A virus once declared eradicated in the U.S. reappeared in Fredericksburg in April. An analysis of state health data by the Virginia Center for Investigative Journalism at WHRO shows vaccine hesitancy and gaps in health care have left some public and private elementary schools vulnerable to the spread of the highly contagious virus.
By Kunle Falayi
The Virginia Center for Investigative Journalism at WHRO
The first case of measles hit Virginia in April, raising risks for a troubling comeback 25 years after U.S. health officials declared the eradication of the virus.
But the spread of the highly contagious virus and a growing anti-vaccine sentiment could leave one population increasingly at risk – kindergartners.
Just half of Virginia’s public and private kindergarten classes reported a 95% vaccination rate – the key threshold for herd immunity – at the start of the 2024-25 school year, according to an analysis of state health data by the Virginia Center for Investigative Journalism at WHRO. The average measles vaccination rates for kindergartners include a 92% rate in Hampton Roads, 94% in Richmond, and 96% in Northern Virginia.
School administrators say vaccination numbers have increased since the health data was recorded at the start of the school year, but public health officials across the commonwealth are scrambling to educate parents about the importance of vaccinations to curb the spread of measles and prevent its sometimes devastating consequences.
“We need to target those schools and do a very personalized outreach to see if we can get those kids to be vaccinated,” said Dr. Susan Girois, Director of the Norfolk Department of Public Health. She tracks the number of unvaccinated children in each school on a whiteboard in her office.
In schools, where contact is easy and children can carry an infection home, herd immunity keeps the virus contained, experts said.
While vaccination hesitancy has featured prominently in conservative political discourse, low vaccination rates are found in both cities and rural counties throughout Virginia, regardless of community politics or demographics, according to the VCIJ analysis.
Even though just half of the state’s kindergarten classes have reached ideal vaccination levels, Virginia’s overall coverage rate for the measles, mumps, and rubella (MMR) vaccine among kindergartners is 94.2%, above the national average of 92.7%, according to the Centers for Disease Control and Prevention (CDC).
Dr. James Nataro, Physician in Chief of the University of Virginia Children’s Hospital, said herd immunity is vital because it prevents individual cases from spreading in a community. As a result, he said, “the virus is going to burn out.”
Efforts by public health experts are increasingly complicated by a growing national wave of vaccine skepticism — fueled in part by prominent anti-vax figures like Secretary of Health and Human Services Robert F. Kennedy Jr.
The number of people choosing not to vaccinate their children is increasing nationally. One 2024 study found that 1 in 5 parents in the U.S. are now vaccine-hesitant.
Experts say public skepticism, despite the vaccine’s long safety record and effectiveness, contributes to why many parts of Virginia still struggle to attain the desired level of immunity.
Poverty and limited access to health care can also be a barrier. A 2024 CDC report found that children born between 2019 and 2020 living below the federal poverty level had lower vaccination rates than children living at or above the poverty level for almost all vaccines.
Only 11 states met the herd immunity threshold last year.
Source: CDC
Measles’ ruinous path in the US
In the decade before the first measles vaccine was introduced in 1963, nearly every child in the U.S. had measles by the time they were 15 years old, according to the CDC.
An estimated 48,000 people were hospitalized with the virus, and more than 400 people died annually on average in the pre-vaccine era. The CDC believes that up to four million people were infected annually, although most cases were not reported.
Some infected persons had fevers reaching 104 degrees. Others developed a cough, runny nose, inflammation, conjunctivitis and tiny white spots inside the mouth. In roughly three of every 1,000 cases, an infected person would develop acute brain swelling, or encephalitis, which often resulted in permanent brain damage, the CDC said.
The disease also proves fatal in about 3 of every 1,000 cases. But death is not the result of the disease that alarms public health experts. The effect of a measles infection on a child is “part of the iceberg under the water that nobody considers,” Nataro said.
“More patients are going to get encephalitis who don't die, but end up being neurologically impaired for the rest of their lives with blindness, deafness, severe seizure disorders or paralysis,” he said.
The first licensed measles vaccine reached the public in 1963. Within five years of its release, annual reported cases had dropped by more than 80%.
In 1971, vaccines for measles, mumps and rubella were combined to make the MMR vaccine, which is still considered a highly effective immunization.
In 2000, due to near-universal vaccination rates, the disease was declared eradicated in the U.S. The virus remained active in other parts of the globe and is still considered one of the leading causes of blindness in low-income countries.
But on April 19, the Virginia Department of Health announced the state’s first measles case this year, striking a child under the age of four years old. The child potentially exposed others at health centers in Woodbridge and Fredericksburg.
The department said the patient had recently travelled internationally and reaffirmed that vaccination would protect the public.
Source: OurWorldInData
“Vaccination remains our best defense against measles and is safe and highly effective at protecting people and preventing outbreaks,” said State Epidemiologist Laurie Forlano in a department alert.
What school vaccination records show
The state requires public and private schools to report student vaccination rates to the Department of Health at the start of every school year. The numbers are self-reported, and children may remain in school if they agree to get vaccinated during the school year, or qualify for a religious or medical exemption.
It is difficult to know the exact current vaccination rates for all schools in the state. Some schools did not submit data for the survey. Also, schools permit students to catch up on their vaccinations in the course of the school year.
The state’s 56,000 homeschooled children are also excluded from the vaccination data, although parents are bound by the same immunization regulations as parents who enroll their children in schools, the Department of Health told VCIJ.
“While not all schools may reach a 95% herd immunity threshold based on immunization documentation available at the beginning of the school year, it is likely that vaccination rates increase as the year progresses,” the Virginia Department of Health said in response to an enquiry about the measles vaccination rate.
The self-reported vaccination data from schools provides a glimpse of how much protection schoolchildren across Virginia may have.
Schools that had not met the herd immunity threshold are scattered across every region of the state, as are those that have met or surpassed it.
In fact, at the county and city levels, the pattern is similar.
Warren County reported the lowest rate of measles vaccination statewide. Just two schools encompassing fewer than 23 students reported data from the county. Of these, only about half of the kindergartners had measles vaccinations.
An official told VCIJ that the numbers are not representative of the situation in the county.
“Out of around eight schools that have kindergarten-age children, only two of them reported their vaccination rates. So, it's hard to generalize that number for the entire locality,” said Katherine Shroeder, the Population Health Manager for the Lord Fairfax Health District. The district includes Warren, Clarke, Frederick, Page and Shenandoah counties, as well as the City of Winchester.
She said that encouraging immunization is a continuous effort in the health district.
A few counties reported complete vaccination coverage. All the kindergartners across Prince Edward, Rappahannock, and Bland counties, as well as the City of Emporia, are fully vaccinated.
In Fredericksburg, where the Department of Health traced exposure to the recent measles case, the vaccination rate at the kindergarten level is about 90%.
The district expects the rate to increase in the course of the school year, said an official of the Rappahannock Area Health District, which covers Fredericksburg. The district does not have the current MMR coverage data for Fredericksburg.
The other city connected to the measles case, Woodbridge, has an average vaccination rate above 95%.
Overall, the data shows public schools had better rates than private schools.
About 94% of kindergarteners in Virginia public schools were vaccinated at the start of the school year. Private school kindergartners had an 88.9% vaccination rate, according to the analysis.
The difference is evident in parts of Hampton Roads. In Chesapeake, for example, while the average vaccination rate across public kindergarten classes remains below the herd immunity threshold, the rates are even lower in private schools.
One in five kindergartners in Chesapeake’s private schools had not received the vaccination at the start of the school year.
“We've noticed that vaccine hesitancy seems to be higher in private schools,” said Chesapeake Health Director Dr. Nancy Welch. “Private schools do no
Schools with the lowest rate of measles vaccination
The measles vaccination rate among kindergartners in 10 schools—home to nearly 1,000 kindergartners —is the lowest in the state, with rates falling below 50%.
Efforts to reach vaccine skeptics
Public health officials in Virginia have been reaching out to schools and parents, hoping to reach hesitant community members.
In Norfolk, Dr. Girois distinguishes between anti-vaxxers who are dead set in their decision against vaccinating their children and those who are hesitant because of genuine concern to keep their children safe.
The latter are the ones she believes public health experts like herself have the hope of successfully reaching.
“People all have a rationale inside them as they simply want to protect their kids,” she said. “Respecting that and trying to listen to the rationale and then trying to have a conversation through that rationale, can get people to think and have more information to accept vaccines.”
In Chesapeake, Dr. Welch and her team are concerned that controversial vaccine messaging is confusing parents and fueling hesitancy about the MMR vaccine.
“Parents don't necessarily get the soundest information that is reassuring for them,” Welch said, “and that's why it is important that we help them to understand what the vaccine does.”
Reach Kunle Falayi at kunle.falayi@vcij.org