Measles is a viral infection of the upper respiratory tract that causes a fever, cough, and distinctive rash. There can also be white spots that develop inside an individual's mouth. It can be deadly, with a mortality rate of about one to three per 1,000, typically from unvaccinated patients developing spinal meningitis or acute post-infectious measles encephalitis from the infection.
If a person receives the two doses of the MMR (measles, mumps, rubella) vaccine, they have 97% lifetime protection against measles.
The recommendation is to get the first dose at age one and the second at age four.
Dr. Erin Adonnino is a pediatrician for Wilmington Health. She said she’s had families ask for the MMR vaccine at six months, which she can do; however, they’d have to get another dose at age one.
“That's just because, basically, the immunity in that early time does not sustain throughout because they still have an immature immune system. We still have some antibodies and immune system from mom, and so we don't get the long-lasting effects of that shot,” she said.
Jon Campbell is the health director for New Hanover County. He said they've been working with the state to prepare for if and when measles arrives in the Cape Fear region. Cases were just reported in counties in the triangle on Wednesday.
“We've also done some coordination and tabletop exercises with the Novant system. So we have done quite a bit of preparation, so to speak. We have all supplies on hand in order to respond to a measles outbreak,” he said.
He encourages everyone in the community to know their vaccination status — and, if they don’t, to call their physician to obtain those records.
The New Hanover County Health Department does offer the vaccine weekly during normal business hours. They have extended hours on Tuesdays until 7 for those working later in the day.
Cape Fear region school protection levels
Overall, schools in New Hanover, Brunswick, and Pender counties all have medium coverage for the MMR vaccine (90-94%) at 94%. That's a regional average that includes private, charter, and public schools.
Campbell unpacks what a 95%+ rate would mean.
“The 95% really is that herd immunity, that if a disease enters your community, and you are at a vaccination rate of 95%, transmission will not continue,” he said.
But a significant number of schools fall below that level of herd immunity.
Recent data from the state also show that only half of elementary students in New Hanover and Brunswick attend schools where herd immunity of 95% has been achieved. Pender students have better coverage, with 60% attending schools with this rate.
However, Campbell said there are always limitations with data, in that it only captures those who submitted immunization paperwork by the 30th day of school. It's also from the 2024-2025 school year.
While a high coverage of above 95% would stop the spread of measles, some schools have coverage below 90%. Most of them are private schools; public schools, by state law, require students to submit immunization records to attend.
One of the lowest MMR vaccination rates, at 55%, is at the private school in New Hanover County, the School of Wonder. It’s a small school, and only data for kindergarten and first grade could be reported (the threshold is above 10 students).
An outlier for NHCS is Freeman Elementary at 89%.
Campbell said, “I don't have specific information right now about Rachel Freeman, but certainly, what we try to do is we try to be available to provide vaccines. There are times that we have provided vaccines in the school systems because it has been more accessible.”
While some schools are more vulnerable to a possible measles outbreak, 16 elementary schools in New Hanover County have rates at or above 95%. There are seven schools in Brunswick County and three schools in Pender with complete herd immunity.
If there were to be an outbreak of measles, those who are unvaccinated would have to automatically be quarantined for 21 days. Campbell explains why:
“If you were exposed to measles, you will develop symptoms typically in the timeframe of one to two weeks. However, some individuals do not develop symptoms until three weeks later,” he said.
Adonnino said measles can spread four days before symptoms appear — and it doesn’t have to be through coughing; it can spread through breathing.
Campbell added that for families “that can have a significant impact on caregiving and school access, so that's one of the reasons that we are available to provide education and accessibility for vaccines.”
As health director, he said “strongly encourages all individuals to consider vaccination” and that the MMR vaccine is worth taking, if one can.
“This is a vaccine that's been around for quite some time. It's been shown to be highly effective. However, that being said, I can't speak for the unique nuances of every single individual, so I would encourage them to have a one-on-one conversation with their healthcare provider,” he said.
However, Adonnino said there are very few reasons a person should not get the vaccine and receive a medical exemption for it — and in her three years of practice, she has never written one.
The only ones who have "contraindications" or reasons for not getting the MMR vaccine are going to be children and adults with immunodeficiencies, or children undergoing chemotherapy, pregnant women, children who experience anaphylaxis after the first dose, or someone who has active or untreated tuberculosis.
If a person receives a medical exemption for the MMR vaccine, that’s done through a physician’s office with formal paperwork submitted to the state; however, with a religious exemption, it’s a letter attesting that vaccination is against the individual’s religious practices.
“There's, there's not a standardized form that is attested by a religious leader in the community. It is simply a narrative generated by the parent or guardian to the school system,” Campbell said.
In New Hanover County, about 5% of students who are supposed to receive immunizations before attending school have received an exemption for medical or religious reasons; 4% are exempt in Brunswick, and 3% exempt in Pender.
Adonnino added that she often deals with misinformation surrounding the aluminum that is in vaccines.
“It's actually kind of used as a transportation device, so basically, the vaccine can get transported to our immune system, so that our [it] can see it and, basically train it against it," she said. "And so I like to think of it as the school bus: it picks up your kids, drops them off, but it doesn't ram into the building, so the aluminum isn't absorbed at all. We get rid of it and pass it through,” she said.
And, according to Adonnino, there are no credible studies that link vaccines to autism — and that pediatricians often start screening for autism around the age of two, and sometimes, parents want to connect their vaccine schedule with the timing of this screening process.
- Check the MMR vaccination rates at your child’s school
- Measles cases across the state, NCDHHS
- Kindergarten immunization dashboard
