A measles outbreak in Hennepin County has spread to an elementary school in Minneapolis, bringing the total number of cases in Minnesota, since May, to 51.
Minnesota Department of Health officials are contacting unvaccinated students who may have been exposed. Minneapolis Public Schools asked parents via email to vaccinate their families and update immunization records. School and health officials declined to name the school, citing privacy concerns. It’s unclear how many students might be sick with measles, and how many unvaccinated students might have been exposed.
About 70% of the students at the school are fully vaccinated and 2% have non-medical exemptions, according to MDH. (Parents in Minnesota are allowed to opt out their children from vaccines for philosophical reasons, referred to as “non-medical exemptions.”) Students at the school who are not vaccinated will be excluded from attendance for 21 days.
The Health Department is currently assessing plans for the 27.3% of students with “in-progress or missing doses,” who have received either zero shots or one shot in the two-vaccine series.
The outbreak, which impacted at least one Islamic religious school in August , comes amid falling immunization rates nationally and locally. Because measles is so contagious, at least 95% of people in a community need to be vaccinated in order to protect the entire population — a concept referred to as herd immunity.
According to state health data from 2023, just 14% of kindergartens in Hennepin County meet the threshold of herd immunity for the measles, mumps, and rubella (MMR) vaccine. (Rates are often lower in kindergarten; some kids may complete the vaccination series later.)
The Minnesota Department of Health said it is still assessing the number of unvaccinated students who might need to stay home from school as a result of exposure. MDH is in the process of reaching out to families who have not provided an immunization record to the school. The school district and health department have asked these students to stay home until their vaccination status is confirmed. In July, the Minneapolis City Council approved an agreement between the city health department and Minneapolis Public Schools to update student vaccine records, citing 2,000 missing student immunization records in the school district. Missing records can cause a delay in quarantining at-risk students, the city noted.
A Sahan Journal analysis of state vaccination and school demographic data found that of the 20 schools with the lowest MMR vaccination rates, 11 are private Christian schools and seven are public charter schools that serve mostly Somali students. All six of the parochial schools for which demographic data is available primarily serve white students.
Since state health data doesn’t separate partially vaccinated from unvaccinated students, Sahan Journal adopted a three-tier method to classify a kindergarten’s herd-immunity status:
- At herd immunity: At least 95% of students are fully vaccinated.
- Not yet achieved herd immunity: Less than 95% of students are fully vaccinated. Some students may have received one dose of the vaccine.
- No herd immunity: More than 5% of students have medical or non-medical exemptions for the vaccine.
“The main concern in a school setting is the potential for further spread among unvaccinated children,” Cynthia Kenyon, a senior epidemiologist supervisor with the Minnesota Department of Health, said via email. “We are concerned for two reasons: First, they may contract measles, which can lead to serious complications and hospitalization; second, they may miss several weeks of school while remaining at home.”
A quarter of people infected in the current outbreak have required hospitalization, according to MDH. Among those under age 5, two thirds of patients have needed to be hospitalized. Most cases have been concentrated among unvaccinated children in the Somali community.
Epidemiologists say that measles outbreaks in the United States often start when people travel to countries where the disease is widespread. These people may return home and spread the disease to family and others — sometimes before developing symptoms themselves.
Children who are unvaccinated and have been exposed can get an MMR vaccine within three days of exposure, which can prevent infection. But if families opt out of vaccination, exposed students are required to stay home for three weeks to avoid further spread of the disease.
Measles is a respiratory virus that can cause symptoms such as a cough, rash, fever, and runny nose. Infections can lead to serious conditions including pneumonia, permanent brain damage and death. In pregnant people, measles increases the risk of premature labor, low birth rate and miscarriage. Children under age 5 are at the highest risk for severe outcomes. In 2022, the disease caused about 136,000 deaths worldwide, according to the World Health Organization. There is no specific treatment for the disease.
Measles spreads easily through the air, more readily than most respiratory viruses. Active virus can linger in a room hours after an infected person was there.
A 2017 outbreak in Minnesota led to more than 70 cases, mostly in the Somali community. Another cluster of local cases in 2022 affected 22 people.
Addressing misplaced fears about measles and vaccines
Munira Maalimisaq, a family nurse practitioner at Park Nicollet and the CEO of Inspire Change Clinic, visits mosques to educate people about measles. She said she asks her audience if they know what measles looks like. The response she usually hears? “It’s just like a cold,” or, “you’ll get a fever, a rash, and maybe body aches.”
“They’re minimizing it,” Maalimisaq said. “They’re not thinking of the bigger picture.”
When Maalimisaq explains that measles can lead to brain damage, lung problems and hearing loss, people are surprised. Instead of fearing the disease, she said, many distrust the vaccine. That fear starts with widespread misinformation about autism, which is often diagnosed in children who are around 12-15 months old. That’s also the age when clinics first give kids the MMR vaccine.
Outreach efforts need to change, she said. “I think we need to do something differently to get all of us on the same page,” Maalimisaq said.
One way to create a more informed, resilient community, according to Maalimisaq? Trusted health care leaders and clinicians in the Somali community should use every health encounter to listen to patient concerns and educate people about the safety of the vaccine.
“We need to take ownership of the problem,” she said. “Parents and teachers need to say, ‘Hey, this is an issue. This is one thing our kids should not be dying from.’”
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