it.

While two doses of the measles-mumps-rubella vaccine is 97% effective in preventing measles, those who are unvaccinated are at high risk of infection if they are exposed.

Christian school refused to share student information

Based on internal health department records, Healthbeat reported last month that during winter break there were delays quarantining people who had been exposed to measles – just prior to the holiday recess – at three public schools and one private Christian school.

In most cases, the schools were closed and didn’t have anyone available to provide information.

But when outbreak investigators reached Westgate Christian School in Spartanburg, the principal refused to provide information required to ensure those at risk of spreading the disease knew of the need to stay in quarantine, according to a health department warning letter to the school that Healthbeat recently obtained under South Carolina’s public records law.

According to the Jan. 9 letter, Westgate Christian School Principal Gail Grab responded to requests for information about exposed students by sending an email on Dec. 30 that said in part: “We will not provide personal details and immunization status information for the students in our school.”

Then when Grab sent outbreak investigators a list of exposed students on Dec. 31, the only names on it were the siblings of the person who had measles.

The department’s “final warning” letter on Jan. 9 gave the school until 1 p.m. the next day to provide the required information about all students who were had contact with the person with measles or the department would issue a public health order, under which the school could face fines of $1,000 per day for each exposed student’s name left off the list.

“Your continued failure to comply with this lawful demand has significantly impeded DPH’s ability to conduct mandatory case investigation, contact tracing, and quarantine monitoring,” the letter said. “This lack of cooperation places quarantined students, school staff, and the families of your students at increased and unnecessary risk of measles exposure, a highly contagious and serious disease.”

The school did comply before the deadline, Bell said.

Grab did not respond to requests for an interview on Wednesday. Pastor James Wooten, Westgate Christian’s president, replied Wednesday to emailed questions about the letter by saying he was traveling. He previously told Healthbeat that the school thought it had provided all necessary information on Dec. 31. He did not previously disclose that the school’s principal had sent an email refusing to provide required information.

Plans unclear at schools with past delayed measles investigations

Officials at the other three schools where state investigations of measles exposure incidents were delayed during winter break did not answer Healthbeat’s questions Wednesday and Thursday about any changes they have made for the upcoming spring break period.

Mark Robertson, principal at Global Academy of South Carolina, a public charter school where state records show only 21% of students are up-to-date with school immunizations, said he had no comment.

A vaccination rate of 95% is needed in communities to stop the spread of measles.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

Cynthia Robinson, a spokesperson for Spartanburg County School District 6, did not respond to emails and calls on Wednesday and Thursday. Delays investigating measles cases over winter break occurred at the district’s Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on vaccines.

Other schools that had delayed measles exposure investigations over winter break were in Spartanburg County School District 2: Sugar Ridge Elementary, where state data show 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines, also had delays investigating measles exposures during winter break, Healthbeat previously reported.

Adrian Acosta, a District 2 spokesperson, did not answer Healthbeat’s questions about what the district will do differently during spring break to avoid the winter break problems providing health officials with measles contact tracing information.

Acosta first sent a statement saying a district nurse supervisor is available 24/7. Then when asked if this person will be available during the spring break vacation period, Acosta emailed another statement saying school administrators are “always on the job.” Acosta added: “If an administrator knows they will be out of touch or unreachable, then it is expected that they have a communication plan in place.”

But Acosta did not respond to questions about what the district will do differently during spring break to prevent a recurrence of the delays.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Healthbeat is a nonprofit newsroom covering public health. Healthbeat is published by Civic News Company, which also publishes Chalkbeat. Sign up for Healthbeat’s newsletters here.

Measles cases surged after holiday school closures delayed outbreak investigations

2026-02-17T13:00:00+00:00

This story originally appeared in Healthbeat. Sign up to receive Healthbeat’s free national newsletter here.

South Carolina’s state health department faced a significant problem in the critical weeks before the state’s measles outbreak surged in January.

As schoolchildren continued to fall ill with measles in late December, outbreak investigators needed help from schools to get contact information for the classmates, staff, and others who had been exposed. They needed to be warned quickly so they wouldn’t spread the virus to others if they were infected.

But schools were closed for their two-week winter break. Nobody was available at most schools to provide the information health officials needed, according to South Carolina’s state epidemiologist and records obtained by Healthbeat.

This communication gap between the South Carolina Department of Public Health and schools in Spartanburg County – the outbreak’s epicenter – resulted in delays quarantining people who were at risk of unknowingly spreading the highly contagious disease. An infected person is contagious beginning four days before the tell-tale measles rash appears.

At the same time, the state health department was grappling with its own holiday staffing challenges, according to the internal DPH outbreak reports that Healthbeat obtained under South Carolina’s public records law.

While the number of measles cases grew in December, the number of DPH staff assigned to combat the outbreak dropped. The internal DPH reports repeatedly note concerns about holiday staffing, workloads, burnout, the availability of backup staffing, and “limited support due to workforce reduction in April 2025.”

Only after New Year’s Eve did outbreak staffing begin to increase significantly, records show.

Dr. Linda Bell, the state epidemiologist who is leading South Carolina’s outbreak response, said that despite challenges, public health staff “worked diligently throughout the holidays.”

“DPH made many efforts to reach impacted schools over the holidays with limited success because the schools were closed,” Bell said in written responses to Healthbeat’s questions.

By early January, the South Carolina measles outbreak surged to become one of the largest in the United States in decades.

“It’s impossible to know exactly what impact school closures and the resulting delays had on the spike in cases,” Bell told Healthbeat.

However, the delays hampered one of the department’s key strategies for slowing the virus’ spread: Rapid identification and home quarantine of exposed children and adults who were at risk of developing and further spreading the disease because they aren’t vaccinated.

“Our inability to get contact information for potentially exposed students and notify those families resulted in some people being out and about in the community without knowing that they were infectious,” Bell said. “The consequences being new cases due to additional exposures from people who would have otherwise been in quarantine had we been able to make contact.”

This occurred during a time of increased socializing over the holidays, she noted.

It usually takes a week to 12 days, and sometimes as long as three weeks, for people infected with measles to start showing symptoms. The virus spreads through the air when a contagious person breathes, sneezes, or coughs.

Before Spartanburg County schools closed for winter break on Dec. 22, the state health department had logged 144 measles cases since the outbreak began in early October, state data show. In the three weeks after schools reopened during the week of Jan. 5, outbreak investigators were chasing after more than 500 new cases of measles.

The outbreak continues to grow, reaching 950 confirmed cases in South Carolina as of last week, a tally that doesn’t include cases sparked in other states.

School officials with Spartanburg County’s District 2 and District 6, whose elementary schools were among those with delayed exposure investigations during winter break, have declined repeated requests from Healthbeat for interviews or information about their procedures for providing time-sensitive public health information during extended school break closures.

Both districts have had multiple measles exposure incidents in their schools since the outbreak began last fall, requiring dozens of students to be excluded from class due to quarantines.

What happened in South Carolina is a cautionary tale for health departments and schools across the United States – especially as measles makes a resurgence amid declining vaccination rates. So far this year, at least 24 states have reported measles cases to the Centers for Disease Control and Prevention.

In the coming weeks, schools across the country will be closing again for spring break.

“I just want to emphasize how normal Spartanburg is,” said Scott Thorpe, executive director of the nonprofit Southern Alliance for Public Health Leadership, noting that the pockets of low vaccination rates that have fueled the South Carolina measles outbreak are also common in other communities. “I hope that everybody is really preparing for this, because I don’t think it’s going anywhere anytime soon.”

With some communities having multiple school districts plus numerous private schools, Thorpe said that strengthening lines of communication between public health and schools takes time. “To try to figure out how to interact successfully in all these circumstances, in a crisis situation, is really hard,” he said.

School nurses, staff often not paid to work over breaks

Pat Endsley, president-elect of the National Association of School Nurses, said school breaks can pose a special challenge for health departments doing infectious disease contact tracing because school nurses and other staff often aren’t being paid to work during those periods – and they may even be traveling out of town.

With every state operating differently, Endsley said she’s not aware of any national best practice for addressing school contact tracing for measles during extended school break periods. A lot of the best practices were written specifically to address the emergence of the Covid-19 pandemic, she said.

“The gold standard would be to have some kind of person who is at the school, who’s not going anywhere, who could have access to information,” said Endsley, who served as a school nurse in Maine for 23 years and now teaches full time.

“Maybe that’s something that would come out of South Carolina, or Texas, or these other places with measles,” she said. “Based on this information, we could develop some exemplars of communication.”

How the South Carolina measles outbreak grew from 5 to over 900 cases

In at least some communities, health departments have found ways to ensure measles exposure investigations aren’t thwarted by school breaks.

Health officials battling another large measles outbreak along the Utah-Arizona border said they had no difficulties reaching impacted schools over the recent winter break.

“Our epidemiologists report that contact tracing and other issues involving students ran uninterrupted over the winter holidays, mainly due to frequent communication with an established point of contact with our largest school district,” said David Heaton, a spokesperson for the Southwest Utah Public Health Department. The school contact was available to help over the holidays, Heaton said.

Dani Lagana, a spokesperson for the Mohave County Department of Public Health in Arizona, said the department’s measles response activities are not dependent on school calendars.

“Effective contact tracing in school-associated cases relies on established communication protocols and coordination between public health and education partners,” Lagana said by email. “Health departments routinely plan for coverage during holidays and breaks to ensure appropriate notification and follow-up when needed.”

It’s unclear why – before winter break closures began – similar arrangements weren’t put in place between the South Carolina DPH and schools in Spartanburg County.

“DPH cannot direct school employees to come to work to assist with outbreak investigations,” the South Carolina department said in an emailed statement to Healthbeat.

The department said it has contact lists for school administrators, but these administrators may not have access to the detailed information outbreak investigators need when schools are closed.

“Comparisons of response activities from one jurisdiction to the next should be made with caution,” the state health department said. “Each jurisdiction has unique circumstances including differences between centralized vs. autonomous county public health agencies.”

Winter break delays in investigations of measles exposures occurred at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In South Carolina, public health activities are centralized and provided by state DPH employees at offices across the state. Arizona and Utah, have multiple local health departments covering a single county or multi-county region, in addition to state health departments.

Healthbeat asked each of Spartanburg County’s seven public school districts whether they had any policies or procedures that would specifically enable rapid sharing of student contact information during holiday breaks with public health officials who are trying to control infectious disease outbreaks. None of the districts provided answers to these questions.

What a Supreme Court decision on inclusive curriculum could mean for vaccine laws

Schools play an important role in helping public health investigators quickly determine which students, teachers, staff, and visitors may have been exposed to the infected individual. Not only does measles spread through the air, the virus can linger in a room for two hours after the contagious person has left.

School staff can provide health investigators detailed information about the movements of an infected student – and who was around them while they were contagious – by going through class schedules and rosters of those participating in extracurricular activities and riding on school buses. They also know which students lack immunity to measles because school records show which ones have exemptions from vaccine requirements for medical or religious reasons.

Rapid notification of at-risk individuals is critical, health officials say, so they know to quarantine at home and watch for early signs of measles that might otherwise be mistaken for a cold or the flu. In the four days before measles’ hallmark rash appears – and the person is already contagious – their earliest symptoms are typically a fever, cough, runny nose, and red, watery eyes.

“I definitely can see the issue that DPH had during winter break with schools closed two to three weeks, and no way to do that school notification, contact trace, get information from nurses,” said Dawn MacAdams, president of the South Carolina Association of School Nurses. “But then you run into: nurses don’t get paid during that time.”

MacAdams said that during Covid, school nurses faced overwhelming workloads and long hours helping with contact tracing without being paid for the extra work. “Nurses were working Christmas Eve, Christmas Day, New Year’s because the numbers were exploding and the guidance was changing,” she said.

MacAdams said she’s not sure what the solution is for ensuring timely contact tracing of school-associated measles exposures when schools are closed.

“That’s a really good question to think about with DPH on what are the things we can do,” she said. “Most spring breaks are somewhere the first or second week of April this year. So we’re going to be in another desert of the availability of school personnel to provide information.”

Records show quarantine delays at five Spartanburg schools

Internal South Carolina DPH reports show there were delays during winter break notifying and quarantining people who had been exposed to measles at three public schools, one public charter school, and one private Christian school.

For the exposure incidents at these schools, the department’s internal daily outbreak summary reports during winter break repeatedly listed that health officials were reaching out to the facilities or that the status of quarantine actions were still “TBD” – or to be determined.

It’s unclear how many exposed students and staff weren’t contacted quickly because these schools were closed. “Parsing out all those we were working to reach, whether students or others, during that time when cases were surging is not possible,” Bell said.

Measles investigation and quarantine delays occurred at Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines.

One of the schools where winter break investigation and quarantine delays occurred is Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines, including the measles, mumps and rubella shot. To prevent measles outbreaks, 95% coverage is needed.

It took Global Academy until Jan. 9 to provide outbreak investigators with a requested “line list” detailing the names and contact information for exposed students and staff, the DPH documents obtained by Healthbeat show. The school’s winter break was Dec. 22-Jan. 2.

“Global Academy finally provided a line list yesterday, and we are going through it,” a DPH official said in a Jan. 10 email updating the South Carolina governor’s office on the outbreak response.

The school’s principal, Mark Robertson, did not answer Healthbeat’s questions and told a reporter to contact DPH.

Global Academy was one of the first two schools to have confirmed measles cases when the outbreak began in early October. The school has had repeated rounds of students being quarantined and excluded from class.

Other schools that had delayed winter break investigations of measles exposure incidents included large public elementary schools in Spartanburg County School Districts 2 and 6, the records show. Throughout the outbreak, the district’s schools have had exposure incidents requiring students to quarantine, state records show.

In District 2, winter break delays occurred in investigations of exposures at Sugar Ridge Elementary, where state data show 78% of students are up-to-date on school vaccines, and at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In District 6, the delays also occurred at Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Officials with both districts have declined repeated requests from Healthbeat since Jan. 9 for interviews or answers to specific questions about the outbreak’s impact on student health, as well as the circumstances surrounding the exposure investigation delays over the winter break.

Health officials’ efforts to get complete exposure contact information from one school were so protracted coming out of the winter break that they were preparing to issue a formal public health order to force compliance. The school says it promptly provided information.

In January, the state health department issued a “final notice letter” to Westgate Christian School in Spartanburg because of the school’s continued “noncompliance,” Healthbeat reported earlier this month. The school was closed for its Christmas break from the afternoon of Dec. 19 through Jan. 2.

Outbreak investigators had been asking for contact information for exposed students and staff since Dec. 29, Bell said. A list that the school provided on New Year’s Eve was deemed “insufficient.”

When Westgate Christian’s break was over and the requested information still hadn’t been provided, Bell said the department issued a “final notice” to the school on Jan. 9. The letter warned that if the information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.”

The issue was resolved the next day when the school provided the requested information, Bell said.

Pastor James Wooten, Westgate Christian’s president, said that until the school’s administrator received the “final notice” email – at 5 p.m. on Friday, Jan. 9 – she thought the health department had been provided everything it needed on Dec. 31.

“Other than a thank you acknowledging receipt, she received no further correspondence or request for information until the final notice warning,” Wooten told Healthbeat last week. School officials wonder why, if outbreak investigators needed more information, “they didn’t simply reply to the email and request it,” Wooten said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

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