Broward County, Florida now is up to nine cases of measles, two of them in children younger than four.

Seven of the nine are students at Manatee Bay Elementary in Weston. The other two in Broward County are younger than four. It’s unclear whether they are siblings of students at the elementary school

Florida health officials have not been forthcoming with information.

When Floridians learned of an outbreak in measles at a Weston elementary school, it was the public school district that provided information to the public, not health officials. The health department has held vaccination events at the school and in the community, however, it has not provided information on how many people in Broward County have been vaccinated for measles since the outbreak began last week.

The outbreak in Florida started with four cases reported on the state’s disease surveillance website. Outside of Broward County, another case was reported in Polk County over the weekend, bringing the total in Florida to 10 cases.

Meanwhile, all media questions about whether these cases are in the unvaccinated, whether the younger children with measles are siblings of infected at Manatee Bay and whether the newest case is in a college student have gone unanswered by Florida’s health officials.

Similar to the early days of COVID, Florida health officials are not providing answers to questions the public wants to know: How did measles get to Florida, is it just the unvaccinated, how exactly is this once-eradicated disease spreading in South Florida? How many people in Broward County have been vaccinated at the recent events.

Local health officials in Broward County and Polk County have redirected reporters inquiries to the Florida Department of Health’s main communications office in Tallahassee. That office has not respond to multiple inquires from the South Florida Sun Sentinel and the Orlando Sentinel.

John Sullivan, a spokesman for Broward County Public Schools, has provided information on cases in Manatee Bay and the school district’s response informing the public about cleaning measures at the elementary school. On Tuesday, 82 students were absent at the school, an improvement from the more than 200 absent last week.

The only communication thus far from the Florida Department of Health has been a letter sent to parents at Manatee Bay from Surgeon General Joseph Ladapo, Florida’s top health official. Ladapo, nationally known for his outspoken skepticism toward the COVID-19 vaccine, sent a letter this week to parents at Manatee Bay Elementary School.

“Due to the high immunity rate in the community, as well as the burden on families and educational cost of healthy children missing school, (the state health department) is deferring to parents or guardians to make decisions about school attendance,” Ladapo wrote.

His letter states that when a school has a measles outbreak, it is “normally recommended” that unvaccinated students who haven’t previously had the disease be kept home for three weeks “because of the high likelihood” they will be infected.

But the letter then says the state won’t turn that recommendation into a mandate.

His recommendations to parents have doctors, epidemiologists and infectious disease specialists across the country outraged.

“This is unprecedented. Those with no prior immunity need to isolate for 21 days,” epidemiologist Katelyn Jetelina wrote in her popular public health science newsletter. Jetelina says “measles is one of the most contagious diseases on earth.”

Jetelina also points out Ladapo’s letter failed to recommend kids without immunity get vaccinated. “Many parents don’t know that unvaccinated kids can still get protection from a vaccine within 72 hours of exposure. (Also, the standard of care is that if they get vaccinated within 72 hours, they can return to school as long as they don’t develop symptoms.)”

She believes Ladapo’s recommendations puts more children at risk. “Measles has a long incubation period. It takes 5-21 days from exposure for symptoms to develop. So even if a child, especially an unvaccinated one, doesn’t have symptoms, they may be contagious and spread it to others, including in the community,” she said.

The absence of information comes as the threshold for measles vaccination is below where it needs to be for Florida’s kindergartens. Florida allows students to opt out of required vaccinations with medical or religious exemptions.

Measles, which is identified by the rash that starts near the hairline and spreads, often can be treated at home with over the counter medication. However it does bring serious health risks. For people without immunity, 1 in 5 will be hospitalized, 1 in 20 will develop pneumonia (the most common way measles kills young kids), 1 in 1,000 will develop encephalitis (infection of the brain, sometimes causing permanent brain damage), and 1 to 3 in 1,000 will die.

Cases of measles have been recorded in at least 11 U.S. states since the start of the year, as local health officials attempt to prevent the spread of the disease.

The National Foundation for Infectious Diseases (NFID) and the Centers for Disease Control and Prevention (CDC) recommend that adults born in 1957 or later who do not have evidence of immunity should receive at least one dose of the Measles-Mumps-Rubella vaccine, also known as the MMR vaccine. Most insurance plans cover the cost of MMR immunization.

In response to questions on whether Florida has reported how many measles shots have been given out since the state’s outbreak began or a state action plan, CDC spokesperson Lisa George said only Florida health officials have that information.

State and local health departments have the lead in investigating measles cases and outbreaks when they occur, she said. CDC will continue to closely monitor reported cases.

On Monday, the Association of State and Territorial Health Officials put out this statement:

“Vaccination is the best and safest way to protect children. Two doses of measles vaccine are more than 97% effective in preventing the disease entirely, and vaccinated people may continue to engage in routine activities even if they are exposed to someone with the disease. When community vaccination rates drop below 95%, however, outbreaks become more common because the disease can spread from one vulnerable person to another.”

The association’s recommendation is the opposite of what Ladapo advised parents: “Because of the risk of severe disease from measles and the high likelihood of transmission to others even before symptoms are evident, well-established public health practice recommends that unvaccinated persons exposed to measles stay home for at least 21 days to prevent further growth of the outbreak.”

Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].

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