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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.
“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.
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
