With measles cases reported in North Carolina, local families might wonder if their children are at risk of contracting the highly contagious disease.
More than 46% of elementary schools in Robeson, Scotland, Columbus, and Bladen counties are at an increased risk of an outbreak, according to vaccination data compiled by the N.C. Department of Health and Human Services.
Twenty-two of the counties’ 47 public and private elementary schools fall below the 95% vaccination coverage threshold the Centers for Disease Control and Prevention says is necessary to protect against a measles outbreak. The data is from student vaccination reports submitted by schools to the state 30 days after the start of the 2024-2025 school year. Reports on this school year are not yet available.
At Public Schools of Robeson County, 68% of students in kindergarten through fifth grade attend schools with vaccination rates below the threshold.
“The people that are vaccinated, they’ve done what they’re supposed to do as far as being protected,” Robeson County Health Director Suzanne Jackson said. “The best means of protection would be the CDC recommendations.”
The CDC recently changed its recommended schedule for some vaccines, including hepatitis B. But the agency still advises that children get the two-dose series of the measles, mumps, and rubella (MMR) vaccination, with the first shot administered between 12 and 15 months, and the second between 4 and 6 years. All kindergartners are required to have the shots in North Carolina.
Half of K-5 students in Columbus County— almost 1,080 kids— attend schools with MMR vaccination rates below 95%. In Scotland and Bladen counties, 44% and 31% of elementary students are at schools below the threshold, respectively.
Cases Linked to South Carolina
Measles can cause rash and fevers as high as 104 degrees. It is transmitted through the air, and a single infected person can infect up to 18 others, according to the World Health Organization.
Children younger than 5 who haven’t received the vaccination and contract measles are more likely to develop complications from the disease, including pneumonia and brain swelling, according to the CDC.
North Carolina has reported 13 measles cases since December, primarily in unvaccinated children or in those whose vaccination status is unknown, according to state health officials. Many of the cases have been traced to Spartanburg, South Carolina, the site of the latest U.S. measles outbreak.
“People need to be aware that the risk of being exposed is growing,” Dev Sangvai, secretary of the N.C. Department of Health and Human Services, said in a news conference on January 8.
‘Pockets’ of Unvaccinated People
Robeson and Scotland counties have what the state calls “medium” MMR vaccination coverage, meaning the average coverage at elementary schools is between 90% and 95%. This means the counties are at risk of a measles outbreak, but the risk is not as high as in counties with low vaccination rates. Durham County’s elementary schools, for example, have an estimated 88% overall MMR vaccination coverage rate.
Columbus and Bladen counties have high coverage, both meeting 95% overall coverage threshold.
But that doesn’t mean measles doesn’t pose a risk, according to Dr. Erica Wilson, medical director of the Medical Consultation Unit with the state’s Division of Public Health.
“Having pockets where there are large groups of people who are unvaccinated or under vaccinated does increase the risk for a larger outbreak,” Wilson said at the news conference earlier this month.
Fewer than 75% of students at Highlander Academy, a private school in Red Springs, are fully vaccinated against measles, the lowest coverage among elementary schools in the four-county region. Rosenwald Elementary in Fairmont has a 75% vaccination coverage rate.
About 78% of students at Homestead Christian School, a private school in Bladen County, have received both doses of the MMR vaccine. About 87% of students at Sycamore Lane Primary School in Scotland County are fully vaccinated.
Students who are not up to date on vaccines by the time they enter kindergarten might contribute to a county’s increased risk. Almost 9% of kindergartners in Scotland County weren’t up to date on at least one of their nine required vaccinations after the first 30 days of the 2024-2025 school year, according to the state’s immunization data. That’s more than three times the state average of 2.6%.
Amanda Holland, director of Scotland County’s Department of Health and Human Services, said the agency has identified three schools—Sycamore Lane Primary School, Wagram Elementary, and the private Christ the Cornerstone Academy—that should improve their vaccination rates.
“We’ll be looking at how to specifically work with those schools on how to improve immunizations,” Holland said at the agency’s advisory council meeting on January 20. She said the health department could host vaccination clinics beyond the peak back-to-school season.
Parents can get medical and religious vaccine exemptions for their children. The percentage of students with religious exemptions more than doubled in North Carolina between 2020 and 2024, increasing by more than 5,100 students, according to state data.
Holland said the exemptions could be contributing to local schools’ vaccination coverage percentages. In the 2024-2025 school year, 12.5% of kindergartners at Christ the Cornerstone Academy had some sort of exemption, data shows.