Dr. Erin Brickley has never seen a case of measles. She studied it during her medical training and remembers the panic during her residency when a child arrived with a suspected case of the highly contagious virus. That scare turned out to be a false alarm.
“I remember we were all like, ‘Oh my God,’” she said. “We were all fully vaccinated, so it shouldn’t have been an issue for us, but we all felt scared. If we had measles [in the department], what would that mean for the pediatric floor?”
Today, she’s a pediatrician at a private practice in Marion. Even though she and her colleagues have never seen a true case of measles, they’re bracing for the virus to surface in Southwest Virginia.
“We definitely have a risk of measles happening in the area,” Brickley said. The recent outbreak of six cases in central Tennessee isn’t too far from Virginia, she pointed out. Tennessee reported its first measles case on March 21.
Public health officials have reported about 800 measles cases across at least 25 states. The Centers for Disease Control and Prevention updates its online measles dashboard only once a week, meaning the actual number of affected states may now be higher than the last update on April 18.
Over the weekend, Virginia reported its first case of measles, a child under age 5. The health department did not release the child’s exact age, but said the patient had recently traveled internationally and may have exposed others at a clinic in Fredericksburg.
Measles is highly contagious and can spread before it’s even detected. The virus is often contagious for about four days before symptoms begin, according to the CDC. The initial symptoms present as a cough, fever and runny nose. It takes a few days more before the characteristic rash appears on the skin. The patient is considered contagious for at least four days after the onset of the rash.
With summer vacation approaching and school-required vaccination rates still lagging since the COVID-19 pandemic, Brickley is worried.
Measles was eliminated. Now it’s back.
In 2000, measles was considered eliminated in the United States. Cases could still crop up in the country, but widespread vaccination prevented outbreaks.
Before the vaccine was introduced in 1963, measles was nearly universal among children in the U.S. Each year, about 48,000 people were hospitalized and 500 died from the virus, according to the CDC.
The recent outbreak started in late January in West Texas. Since then, Texas alone has reported 624 cases.
Health and Human Services Secretary Robert F. Kennedy Jr. has amplified false claims about the measles, mumps and rubella vaccine, including the debunked idea that it causes autism and incorrect claims that the vaccine is more dangerous than contracting an infection and that vitamin A can prevent measles.
A 1998 study published in the medical journal The Lancet claimed that the MMR vaccine caused behavioral problems in 12 children with existing developmental disorders. The journal later retracted the study.
A KFF poll released Wednesday found that about 24% of Americans believe that the measles vaccine either definitely or probably causes autism, while about 75% feel that this claim is either probably or definitely false.
The same poll asked about Kennedy’s claim that getting the vaccine is more dangerous than becoming infected. About 19% said this is definitely true or probably true, compared to about 81% of people saying this is probably or definitely false.
On the question of whether vitamin A can prevent a measles infection, about 25% of respondents said this is definitely or probably true, compared to 75% who said this is probably or definitely false.
Some localities fall below the herd immunity threshold
Kids across the country are required to have certain vaccinations before attending daycare or public and private schools. In addition to the measles, mumps and rubella vaccine, students must be immunized against hepatitis B, pneumonia, rotavirus (commonly known as the stomach flu), polio, chickenpox, hepatitis A, diphtheria, tetanus and pertussis.
There are two possible exemptions: medical exemptions, which must be signed by a doctor or specialist, and religious exemptions.
In Smyth County, where Brickley practices, 98.5% of public school kindergartners received all required vaccinations in fall 2024, with an exception: About 92% of students at Marion Elementary School had received the required vaccinations with 7.2% filing a religious exemption, according to the most recent immunization data on the Virginia Department of Health website.
This rate exceeds the 95% threshold needed to prevent an outbreak and protect those in the community who aren’t able to get the vaccine for medical or age reasons, but vaccination rates in several nearby counties fall short as well.
To the west, 88.9% of Washington County kindergartners received all required immunizations in fall 2024. This marks a slight decrease from fall 2023, when the school reported that 89.4% of its kindergartners were fully vaccinated.
Statewide, 88.9% of kindergartners were fully vaccinated in 2024.
The state only started collecting separate data on the measles, mumps and rubella vaccine in fall 2024, so it’s unclear how those rates have changed over time.
Washington County schools reported that 91.3% of kindergartners had completed the series needed to prevent measles.
In Tazewell County, 89.6% of public school kids had received both doses of the measles vaccine in 2024.
These Southwest Virginia school districts reported measles vaccination rates that are below the 95% threshold needed to prevent measles outbreaks. According to state data, only 89.7% of students in Wise County Public Schools received both doses of the measles vaccine. In Floyd County, the rate was 90.5%, Wythe County reported 89.9% and Henry County came in at 93.5%.
School nurses are on the front lines
Schools are required to send immunization data to the state health department by the first day of class. Some students may still be in the middle of the vaccine series or be a few days early or late on booster shots, factors that can skew the numbers, according to Lisa Singleton, the supervisor of nursing and school health coordinator for Tazewell County Public Schools.
Singleton’s team of school nurses keeps track of any student who isn’t fully immunized and hasn’t submitted a religious or medical exemption to the school. They work hard to communicate with families to make sure students receive the vaccines they need, she said.
The state doesn’t collect updated vaccination data after the school year begins, so the numbers reported in the fall might not reflect improvements later on.
Singleton said most parents, especially those with young children, are cooperative and open to completing the full childhood vaccine schedules. She said students in the district are well protected, though a measles case is still possible.
“We will have a family here and there who really feel strongly about not participating, and they will usually file under a religious exemption,” Singleton said.
Under Virginia law, parents can seek a religious exemption by filling out a simple form with the student’s name and a signature from the parent. The form must be notarized before submitting it to the school, Singleton said.
Religious exemptions rising in some places
These exemptions have increased in the Tazewell County Public Schools. At the start of the 2023 school year, about 1.6% of kindergarten parents filed religious exemptions. By the start of the 2024 school year, that number had increased by about 37.5%, with seven students receiving religious exemptions.
Some other Southwest Virginia school districts are seeing similar trends.
In Wythe County Public Schools, religious exemptions for kindergartners rose from 1.8% in 2023 to 4.1%, about 11 kids, in 2024. State data shows that only 89.9% of kindergartners had received both measles vaccine doses by the first day of school — well below the 95% threshold for community protection.
Giles County public schools also saw an increase in religious exemptions, increasing from 0.6% to 3.6%, about five kids, over the same period. Despite that, 97% of Giles County kindergartners were fully vaccinated against measles in 2024.
According to the Centers for Disease Control and Prevention, children typically receive the first dose of the measles, mumps and rubella vaccinations between 12 and 15 months of age, and the second dose is given at 4 to 6 years old.
Rhetoric fuels hesitancy
Brickley said a rise in anti-vaccination rhetoric at the national level is influencing more patients to question or reject the vaccines.
“We’re already seeing that impact now. We have more parents who are willing to [say no] to vaccines,” she said.
The challenge is also a generational one. Young parents in her office don’t always understand the need to vaccinate their kids for an illness that’s so uncommon.
“We’ve had so many successes with vaccines, which is why none of us in the Millennial and Gen Z generations have ever seen these illnesses. That’s a good thing that we haven’t seen these illnesses,” she said. “We do these vaccines to protect their children and to keep them healthy.”
Her practice is one of only a few private pediatric offices in the area that accept patients who aren’t fully vaccinated, mostly due to the significant Mennonite population in the region. They’re largely unvaccinated, Brickley said, but still seek wellness checks and other health care services at her practice.
With the likelihood of measles cases on the horizon, Brickley’s office may reintroduce infection-control measures, reminiscent of the pandemic, that are recommended by the CDC to reduce the spread of the virus.
Sick patients could be asked to wait in the car, and front desk staff are now screening patients for symptoms and vaccination status, something they haven’t done before.
But there are some infection control measures that are out of reach for small practices in rural areas. Brickley’s practice doesn’t have a negative air pressure system, which is recommended to help prevent the spread of airborne diseases like measles.
The thought of having sick patients in her office worries her.
“It’s scary, I’m not going to lie,” Brickley said.